A girl uses one of the chlroine dispensers Oxfam installed in Haiti. Photo by Elizabeth Stevens/Oxfam

When I look at pictures of Haiti’s countryside, I’m always struck by how beautiful much of the landscape is, particularly in the rice-growing region along the Artibonite River. But then I think about the grim underside of that beauty—the cholera that can so easily course through rivers like the Artibonite, spreading sickness and death.

The outbreak that started 10 months after a devastating earthquake in 2010 has now claimed more than 7,000 lives and sickened more than half a million people—as if Haiti needed any more trouble heaped on its citizens. The cholera epidemic is reportedly the largest in modern history, and it’s been in the news a lot lately. The New York Times ran a lengthy story early this month and yesterday, NPR filed its own report on the urgent health problem.

The heart of the trouble is the almost complete lack of functioning water and sanitation systems across the country. Many people are pretty much on their own when it comes to providing water for their families: They lug it home from wherever they can find it, and in the rural areas that’s often streams and rivers. Whether it’s fit for drinking—and cholera-free—can be hard for families to determine.

That’s why in the area around Petite Riviere de Nippes, as NPR reported, people are excited about a simple solution Oxfam has been working on: the installation of chlorine dispensers near where they collect their water. The devices are designed to squirt just enough chlorine to purify a five-gallon jug of water. Oxfam is installing about 90 of the dispensers. And the affordability of the chlorine could be the key that makes this solution last, as Oxfam’s Kenny Rae points out in the piece.

“The cost of chlorine is very, very low,” he said. “A $100 tub will cover all these dispensers for six months.”

That’s a sliver of good news for rural Haitians facing a new rainy season and the spike in cholera cases that could trigger.

Oxfam's Elie Saint-Cyr talks to villagers about chlorinating water. Photo by Toby Adamson/Oxfam

Sophie Martin Simpson is an Oxfam monitoring and evaluation officer in Haiti. She wrote this account after a visit to Artibonite province, where Oxfamis working hard to stem the spread of cholera.

I recently returned from two days with our cholera response team in the region of Petit Riviere in Artibonite. I was there to support our team and to collect information from the local population about existing water sources, their access to basic hygiene facilities such as showers and latrines, and their knowledge about cholera and cholera prevention. The first cases of cholera were reported in Artibonite in October and the region continues to be one of the worst hit by the outbreak. As such, it is a focus for Oxfam’s cholera response.

I visited rural communities and talked with people, some of whom proudly showed me their newly constructed family latrines. Before Oxfam began its cholera response program, the majority of communities lacked toilet facilities.

In a number of locations, Oxfam has additionally set up ORS (oral rehydration solution) “corners“ ORS is the most effective way to keep people with cholera hydrated until the cholera-causing bacteria has passed through the body. Community volunteers, trained in treating water to ensure it is safe to drink, in hand-washing practices, and in ORS preparation, staff these sites. If community members suspect they have cholera, they can get instant assistance from the corner volunteer who supplies them with enough ORS and clean water to ensure they stay hydrated on their journey to hospital. Oxfam staffers carry out regular spot checks of these corners to ensure the quality of the treated water and that ORS is being prepared correctly.I was very happy to hear the corner volunteers report a decrease in the number of people presenting cholera symptoms in the past few weeks. It was also good to hear community members speaking repeatedly about the importance and benefit of having such ORS corners within easy reach of their homes as a means to help treat and prevent the spread of cholera.

Before the cholera outbreak, many community members were unaware of the symptoms of the disease, how it is transmitted or how to treat it. Since the outbreak, Oxfam has been working hard to educate people about these issues.

I attended two local meetings during which community members were encouraged to share what they had learned about cholera symptoms, ORS preparation, and how to handle the bodies of people who have died from cholera to prevent further spread of the disease. It was great to watch each and every person at the meeting stand up and with confidence l shout what they knew through a megaphone!

It was also reassuring to find the mystery and fear surrounding cholera– prevalent during the early weeks of the outbreak–dissipating. Oxfam’s health and hygiene messages are clearly getting through to increasing numbers of people who now have the knowledge, skills, and resources to effectively treat and manage cholera within their communities.

Men use a hand auger to drill a well in Haiti. Photo by Tom Mahin/Oxfam

Tom Mahin, a drinking water specialist, flew to Haiti recently to help Oxfam stem the spread of a cholera outbreak that has now reached every province of the country. Here, he recounts some of the challenges of that work.

