Haiti and Cholera in the Modern World,

Haiti and Cholera

In the modern world, despite the numerous technological improvements, natural disasters continue to occur, and with them, often epidemic level disease vectors. In January 2010, an earthquake hit the Island of Haiti in the Carribean. This was one of the worst natural disasters in recent history, putting over 4 million people at risk, with a death toll of at least 300,000, and at least one million individuals displaced from their homes. This was a 7.0 earthquake, powerful, so much so that it devastated buildings, the infrastructure of the Island, and even agricultural fields. Experts, in fact, believe that it may be several decades before Haiti has even marginally recovered, and most of their political and governmental buildings were destroyed. In addition, over 1/4 million houses had to be razed to the ground, and 30,000 commercial buildings were no longer safe for occupation. If this were not enough, scholars believe that the region is now poised for stronger earthquakes and additional environmental devastation (Fountain, 2010).

The global community did respond to this disaster, many sending not only financial aid, but trained rescue and emergency medical teams. So much devastation occurred that most of the Island's communication systems and transportation systems were unusable, the medical care facilities were in ruins, and for utility networks damaged, with some irreparable. There was so little infrastructure left that confusion abounded on who was in charge, what networks were open, how to prioritize shipments, lack of available airport runways, and even a true census of the aftermath. Health issues became serious: water, when available, was polluted; the number dead and unburied bred disease, there was not enough medical personnel to go around to the thousands hurt, and the population, scared and displaced, sometimes resorted to violence just to survive (Lies, 2011).

However, besides the devastating human and economic costs from the earthquake, another critical issue is the immediate damage to the environment and the longer-term effects to the region's ecology. Even prior to the earthquake, clean potable water was scare in Haiti, after the earthquake it is even scarcer. Contamination of natural water sources is long-term, with the risks of e-coli and cholera rampant. Haiti's small agricultural industry will likely remain devastated due to the lack of any decent topsoil, harming the industry and the island's ability to feed itself (Watson, et al., 2007). The earthquake caused a great deal of rubble throughout the island, and about 98% of the forest cover was lost due to strong winds and upwelling of top soil. With a lack of infrastructure and a devastated population, stripping of what little land is available will only compound the problem (Theodore and Dupont, 2012, pp. 55-56).

According to the United Nations Environment Program (UNEP), the most serious early issue is the building waste -- about 50% of all the buildings fell. Even prior to the earthquake, Haiti had severe environmental problems, intensive logging from the 1950s reduced Haiti's forest cover, causing erosion and threatening food and clean water; now even more serious. Compounding all of these environmental issues is Haiti's population, almost 10 million and growing 2.5% per annum. This rapid growth pushed millions into marginal areas like floodplains or other land that could be used to repair the lagging agricultural system (Talk, 2010). This pushed Haiti into an extremely vulnerable position regarding infectious diseases, particularly Cholera, due to the lack of sanitation, lack of potable water, and population density combined with homelessness (Mayo Clinic, 2012).

Cholera is a virulent bacterium that causes infection of the small intestine in humans. The major symptoms of the disease are diarrhea and vomiting, with transmission and infection of the bacteria occurring through drinking water or eating food that has been contaminated by the feces of an infected person. Thus, cholera tends to become a serious public health outbreak in areas in which there is inadequate sanitation or treatment plants, or a large population that uses a body of water (river, stream, lake, pond) for bathing, drinking and disposing of waste (Coleman, 2009).

Primarily, cholera presents itself with a great deal of diarrhea and vomiting clear fluid -- typically beginning 12-60 hours after ingestion of the bacteria. The diarrhea is often called "rice water" and has a fishy odor, producing 3-5 U.S. gallons per day which, if untreated may cause rapid dehydration and death. Three percent of those infected remain asymptomatic but can still pass the disease on to others. Cholera is sometimes known as the "blue death," since many of those infected turn bluish-gray due to loss of fluids. This dehydration is often so rapid and severe that the patient experiences extremely low blood pressure, poor skin rigor, rapid pulse, hyperthermia, and in advanced cases confusion, shock and death (Sack, D., et al., 2004).

As noted, cholera is caused by ingestion of the bacteria vibrio cholera which lives naturally in most all environments, but tends to be less active in colder climates. It takes about 100 million bacteria to cause the disease to manifest in normal adults; but children, the aged and those with compromised immune systems. Interestingly, blood type is a strong cofactor for infection, with those persons with type O blood being the most susceptible (about 40% of most populations). The World Health Organization estimates that globally there are from 3-5 million cases with 100-120,000 deaths directly attributable to cholera. The seriousness of this disease comes from the short incubation period, the fact that almost 75% of those infected continue to infect others, and the lack of robust means to introduce electrolytes and antibiotics into those affected (World Health Organizations, 2012).

As a toxin, cholera attacks the small intestine by burrowing into the walls and reproducing on the mucus. Once the cholera bacteria reach the intestinal wall they no longer need flagella (tails) and begin to excrete toxins that pull water out of the bodily systems and expel it through watery feces and vomiting. Thus, any treatments need to attack the disease by preventing the bacteria's reproduction while rehydrating the body to prevent other symptoms (WHO, 2012).