Behind the Cholera Epidemic - Excreta
The focus on getting clean water for all Haitians is a key part of beating cholera and all waterborne diseases, but another piece of the puzzle – involving the other end of the human consumption system – is just as important.
There is a reason most of Haiti’s water sources – including wells, springs and some aquifers – are contaminated. They are polluted with agricultural run-off, animal waste and human feces.
The first Haitians to fall ill to cholera lived or worked by a river near the United Nations base whose soldiers’ feces are suspected of leaking into the water people used for cooking, drinking and bathing.
“Right now there’s more focus on water, because we can treat water relatively quickly, but in the second and third phase of our National Plan to Fight Cholera, we’re going to focus more on the management of excreta and the construction of latrines,” Pierre-Yves Rochat, responsible for the rural programs of Haiti’s recently created national water and sanitation agency, DINEPA (Direction Nationale de l’Eau Potable et de l’Assainissement), told Haiti Grassroots Watch.
DINEPA is the first national office or agency to have sanitation as part of its mandate. Prior to DINEPA’s creation in 2009, overseeing sanitation fell to cities and towns, but most administrations didn’t take the responsibility seriously. Not one Haitian city or town has a sewer system or sewage treatment center.
No wonder cholera has taken hold so easily.
Chart from July, 2010, report by DINEPA and the International Red Cross Committee.
According to the International Red Cross Committee, in 2006 only 19 percent Haitians had access to a toilet or a decent latrine, making the country one of the most “unsanitary” in the world – 11th from the bottom, on a par with the Democratic Republic of Congo or Somalia. And of the bottom 15 countries, Haiti is the only one where there has been a net loss of access to “improved sanitation” – down from 29 to 19 percent between 1990 and 2006.
While other countries built sewers under their cities as they expanded, cities like Port-au-Prince just extended its canals up the hillsides. Today, while a small percentage of the population has septic systems, most of the capital’s two million people use latrines or defecate into plastic bags which are then tossed into a mound of garbage or a nearby canal.
Human excreta and plastic bags on the ground near a camp. Still taken from MINUSTAH video.
Excreta often sits in the open for days and weeks, until a pounding rain sends it and tons of other garbage careening down the ravines and canals, into the seaside shantytowns and out into the Bay of Port-au-Prince.
The septic systems and latrines that were occasionally cleaned out by “desludging trucks” or the bayakou – who work at night – dumped their harvests where they pleased because until January 12, there were no official dumping places… or regulations.
Dangerous Cholera-laced excreta in Cité Soleil?
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 – Haiti had to come face to face with its excreta.
The new desludging industry flourished, and DINEPA and its humanitarian agency partners scrambled for a place to dump it all. They dug a pit at the Trutier city dump north of the capital.
Excreta Pool. Courtesy of WASH Cluster.
Unprotected workers, shooting excreta into pool. Courtesy WASH Cluster.
“That was the real beginning of any kind of excreta management” in Haiti’s history, Rochat said. “But we need to stop sending excreta to Trutier. We are very conscious of that. It is a temporary situation.”
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. [see From Emergency to Self-Sufficiency?] But “temporary” has now been going on for 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 pit which sits about 2 kilometers from Duvivier, and very near the normal Trutier dump site where about 250 families actually live and sort medical waste and other garbage.
Trutier residents sorting trash. MSB - Swedish Civil Contingencies Agency.
On December 1, the alarm was sounded at the weekly meeting of the Water and Sanitation (WASH) Cluster – chaired by DINEPA and UNICEF and which brings together the government and non-governmental agencies who have been working together since the earthquake.
Asia Ghemri, from the UN Office for Project Services (UNOPS) Operations office which is working with DINEPA to organize excreta management, told colleagues: “The excreta pool is almost full.”
“It’s only a matter of weeks,” she added.
The community just downwind – Duvivier – is fed up.
“We are mobilizing against it. We can’t take the bad odor, and now with cholera, its dangerous,” Salvatory St. Victor of the Committee for the Relaunching of Duviver (KRD) told Haiti Grassroots Watch on Dec. 15. “Also what if those germs go down to the aquifer?”
(Three days later, St. Victor and hundreds of other Duvivier residents demonstrated at the entrance to the stinking pool. One Duvivier resident was shot and killed by police, according to AlterPresse and Haiti Libre. In December 21 note, KRD said three people were killed during and just after the demonstration.)
The unlined pit – which is the size of about four soccer fields – 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.
Map showing subterranean water supplies, with the approximate location of the the Trutier "excreta pool" marked in red. Map taken from U.S. Army Water Resources Assessment of Haiti report.
Already in 2002, a study noted that the aquifer water was feces-infected.
On Dec. 15, Dr. Homero Silva of the Pan-American Health Organization (PAHO) confirmed what many feared.
“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. It is now believed the bacteria lived in the ocean and arrived in several port cities at once.
Peruvian newspaper with article on cholera. Taken from this powerpoint. Download (PDF) the medical journal article: New Insights on the Emergence of Cholera in Latin America.
At the same Dec. 15 meeting, Kelly Naylor, who works for UNICEF and is part of the UNICEF/DINEPA team drafting rules of all excreta disposal businesses and organizations [see From Emergency to Self-Sufficiency?], confirmed that the pit and its contents, as well as 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.
DINEPA’s Rochat agreed, and told Haiti Grassroots Watch that testing is taking place, although results are not yet back.
“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,” he said.
As of Dec. 17, excreta trucks were still dumping at Trutier.
Camps offer special challenge
The capital region’s refugee camps offer a particular challenge.
Currently there about 1 to 1.3 million people living in refugee camps in the capital and three other cities worse-hit by the January 12 earthquake. Some camps have in-ground latrines, which are already overflowing, and others have latrines that need to be pumped out every day.
According to “Sphere standards” for humanitarian disasters, there is supposed to be one latrine for every twenty people, but a June report from the UN Office of Humanitarian Affairs puts the number closer to about one latrine for every 50 to 100 camp-dwellers.
Bon Berger camp in Mariani, south of the capital, has none. About 250 to 300 families live in tents and shanties crammed into an area not much larger than a soccer field. Soon after the January 12 earthquake, CARE built some latrines they called “emergency,” according to Renol Jeudi Jean, the camp manager. But after six months, “they got filled up” and they have yet to be replaced.
“Since then, people have been doing what they need to do on the edges of the camp,” Jean told Haiti Grassroots Watch.
To confirm Jean’s claim, Haiti Grassroots Watch randomly surveyed six refugee families. All of them reported using plastic bags, or simply squatting in the weeds on the nearby riverbank.
Not all camps lack latrines, but many lack the correct quantity, or they are not emptied as often as they should be. Latrines routinely “fill up” and can spill or, as occurred earlier this month, can be overturned by protestors.
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