 

 

 

I arrived a few days ago in the Artibonite Valley in Haiti to work with Oxfam on its response to the cholera outbreak. My focus is on drinking water. The valley is much different than Port-au-Prince where I worked for Oxfam for five weeks after the January 2010 earthquake. Here, it is greener and much less congested, but the valley is also where the cholera outbreak has been the worst. Lack of adequate safe drinking water in villages is a major problem for people, now even more so because of the cholera outbreak.

One of my first tasks was to accompany an Oxfam public health engineer to sites selected for some new wells to provide safe drinking water—key to preventing the spread of cholera– and to see the drilling of wells underway. Oxfam has contracted with two local drilling companies to do the work. The companies don’t rely on expensive drilling rigs: They mostly use hand augers, though sometimes workers dig the wells by hand because rocks make the use of augers impossible. 

Because we need to make the wells available quickly, Oxfam has been advising the companies on how to increase their drilling speed.  In the long-term, these new techniques–which include methods for preventing fine sand from entering the wells and delaying their use– will be less work for the drillers and will result in future wells being available sooner.

Drilling wells is just one of our initiatives. We’re also working to improve other water delivery systems, including in places like Labadie, an area located in a mountainous region that surrounds the valley.  Parts of it are accessible only by foot or horse.

Labadie has a large gravity flow system that provides drinking water from a protected mountain spring to 3,500 people. But it wasn’t functioning, so Oxfam supplied pipes, cement, and other materials, along with technical guidance, so that local residents could make many of the repairs themselves. We’ll pay for the masonry work. Now, water is flowing to 60 percent of the communal taps. The plan is to get water to the other 40 percent and to supply parts and cement for other repairs to ensure the long-term functioning of the system. 

On the way back from Labadie, a long trek in a four-wheel-drive vehicle, I thought a lot about the people with serious cases of cholera who must have come down from these mountains in the recent weeks and months. Young children and the elderly with severe diarrhea and vomiting would have been taken by their families down roads like the one we were on that day, some even without the help of a vehicle. It was unsettling to see how the poor infrastructure in areas like this had increased the spread of cholera and made it difficult for those infected to get to help they needed.

It took me all year, but I finally made it to Haiti earlier this month. It’s a fascinating and beautiful country facing some daunting challenges, and it was an honor for me to participate in Oxfam’s response to the earthquake and the cholera epidemic.

The best moments of the trip were meeting with entrepreneurs rebuilding their businesses right out of the rubble of their homes and their lives. We met one woman named Carole who runs a small shop in the Carrefour Feuilles district in Port-au-Prince out of a small shipping container on the ruins of her home. She painted it pink on the inside. “I just like pink,” she says. She now lives in what used to be a warehouse next door. The roof leaks so much, when it rains, she says, “it’s like being outside.”

“Oxfam is the only one who came here,” she says. We gave her the shipping container, set it up on her land, and helped her with a grant to stock it with drinks, toilet paper, matches, and canned goods. “It put joy in my heart,” she says, “If it weren’t for this container, I don’t know when I would be on my feet…” Now, she says, “I’m on my way.”
The worst moments were encountering people who have lost hope. One 21-year-old man told me his life ended last January 12th. He spent that night under his collapsed home and lost his right leg above the knee. He’s living in a tent at a large camp an hour outside Port-au-Prince, and hobbling around like a ghost on crutches, with no money to finish his education and unable to live in the countryside with his family, where it is simply too difficult for him to move around. I asked him what he wants now, and he said he just wants a place to live, maybe his own house. The prospect of sorting out property rights, rebuilding homes for people who have clear title, and finding places for all the others who don’t, is an enormous challenge, and it’s easy to feel overwhelmed.

I could see why this young man was living in the flat area of the camp instead of out in the countryside. The day after I met him, I spent about five hours with a young woman named Margarite in Artibonite, where the recent cholera epidemic started in October. She was moving around to different agricultural fields explaining to farmers how to prevent transmission of cholera, how to treat their water to ensure they do not get sick, and how to provide care for people showing symptoms of cholera. (Check out the video we just completed about Margarite and her work.)

At one point we had to jump across an irrigation channel; I took a running start and came up a little short, landing one foot in the mud but quickly springing up the bank before I got stuck. I held on to my tripod, but my camera bag slipped off my shoulder and slammed into the bank. I just barely accomplished this with two legs—hard to imagine doing it on crutches.

