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Haiti's progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured

Authors Koski-Karell V, Farmer PE, Isaac B, Campa E, Viaud L, Namphy PC, Ternier R, Ivers L

Received 6 November 2015

Accepted for publication 25 February 2016

Published 24 May 2016 Volume 2016:9 Pages 87—100

DOI https://doi.org/10.2147/RMHP.S75919

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Frank Papatheofanis

Video abstract presented by Louise C Ivers.

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Victoria Koski-Karell,1,2 Paul E Farmer,2–4 Benito Isaac,5 Elizabeth M Campa,5 Loune Viaud,5 Paul C Namphy,6 Ralph Ternier,5 Louise C Ivers2–4

1Department of Anthropology, University of Michigan, and University of Michigan Medical School, Ann Arbor, MI, 2Partners In Health, 3Department of Global Health and Social Medicine, Harvard Medical School, 4Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; 5Zanmi Lasante, Cange, 6Direction Nationale de l'Eau Potable et de l'Assainissement, Port-au-Prince, Haiti

Abstract: Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation's 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government's capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors – not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners' capacity to eliminate cholera.

Keywords:
water, sanitation, WASH, oral cholera vaccination, elimination
 

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