Here in Gonaives, it's often hard to tell the living from the dead. So many are somewhere in between, their bodies limp and pupils rolled back in their skulls. Their pulses are a meek patter and their breath so faint that you have to lean in closely to see the chest rise and fall with strained gasps for air.
Cholera now plagues this city of 300,000 in northern Artibonite, the region in northwestern Haiti where the outbreak was first confirmed on October 23. The disease has already claimed more than 1,000 lives and hospitalized 16,799 more. The truth is the numbers are likely much higher. Travel to Gonaives and people will quickly tell you about those who died on their way to the hospital or entire families that passed away in their homes, only to be discovered later by neighbors.
I traveled to Gonaives to meet our Cholera Emergency Response Team, who supported a local hospital after they received word that it was inundated with cholera patients following Hurricane Tomas. While the number of cases is now starting to plateau in Artibonite, we are still seeing between 60 and 110 patients per day at the hospital, many of whom are young children.
When I step into the hospital, I am immediately hit by the smell of vomit and chlorine.
Patients file in, often carried by relatives, into our triage, where they are assessed based on their level of dehydration. Those who are not severely dehydrated are instructed to sip oral rehydration salts (ORS) while nurses monitor their progress. For those with little fluid left, International Medical Corps transfers them into the hospital for IV fluids and monitoring.
Soon after I arrive, a man and woman shuffle in, carrying two half-conscious boys. They tell our triage nurses that the boys had been sick for two days, but this was their second time at the hospital. The grandmother, Saintilia, 45, says that the serum that they gave her was working and they would like some more. The boys are given plastic cups with ORS and instructed to take a seat and sip slowly, so the nurses can monitor their condition.
She brings the plastic cup to her grandson's lips and goes on to ask if I'd heard of the flooding in Gonaives from Tomas. "People dropped dead on the street," she says. "The flood waters went over [the bodies] and then into homes."
While it's hard to say that Tomas caused the spike in cholera cases in Gonaives, it certainly created the perfect conditions to spread it far and wide, as contaminated water sources spill into homes and contaminate formerly safe food and drinking water. Unfortunately, this is probably not just the case in Gonaives.
"Everyone is sick in my family except us," Saintilia says, pointing at her son and the boy's father, Viviandieu, 26.
She goes on to confess she knows little about cholera. As she cradles her sick grandson, I am saddened by the fact that this will likely not be the case for long. "No one knew anything about cholera... until people started to die," she says.
With the last outbreak 140 years ago, Haiti has no memory or experience in what cholera is and how to handle it. For the majority of Haitian physicians, cholera is only something that they read about in a textbook in medical school. And for the general public, especially those living in remote villages, cholera is like a black plague, moving through communities and claiming lives without reason or remorse. Some think it's another divine punishment for Haiti's previous sins and some see it as an irreversible death sentence. Others think it is spread by fish and some think it's not any different from the diarrhea that people get from time to time.
One woman told me she had not had anything to eat or drink since she first learned of cholera, because someone told her that's how you get it.
But the truth is that cholera is preventable and treatable. What makes it fatal is a delay to care. That's why large scale community education is the most powerful way to save lives in this epidemic. If people know how to protect themselves, they will be less likely to get cholera or pass it onto others. If people know what the symptoms are and that they must go to a doctor right away, they have a better chance for a full recovery.
International Medical Corps has been running community education campaigns throughout Artibonite with community health workers as well as social leaders including Christian and voodoo priests, mayors, and a well-respected local Boy Scout network. These campaigns are also running in and around International Medical Corps' 14 primary health clinics in Port-au-Prince, Petit Goave, Jacmel, and Leogane, to prepare communities as the outbreak spreads further. We also plan to run radio specials and engage Haiti's public bus system of brightly painted tap-taps in the campaign to reach as many people as possible with lifesaving messages.
Within an hour, the twin boys start to perk up and reach for the plastic cup on their own. The family is given more ORS and water purification tablets and instructed how to use them. If the boys' condition worsens, they are to bring them immediately back here so the doctors and nurses can check on them and give them IV fluids if needed.
Just as the four of them get up to make their way back home, a shiny white coffin is ushered in. At least this one gets a proper burial, I'm told. The Gonaives cemetery already has too many anonymous bodies.