I realized later that when my camera bag hit the ground, it broke the UV filter on the end of the lens – but the lens itself was all right. Sacrificing the filter meant I could keep shooting photos of the people I was meeting, so I’ll share a few of them with you here.

Carole got back in business selling drinks and other goods from a shipping container on the ruins of her home in Carrefour Feuilles, in Port-au-Prince. Photo by Chris Hufstader/Oxfam America.

The Petionville Club was transformed from a golf course to a camp for people displaced by the earthquake. Oxfam provides clean water to the thousands of people now living there. Photo by Chris Hufstader.

Clearing rubble in Carrefour Feuilles, Port-au-Prince. Photo by Chris Hufstader.

Getting some water in Carrefour Feuilles. Photo by Chris Hufstader/Oxfam America.

The rain dropped by Hurricane Tomas across Haiti has created perfect conditions for the spread of cholera. Photo by Eduardo Munoz, courtesy www.alertnet.org

The relief that Oxfam staffers felt after Hurricane Tomas doused Haiti earlier this month was short-lived. They knew it would be, says Julie Schindall, an Oxfam press officer based in Haiti.

Though the storm caused limited physical damage, the rain it dumped has created the perfect conditions for another frightening problem: the spread of cholera, a deadly waterborne disease.

“Our staff knew, after decades of working in cholera epidemics around the world, that we hadn’t actually escaped a disaster after the storm,” writes Schindall in a piece posted with Channel 4 News. “As the floodwaters receded, the cholera outbreak that started in central Haiti in late October began its vicious spread.”

From Oxfam headquarters in Port-au-Prince, the earthquake-ravaged capital, Schindall has been monitoring the spread of disease—and the race the stop it. Oxfam is now running three cholera response programs including one for about 100,000 people in the Artibonite province where the outbreak first erupted. The disease has spread to the capital, where aid workers are concerned about conditions in the slums and their lack of water and sanitation.

In the camps for displaced people scattered around the capital, Oxfam is continuing to reach about 315,000 people with water and sanitation services—and specialized public health messages that focus on cholera. But in Cap Haitien, a large city in the northern part of the country where hundreds of cases of cholera have been reported, we’ve had to stop temporarily our activities because of protests related to the elections planned for later this month. And the hault is causing a good deal of concern.

“This is a really difficult situation here in Cap Haitien,” says Elodie Martel, who is leading Oxfam’s cholera response there for about 300,000 people. “Cholera is really straightforward to prevent. It just takes clean water and hygiene education. But every minute counts because the disease can spread very quickly. Now for the past day and a half we haven’t been able to reach people with clean water. They don’t know how to treat themselves at home for diarrhea. And they can’t get to the hospital with all the demonstrations blocking the way. We are very worried that cholera in Cap Haitien will get much worse because of the delay in bringing people the aid they need.”

Hurricane Tomas dumped plenty of rain on the displaced residents of Haiti’s capital over the weekend where countless families continue to live in tents and under tarps in crowded camps scattered across the city. They’ve been there since the January 12 earthquake destroyed their homes. As Tomas churned toward Port-au-Prince, fear of another catastrophe ran high.

But after the storm, Oxfam aid workers reported that damage was minimal to the water and sanitation facilities in the camps where we work—a huge relief (you could hear it in the tone of their messages) since access to clean water and sanitation services is essential in helping to ensure the health of people in the camps.

And there’s no doubt that the preparedness work Oxfam did in advance—including digging drainage ditches, clearing canals, and securing water tanks and latrines—helped keep these critical systems intact.

But there’s lots more work ahead: a cholera epidemic has hit the rice-growing region north of capital. According to the UN’s Office for the Coordination of Humanitarian Affairs, the Haitian government is now reporting that more than 8,000 people have been hospitalized with the virulent waterborne disease and more than 540 people have died from it. Oxfam is very concerned that all the rain Tomas dropped could exacerbate cholera’s spread.

In Artibonite province, where most of the hospitalizations have occurred, Oxfam has launched a major response to combat the outbreak. We have a team of about 25 staffers working in an area called Petite Riviere, with a population of around 100,000. We’ve been distributing water purification tablets and powder, soap, buckets, and oral rehydration salts to about 40,000 people. We’re also carrying out a massive education campaign on how to prevent the spread of the disease. Good hygiene and access to clean drinking water are key.

Workers handle buckets to help with Oxfam's cholera response in Haiti. Photo by Julie Schindall/Oxfam

Julie Schindall, an Oxfam press officer, traveled to Haiti’s cholera-stricken province of Artibonite on Sunday. Here’s what she saw.

