Cholera

Disasters often travel in company. Outbreak of disease is a common companion to some event such as a tsunami, volcanic eruption, flood, earthquake, etc. We can see how it all works right now, if we look again toward Haiti.

The earthquake happened way back in January — ten months ago – killing an estimated quarter-million people, injuring another 300,000, and leaving more than a million homeless. Here we are, nearly a year later, and more than a million are still homeless. It will take years, maybe decades, for that society to recover to a condition of normalcy.

In the meantime, many of those homeless are living in refugee camps that become hotbeds of disease. Medical care is simply overwhelmed by the enormity of the problem, and in spite of  the best efforts of relief agencies that are there to help.

Imagine how difficult it is to feed and supply clean drinking water to more than a million refugees. The water is an especially hard problem to solve, with high ambient temperature quickly pushing victims into dehydration. Then add cholera, a waterborne bacterial disease that causes severe watery diarrhea and vomiting that plunge victims rapidly into lethal dehydration.

In one case reported by the Associated Press, a 55-year-old man named Jillie Sanatus was brought by his son to a clinic. Suffering from cholera, he was so badly dehydrated that the doctor had a hard time finding a vein to initiate an IV to restore the man's body fluids. Even after the IV was successfully started, Sanatus died within 10 hours. His son reported that the family had been drinking water from a river running down from the central plateau. That river tested positive for cholera.

But what's a disaster victim to do? The choice is to die of dehydration due to the heat and scarcity of pure water, or get creative and find another water source. The trouble with wild water is that it cannot be trusted, and unless you have a method of purification, you run the risk of ingesting contamination.

Cholera is a major cause of death in the world. An untreated victim can produce 10 liters of diarrheal fluid per day. Called "rice water stool" this watery discharge is loaded with bacteria that, especially in a refugee camp setting, can end up getting into the groundwater or drinking water supply and thereby contaminating other people. Any infected water or any food washed in contaminated water can transmit the disease. Cholera can kill you in a matter of a few days, especially if you are already in a weakened condition due to dehydration, malnutrition, injury, or other disease.

Today, a cholera outbreak is running wild through Haiti. Already, just days after the outbreak began, there have been more than 200 deaths, and more than 2,700 more are sick with the disease. The disease has spread from remote refugee camps to the major city of Port-au-Prince, and health workers are becoming pessimistic about the ability to contain the outbreak. The potential is for the death toll from cholera to dwarf the deadly impact of the earthquake. In the years from 1899 - 1923, a cholera pandemic killed more than 800,000 in India before it migrated to the Middle East, northern Africa, Russia and Europe.

Could it happen in America? It already did, with at least three major outbreaks in the U.S. during the 1800s. From 1866 - 1873, more than 50,000 Americans succumbed. And again during the "fifth pandemic" from 1881 - 1896, while a quarter-million perished in Europe, 50,000 died from the disease in North America. A study of the history of cholera outbreaks is sobering.

While it cannot be said that the earthquake directly caused the cholera outbreak in Haiti, it is obvious that the two are linked. The first disaster set the scene for the second to appear. It is a pattern that can be depended on to repeat again in the future.

So what can we do to protect ourselves from this dread disease?

• Sanitation is the key to prevention. As long as there is a sanitary system of potable water distribution and sewage disposal, there is little risk. But when a natural or manmade disaster occurs that disrupts these systems or intermingles sewage with the domestic water supply, it is possible for cholera to happen anywhere. 
• Be prepared to purify all of your drinking, cooking and food/hand-washing water. A quality sub-micron backpacking filter will screen out bacteria. Chlorination, ozone water treatment, UV treatment of the water, or boiling for one minute at a rolling boil will eliminate the risk of cholera. 
• Be prepared to safely dispose of your own body waste in a sanitary manner. 
• Do not trust wild water sources, no matter how high up the mountain, nor how pristine the tumbling brook appears.