October 25, 2016
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Cholera Forces Haiti To Face Sewage Dilemma

 PORT-AU-PRINCE - The cholera crisis is forcing Haitian authorities to address an unpleasant and now life-threatening problem – untreated feces.

The first infections likely came from cholera-infected feces in a river, and feces is a main vector of the vibrio cholera bacteria. But Haitian authorities have been slow to face the problem.

With at least 2,591 dead and over 63,000 hospitalised as of Dec. 21, the cholera epidemic has now hit all 10 departments. In some areas which lack clinics and roads, like the department of Nippes, the known mortality rate is almost 15 percent.

Health crews in Haiti are scrambling to get chlorine products and rehydration salts to the four corners of Haiti's mountainous countryside. Teams are setting up makeshift cholera treatment centres, and across the country, radio stations, preachers, teachers and community organisers are conducting public education campaigns about the need to treat water, to wash hands, to cook food.

There are increasing calls for the need to pinpoint the origins of the disease, which likely came from Southeast Asia, probably with a U.N. peacekeeper. In Haiti there have even been numerous demonstrations against the "blue helmets."

But even if every single Haitian gets a supply of chlorine pills for the next three years, and even if clinics are set up all over the country, and even if the exact "patient zero" is discovered, cholera is on its way to becoming endemic. And the country could be hit with another waterborne disease at any moment. 

Because water is not the only problem. There is another one which not discussed so often, perhaps due to its nature – feces, known as "kaka" or "poupou" in Creole. 

"Well, we just go wherever. On the ground, by the river. Not everyone has latrines so we do what we have to do on the ground," Andremène René, a farmer who lives near Mirebalais, told IPS.

"People have been doing what they need to do on the edges of the camp," explained Renol Jeudi Jean, camp manager for the Bon Berger refugee camp south of the capital, whose latrines "filled up" five months ago.

The 300 families at Bon Berger, and René's family near Mirebalais, are part of the 81 percent of Haitians – about eight million people – who do not have access to "improved" sanitation – a flush toilet or a sanitary latrine set-up.

In fact, not one of Haiti's cities or towns has a sewer system or waste treatment. Haiti is the 11th worst country in the world in terms of sanitation, and has actually lost ground over the past two decades, according to the International Red Cross.

"Treating water is something that can be done quickly. That is why we started with that," explained Pierre-Yves Rochat, head of rural programmes for Haiti's National Directorate of Potable Water and Sanitation (French acronym – DINEPA). "But in the second and third phases of the National Strategy [in the Fight Against Cholera], the big focus will be on the management of excreta."

Part of the 14-month plan calls for waste treatment centers in all 10 of Haiti's departments. 

But for now, as for the past two hundred years, most people "do what they have to do" in unsanitary latrines, in the weeds, on a riverbank or on the beach. In crowded cities, they defecate into plastic bags which are then tossed into a mound of garbage or a nearby canal.

The resulting excreta often sits in the open for days and weeks, until a pounding rain sends it and tonnes of other garbage careening down the ravines and canals, into the seaside shantytowns and out into the Caribbean Sea or Bay of Port-au-Prince.

Those with septic systems and latrines hire "desludging trucks" or the bayakou – men with wheelbarrows who work at night. 

In the past they dumped their harvests where they pleased because until Jan. 12, there were no official dumping places

- or regulations. With the mushrooming of refugee camps and the arrival of thousands of "port-a-potties" – there are now about 15,000 in the capital, according to DINEPA – a new desludging industry flourished.

DINEPA and its humanitarian agency partners scrambled for a place to dump it all. The "piscine excreta" ("excrement

pool") at the Trutier city dump on the edge of Cité Soleil was born, but the uncovered, unlined pit is not the answer. 

"We need to stop sending excreta to Trutier. We are very conscious of that. It is a temporary situation," DINEPA'a Rochat told IPS.

"Temporary", because a new dump waste-treatment site being prepared further north, in Titayen, is slated to come on line the first week of January. But "temporary" has lasted many months. And in the meantime, untreated human waste – likely containing cholera bacteria and many other water- and excrement-borne diseases – has been dumped into the open. 

On Dec. 1, the alarm was sounded.

"The excreta pool is almost full. It's only a matter of weeks," Asia Ghemri, from the U.N. Office for Project Services (UNOPS) Operations office, told the weekly meeting of the Water and Sanitation (WASH) Cluster chaired by DINEPA and UNICEF, which groups government and humanitarian agencies that have been working together since the earthquake.

In addition to being almost full, the "piscine excreta" sits on top of the Plaine Cul-de-Sac aquifer, one of the principal water sources for the metropolitan region. Many worry that cholera-contaminated Trutier excreta might leach down into the Cul-de-Sac Plain aquifer, from which many private water truck companies pump thousands of gallons a day. 

About 250 families live nearby, at the regular part of the dump, and the pit is only a couple of kilometres from the community of Duvivier, and from the Bay of Port-au-Prince. 

At another WASH meeting two weeks later, Dr. Homero Silva of the Pan-American Health Organisation (PAHO) re-sounded the alarm.

"There is a danger that the bacteria can go down to the aquifer or out to the sea," Silva told colleagues at the Dec. 15 WASH Cluster meeting. "Vibrio cholera can live for many years.

Silva used to work in Peru, where a cholera outbreak there spread across Latin America and sickened hundreds of thousands. 

Kelly Naylor, who works for UNICEF and had visited the pit that week, confirmed that entire region, including what she called nearby "wetlands," need to be tested to detect whether vibrio cholera is surviving.

"There are definitely serious concerns about what is happening there," she told the meeting.

"When all the excreta trucks stop dumping their materials in Trutier, we need to define a plan to decontaminate the site, if there is a need to do that," said Rochat, who added that the pit will be tested soon. 

The community just downwind – Duvivier – is fed up of waiting for test results or for the new Titayen treatment center to come on line. 

"We are mobilising against it. We can't take the bad odor, and now with cholera, it's dangerous," Salvatory St. Victor of the Committee for the Relaunching of Duviver (KRD) told IPS on Dec. 15. 

Three days later, St. Victor and hundreds of other Duvivier residents demonstrated at the entrance to the stinking pool. 

According to local news agencies, one protestor was shot and killed by police.


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