In central Haiti, the Artibonite province is awash in water. Driving through the cholera-stricken region on Sunday—day three of our emergency cholera response—I see water everywhere: rice paddies, irrigation canals, small rivers, cesspools, and puddles.

As we head inland toward our work site, we stop for directions. I hop out of the car to take a phone call. As I speak on live radio to audiences in the UK, I look down and see a dead pig lying in stagnant water. A few yards away a mother washes clothes as her naked children play in the yard. The heat burns my neck, and I stare, transfixed, at all this water. None of it is safe to drink.

Even before the disastrous quake of January 12, fewer than 20 percent of Haitians had access to a toilet. Only half had safe drinking water. These statistics run through my head as we roll down the road to reach our team of public health experts dispatched to Petite Riviere, population 100,000.

I’ve lived in Haiti for seven months, sent here as part of the Oxfam earthquake response. Each day here I confront poverty and inequality. But today, in the cholera zone of Artibonite, in the midst of the latest Haitian emergency, I feel angry. This is the “rice basket” of Haiti. President René Preval comes from this region. Yet, here in Artibonite, most people don’t have a private, sanitary place to poop and they rely on a dirty river as one of their sources of drinking water.

A small crowd has gathered in front of a broken-down concrete house on the country road. Oxfam public health experts are negotiating a contract with a local radio station. We’ll be broadcasting messages about safe hygiene practices, like hand washing, to 100,000 people by the end of the evening. I approach Jane, our lead public health specialist, and ask her how it’s going.

“It’s going to be ok. We have a lot of education to do, but it’s going to be fine,” she says calmly.

Jane has years of experience working in countries around the world, and this is certainly not the first time she’s seen a cholera outbreak. She runs down a list of planned activities: distributions today and tomorrow of soap, oral rehydration salts and water purification tablets to reach 40,000 people, training community leaders about good hygiene practices so they can go back and train their friends and neighbors, repair of wells and purification of natural water sources.

A few hours later, we gather at our new supply warehouse—a rice processing facility the community offered to us to help stop the spread of cholera. Dozens of men from the neighborhood have gathered to unload the truck filled with buckets and soap; they stand in an excited huddle, many without shoes, as our staff call out directions.

Our last stop before heading back to Port-au-Prince is the hospital at St. Marc, where hundreds of sick people flocked in the first 48 hours of the outbreak. In the fading afternoon light today, however, the hospital is quiet and calm. Doctors and nurses, speaking softly, moving along orderly rows of beds. A man with a megaphone is broadcasting messages encouraging hand washing and eating only cooked food. As we walk through the chlorine foot bath and back to the car, our water and sanitation advisor nods his head with satisfaction.

 “We’ll stop this cholera,” he says. “This disease can’t beat us.”

Photo: Anna Kramer / Oxfam America

When I close my eyes, I can still see the rubble art. Bright fragments–now scattered across a table in the back room of the Miami, Florida, community group Konbit for Haiti–these chunks of concrete were salvaged from the streets of Port-au-Prince after the January earthquake. Now, each painted with a different scene, they hummed with a kind of contained energy: dancing human figures, trees bending in the wind, a seed bursting from its pod.

Beside me, Leonie Hermantin explained that a Miami-based non-profit had brought the pieces here to sell at an upcoming art show. All the proceeds will go back to the artists, she said—back to Haiti.

In fact, even while we contemplated the quake’s aftermath, the country was facing another crisis. A cholera epidemic in the Artibonite and Central Plateau regions has now infected more than 3,000 people.

“The epidemic is not this natural disaster,” said Hermantin, deputy director of the Lambi Fund of Haiti. “It is something that comes from poverty, and a lack of government planning. …  It is rooted in the neglect of rural communities.”

I met Hermantin and other local leaders through Oxfam America’s Haiti community organizer, Sophia Lafontant. We traveled to Miami last week for two days of speaking events featuring Jacqueline Morette, a visiting farmer and leader of a Haitian Oxfam partner organization.

Often, Morette was received as a guest of honor. The power of her message—that women can be leaders in rural communities; that people can earn a decent income from farming; that rural regions matter just as much as Port-au-Prince—seemed to resonate with many who heard her speak.

But the cholera crisis hovered in the background, a shadow that could not be dismissed.

