Imagine yourself in the day-to-day in a crowded, dirty tent camp as a refugee somewhere. You have to stand in line for bottles of clean water, your health care comes from a medical charity with a trailer, and you never know whether your next meal will come from UN trucks or your own resourcefulness to scrounge something that your neighbors have not already found. You do the best you can, though, and you look forward to the good days when you can turn a nice big bag of beans or something into a meal to divide with your family in a tent that is inevitably too small for you. On bad days, though, your water might be tainted with Vibrio cholerae, a nasty little bug with a very short incubation time. You might not feel so good a few hours after that meal – and by the same time the next day, you could be dead.
Cholera is an aggressive water-borne disease that is currently running rampant through the world, the news, and the global health blogosphere. An outbreak reared its ugly head in Haiti last week when five cases were detected in Port-au-Prince. The disease has since spread through the population: 284 people have died so far, and over 3,600 people have been infected. Despite so many people living in high-density refugee camps with little to no sanitation, many are still surprised: it is the first time the island has seen cholera in 100 years, and after nine months I guess people were beginning to entertain the optimistic notion that the earthquake-ravaged nation might be able to avoid it. The debate over whether or not the outbreak (which some are already calling an epidemic) is contained rages on. Meanwhile, a much larger epidemic is running rampant through Nigeria (though I suppose having eleven times as many cases and five times as many deaths will still not make you more noteworthy than Haiti – after all, Nigeria sees cholera every year). It has already appeared in flood-affected areas of Pakistan and in the aftermath of the mostly-ignored floods in West Africa. Basically, where there are floods, natural disasters, and/or refugee camps, there is cholera.
The extremely rapid spread of the disease through disaster areas underscores the extreme importance of prevention planning and education. In Haiti, for example, you would think that a nine-month lag would have allowed for ample time to have systems in place to deal with this kind of outbreak, but that unfortunately does not appear to be the case: Melinda Miles, director of Let Haiti Live, told UN Dispatch last week that “it is absolutely stunning that so little was in place to prepare for [the outbreak]…It is certain that many unnecessary deaths will be the result of poor planning and slow response.” On the other hand, Care has held hygiene awareness sessions for more than 10,000 people affected by the flooding in Benin. Even if cholera never appears, preparations for it are never in vain: having clean water, proper sanitation, and stocks of oral rehydration salts are always a good idea.