By Marc Hujer
http://www.spiegel.de/international/world/0,1518,726563,00.html

Haiti, the battered Caribbean island, is fighting a new enemy: Thousands have fallen ill with cholera and hundreds have already died. The government and international aid organizations are desperately trying to prevent the epidemic from reaching the capital.

Once a day, a stench descends upon the Champ de Mars when David Larose arrives in his small truck to empty the portable toilets.

Even the people who have been living here for months, in tents or huts made of refuse -- the people who, since the earthquake on Jan. 12, have stoically endured their fate while surrounded by the constant odor of squalor -- turn away in disgust at this overpowering stench.
Larose is the head of the hygiene team responsible for the Champ de Mars, a park in the center of the Haitian capital Port-au-Prince. He has a driver and an assistant who starts the pump when he tells him to, who repairs it when it gets clogged and who fetches the bucket containing the toxic blue liquid that is used to disinfect the sidewalk whenever there's a spill. But the real work, the work of pumping out the toilets, is Larose's job. He does it without a mask or gloves. He isn't worried about catching anything, because he's convinced that he is immune.

It takes Larose's pump two minutes to suck out the contents of each toilet. His tank has a capacity of 2,000 liters (528 gallons), but he could use a bigger one. Then he wouldn't have to make the one-hour, round-trip journey to the dump as often.

He is fighting a hopeless battle, the battle to prevail over the cesspool of Port-au-Prince. But Larose, his team and the regular disposal trips ordered by the government since the epidemic began represent the hope that residents of the Haitian capital will be able to avoid cholera. Larose's men are working overtime to help fend off the epidemic. Sometimes they empty more than 200 toilets a day, but his colleagues still wind up calling for help because even that number is not enough.

Port-au-Prince is taking whatever precautions it can. Emergency centers are being set up, including tents where hundreds of cholera patients can be treated simultaneously. Government agencies and aid organizations are using the radio stations to disseminate information about hygiene and simple, preventive measures, like frequent hand washing, boiling water for drinking purposes and adding salt and sugar to water.

No Signs of a Better Haiti

Aid workers wielding megaphones are driving around the city, telling people how important it is to use soap. But is this country even capable of protecting itself? It's been nine months since a devastating earthquake struck Haiti, and yet parts of the country still look like war zones. Close to 10,000 non-governmental organizations (NGOs) are providing emergency aid, but Haiti is still a long way from being a functioning country. And despite all the help, there is no evidence that a better Haiti is being built.

Nine months after the earthquake, hygienic conditions are still catastrophic, and almost 1.3 million people are still living in makeshift huts made of plastic tarps. The country lacks housing, infrastructure or even a plan to regain its autonomy one day. For many experts, the cholera outbreak is mainly an indication of how vulnerable this troubled island remains.

The first priority for the aid workers is to protect Port-au-Prince from the impending disaster. The situation is extremely serious, says Nigel Fisher, the United Nations representative in Haiti, and it would be irresponsible in light of experiences with epidemics in other places not to prepare for a major outbreak.

Gabriel Thimothée, the director of the Haitian Public Health Ministry, tries to allay such fears. "We can prevent a pandemic," he says, partly because of international support. Venezuela is sending medication for 2,000 cholera patients, and a team of 15 doctors arrived from Mexico in the middle of the week.

Low Infection Level in Port-au-Prince

The numbers of victims are not as dramatic as initially feared. So far, around 4,700 have been hospitalized and at least 337 people have been killed by the epidemic. The number of the infected has stopped rising as quickly as before. Another piece of good news is that all of the cholera patients in the capital contracted the disease in the Artibonite region, not in Port-au-Prince.

Noting the relatively low number of infections and the lack of deaths in Port-au-Prince, Delphine Chedorge, the head of the Haitian mission for the aid organization Doctor's without Boders (MSF) said: "This is good, but hardly a reason to let down our guard." Chedorge believes that the next four weeks will be critical. If there are no new infections during this period, Haiti will have dodged a bullet. MSF has set up three new cholera treatment centers in the capital, each with capacity for up to 200 beds, and it is adding 10 smaller centers. Other organizations are following suit, including the Red Cross of Germany.

The government and aid organizations are now training volunteers, known as "community mobilizers," to educate the public. They recommend that people no longer eat uncooked vegetables and that they only use clean water. The NGOs are distributing soap and water treatment tablets that contain chlorine.

The news that thousands of people had become infected with cholera in the Artibonite Department, between the cities of Gonaïves and Saint-Marc, a three-hour drive from the capital, triggered alarm bells in Port-au-Prince just over a week ago.