Oxfam is responding to the epidemic, as are some Miami-based groups, including the health organization the Center for Haitian Studies. “We have a warehouse of medical supplies, and we’ve already established contact with the government and the Ministry of Health,” said the Center’s director, Dr. Laurinus Pierre, when I met him at his clinic in Miami’s Little Haiti neighborhood.

Some people I spoke to, like University of Miami professor Dr. Jean-Pierre Fontaine, emphasized the need for the Haitian government to provide stronger leadership.

“In this crisis, there has been a lot of talk about the international community, and not so much about the Haitian authorities,” said Fontaine. “One thing I want to see is for the government, and the authorities in rural sectors, to acquire the capacity and the will to prevent disasters … and address the causes.”

Most of all, I heard one thing from the Haitians I met in Miami: despite the distance, Haiti is still home. And even in the face of enormous challenges, they believe their country will emerge stronger. Whether through their own efforts, or by supporting others, many were determined to do all they could to help—driven by the same exuberant, tenacious pride that turns earthquake rubble into something beautiful.

Miriam Aschkenasy and Oxfam Ambassador Emile Hirsch attend a community meeting in Mudzi, Zimbabwe. Photo: Nabil Elderkin / Oxfam America

In April, Oxfam Ambassador Emile Hirsch traveled to Zimbabwe with Oxfam’s Miriam Aschkenasy and Lyndsay Cruz to see first-hand Oxfam’s response to the cholera crisis that has hit the region.

Below, Aschkenasy, Oxfam’s public health specialist, writes about the second day of their five-day trip.

I am always so tired at the end of the day in Mudzi, a region in the northeast part of the country where Oxfam has been working on the cholera outbreak. After a two-hour car ride from Harare we arrived at the Pumpkin Hotel–the only hotel in this region. We settled in (Emile got the suite with the waterbed, and I got the one next door) and had some lunch: Eggs and sadza, a finely ground cornmeal boiled in water.

After lunch, we headed out to look at a bore hole–a narrow well drilled deep into the ground.  Mudzi has hundreds of them. They’re the source of drinking water for many people in this rural region. This one was a half-hour-drive away on a bumpy, dry road–and when we arrived, we found hundreds of community members waiting for us.

Sitting in two large groups, they had prepared a speech and gifts: beautiful hand-crafted baskets and several large bags of fresh peanuts tied in large burlap bags with “product of USA” stamped on their sides. These bags had been recycled from earlier food distributions. The villagers wanted to show their gratitude for the work Oxfam and our local partner, Single Parents Widow (er)s Support Network, or SPWSN, had done together: teaching communities about hygiene, providing them with basic goods like soap, and repairing their bore holes.

Emile confessed to me that he thought the word was “boar” hole. And why not? if you were not a water engineer or public health person or someone dependent on these holes for water, how would you know what they were?  It made me realize how little the developed world knows or understands about those who still fetch water by hand and don’t have access to flushing toilets–or even pit latrines.

Back at the meeting, Emile addressed the village, thanking them for their hospitality and acknowledging their strength as a people and as a community. He was nervous and I could tell he had really thought through what he wanted to tell his hosts.

That is why this trip is so important: To get the word out.  Yes, the number of cases of cholera might be less each week, but what about next year?  How do we stop an outbreak from happening again? This year in this village this outbreak left 25 orphans. This is a staggering number of children who have lost their stability–all because they and their families could not access clean water.

As we drove back to the Pumpkin Hotel, I thought again, with amazement, about how so much devastation can happen in such a beautiful setting, and how the people can keep going with such optimism and positive attitudes. I realized it had been an important day for Emile, too: He was beginning to understand the context of people’s lives, how they cope, and the importance of supporting them when their options run out.

Read more of the story on our website.

Villagers work on repairing a broken well, known as a bore hole, in the Mudzi district of Zimbabwe.

I have just returned from Zimbabwe where a cholera outbreak has now sickened more than 80,000 people and killed more than 3,700 of them. Clean water and public health education are critical in fighting the spread of this disease. Oxfam and its local partner, Single Parents Widow(er)s Support Network, are providing both of those things. Below are a couple of audio blogs that capture some of that work.

In the first blog, public health educators are singing a song–one of several they use–to two large gatherings of villagers. The song is in Shona and it’s advising people who use the bush as a bathroom to properly cover their feces afterwards. The second audio blog tells the story of Ronald Marozva, an engineer who travels around rural Mudzi repairing the broken wells so many people depend on.

Cholera Song

Mudzi Water