Focus on Cholera

Photo by John Carroll
Laplaine, Haiti

November, 2010
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November 17, 2010

Officials in Haiti Defend Focus on Cholera Outbreak, Not Its Origins
By RANDAL C. ARCHIBOLD

MEXICO CITY — Medical authorities in Haiti defended their decision Tuesday not to focus on finding the origins of a cholera outbreak that has killed more than 1,000 people and stoked violent demonstrations against United Nations peacekeepers, whom many people blame for introducing the disease.

Protests that began Monday and carried into Tuesday in some places left two people dead as demonstrators directed their ire at the peacekeepers, a 12,000-strong, multinational force that arrived in Haiti in 2004 in response to political conflict.

A spokesman for the United Nations force said the protesters were using the escalating cholera epidemic as an excuse to push the troops out and destabilize the country before the Nov. 28 presidential election.

“These are not genuine demonstrations,” said the spokesman, Vincenzo Pugliese. “They are using spoilers paid to create chaos.” United Nations health workers said the demonstrations were hampering the treatment of victims in Cap Haitien, where supplies are running low and the death rate is high.

Some Haitians see the peacekeepers as hard-line occupiers while others support them out of concern that the national police are unable to maintain order.

Tensions around the force have increased after health officials identified the cholera strain as coming from South Asia and found that the bacteria, which lives in feces, had contaminated a river where Nepalese troops had arrived in October shortly before the outbreak began.

Reporters in Haiti found signs of poor sanitation at the camp, but the United Nations mission has steadfastly denied that the troops are to blame, and has said repeated tests have failed to link the cholera to them. South Asia is home to many cholera strains.

Scientists have said that based on initial testing of its genetic traits, the cholera strain appears to have been brought to Haiti in contaminated food, water or carried in an individual. Before this outbreak, cholera had not been documented in Haiti at least in the past century.

And while the testing has not linked the disease to the troops, the World Health Organization said, it could not be ruled out. A full inquiry of the outbreak’s origins has not been undertaken.

“We are focused on treating people, getting a handle on this and saving lives,” said Daniel B. Epstein, a spokesman for the Pan American Health Organization, the branch of the World Health Organization operating in Haiti.

Dr. Jordan Tappero, an epidemiologist with the United States Centers for Disease Control and Prevention, who is leading medical investigators in Haiti, said by telephone that it was unlikely that scientists would pinpoint where the outbreak began, and that he did not think mounting an all-out effort to find the answer “is a good use of resources.”

Outside epidemiologists said it was important to study the bacteria and where it came from to expand understanding of how the disease travels and mutates, but they generally agreed that treating victims was more important.

Studying the genetics of the strain “would give a better idea where it came from,” said Dr. David Sack, an epidemiologist at Johns Hopkins Bloomberg School of Public Health who studies cholera outbreaks, “But I agree it is more important to prevent the disease and control it. It should not be killing people.”

The Haitian government said Tuesday that the death toll had reached 1,034, with 16,799 people treated for cholera or symptoms of the disease.

Health officials in the Dominican Republic said Tuesday that they had found the first confirmed case of cholera, in a Haitian citizen who recently returned from his home country, The Associated Press reported.