Disease Would Be Difficult to Stop in Capital

Cholera. It sounded like the beginning of the catastrophe that aid organizations and doctors had warned about again and again. There had been no cholera cases in Haiti in 50 years, but the pathogen, the Vibrio cholerae bacterium, would more than likely spread rapidly through the tent cities in the capital. Cholera, the disease of the poor, transmitted through contaminated drinking water and unclean food, would be very difficult to stop in Port-au-Prince.

The first signs of a new disaster in Haiti came on a Thursday more than two weeks ago. By the next day, Friday, more and more patients were coming to the St. Nicolas hospital in Saint-Marc with severe diarrhea. There were 450 cases by last Saturday, Oct. 23. Doctors and nurses worked day and night, and MSF volunteers set up an additional, 400-bed cholera treatment center on a soccer field next to the hospital. It was still far away from Port-au-Prince, but as little as a rumor was enough to strike fear into the hearts of people in the capital.

"One never knows what to do with such warnings," says Bernard Ethéart, a former cabinet minister who runs the Mélodie radio station today. "It's possible that the situation is truly serious, but it could also be that some people see it merely as a way to gain attention and raise new funds from donors."

Moments of Destruction Are Part of Cityscape

Haiti is a country where people already had very little before the earthquake, and now it seems as if there were no room left for those people anymore. The ruins are still standing, nine months later: stairways, rooms and sometimes entire floors that survived the quake, monuments of destruction that have become part of the cityscape. The only difference is that the dead bodies have since been removed.

Margareth Jean-Marie is in her tent on Champ de Mars, getting her six-year-old daughter Dayana ready for kindergarten. She lived in a one-room apartment around the corner before the earthquake. The building has disappeared into the rubble.

She has fetched water from near the toilets, washed her daughter, tied white ribbons into her hair and dressed her for the day. There is a makeshift mirror made of aluminum foil on the table, but her daughter won't look at it. She is a child without a smile.

Her mother says that they don't talk about cholera in kindergarten. The children are too young for that, she says, but she is very afraid of the disease that is breaking out everywhere here in the tent city on Champ de Mars. She is aware of the warnings about not drinking the water that's available out in the square. But what can she do? "It's the only water we have," she says.

In many places, people get their water from hoses that hotels and aid organizations have placed on the sidewalk. They wash themselves in plastic buckets, using soap and old toothbrushes. Then they empty the buckets next to their tents and the water runs down the street, where it drains away or evaporates. Water is also available for sale, but who can afford it?

Aid Workers Are Still in Emergency Mode

"This epidemic is just another disaster in a long chain of catastrophes on this island," says Julie Schindall, the local spokeswoman for international aid organization Oxfam. The international aid workers should have started reconstruction work long ago, but everyone is still in emergency mode, says Schindall, and that's the problem.

It seems absurd that aid workers from around the world have achieved so little by now. Until recently, they were quick to point out that at least they had prevented disease outbreaks. But even that tiny success has now been destroyed. For decades, Haiti has received international aid every time disaster struck, but no one ever managed to build a functioning community.

Some experts even wonder whether the large numbers of aid workers on the island could actually be an impediment to reconstruction. "We have established a republic of NGOs," Edmond Mulet, director of the UN mission in Haiti, said a number of days ago. Instead of turning over responsibility to the Haitians, says Mulet, the aid workers have created many structures that replace the government in areas like education and healthcare. According to Mulet, this is why the international community is partly responsible for the weak Haitian state.

Haiti is a country of superstitions, and there are many rumors swirling about. Some say that people in the neighboring Dominican Republic dumped sewage into the river, or that UN peacekeepers from Nepal brought the disease to the country. Last Wednesday, 300 local residents attacked a cholera center in Saint-Marc because it seemed somehow sinister to them.

On Thursday, the St. Nicolas hospital in Saint-Marc is still crowded with patients. They come to the hospital because they have diarrhea and are vomiting, but having these symptoms doesn't necessarily point to cholera. Nevertheless, the fear has become so overwhelming that there are now 70 people in the lobby waiting to see a doctor.
Those patients who do appear to have cholera are admitted. Some 30 patients are lying on a large piece of cardboard on the floor, where nurses have given them infusions. Without fluid replacement, they could die in as little as four hours, like the first people who became infected with cholera the week before last. Many were unfamiliar with the symptoms and didn't take them seriously. By the time they arrived in the hospital, it was often too late.

The next hurricane, which normally strikes the island in the autumn, was long a topic of discussion in Haiti. When it didn't arrive, people talked about the next earthquake, and when it didn't happen, cholera struck. The question is not whether a catastrophe will ravage Haiti, but which one will do it first. The possible threat now is Tropical Storm Tomas, which is forecast for later in the week and could strengthen to become a hurricane.