Complexities of Cholera in Tilori, Haiti: A Day in the Life
Dr. Autumn Quezada de Tavarez
Assistant Professor of Latin American History
Roger Williams University
There are many health concerns in Haiti – clean water, sanitation, a severe lack of medicines, a general infrastructure, AIDS, chronic diseases and communicable diseases. Of the many aliments fevers, dysentery, tropical diseases such as dengue, and respiratory illnesses rank the highest. However, TB and cholera have the potential to be most deadly.
Dr. Paul Farmer, physician and anthropologist, devotes most of his energies through the Boston based Partners In Health to treat and contain TB and cholera. Farmer in his notable study titled Infectious Diseases and Inequalities cites that Tuberculosis is a global epidemic and the leading cause of death – “stupid deaths” he calls it. Treatment and monitoring can help to stem that epidemic. Between the years 2012 and 2013, Tilori had over 200 confirmed cases of TB – a town of 17,000+ persons. Meanwhile, cholera is a daily threat to the majority of populous in Tilori, as it affects peoples of all ages.
Tilori, Haiti sits on the border opposite the Dominican town of Restauracion in the Department of Dajabon. A visit to the town of Tilori on market day offers the few visitors an opportunity to experience the town at it’s busiest. A walk through town is an exercise in chaos. Haitians from nearby towns bring their wears ton horseback and via mules to town to sell, exchange and barter. However, beyond this façade is a deeper experience; one of health. Dusty roads filled with sharp rocks present also as streams of sewage. Children run barefoot through water infested with E. Coli and excrement. Living in such close proximity poses the severe dangers of contamination that develops into cholera. The greatest danger of cholera is dehydration and a shortage of hydration salts poses an enormous mortality threat.
On this day, in January our guide, educator and town leader Tete weaves us through the roads to visit schools and clinics.
I ask Tete: “When was the last case of cholera?”
His response in Spanish: “We are in the time of cholera. Last week we had eight cases. One died, but seven survived. Gracias a Dios.”
Tilori houses one hospital with one doctor and one nurse to serve over 17,000 inhabitants. That’s an incredible imbalance to consider. The main hospital houses three rooms: one consultation room as a line of people awaiting consultation; a maternity room for birthing; and a filing room. The consultation room has less than ten operating beds.
The birthing room has three birthing beds.
Separate from the main hospital is the house specifically devoted to cholera containment. This wooden structure has three rooms with a number of wood beds with holes and a bucket beneath to catch the copious amounts of liquid excrement from each patient. On this day there are no patients and we are instructed to touch nothing. This is a dangerous infectious disease. In the entry way are large spray bottles to disinfect the building daily with special chemicals to clean the crude hospital. One can only image the horror of cholera when the hospital is filled with patients suffering or near death.
It is difficult to imagine a community as large as Tilori living with the daily reality and horror of cholera, a disease brought recently by UN workers. This is their reality – a reality beyond the human catastrophe of the earthquake of 2010 with killed over 400,000 people near the capital leaving hundreds of thousands of children orphans. Many fled the capital for the frontier with the Dominican Republic.
Haiti is an incredible nation of peoples strong with a will to live, to survive. As the poorest nation in the western hemisphere, one is struck simultaneous will to live, survive and prosper in the face of governmental impotence and mismanagement. Dr. Farmer famously posited a thesis known as “structural violence” which helps us to understand the situation in Haiti and in other places where peoples are forced to survive in the face of tragic governmental neglect. Despite this neglect, Haitian education is excellent – in French, Kreyol and English. An enormous feat being that they have no materials for student in the classroom. This speaks to the strong will of Haitians. Yet it is hard to not recognize how this structural violence robs people of their human dignity. Children beg – “Dame un peso.” Or they sell themselves.
The tragic story of Haiti is both one of severe neglect. Yet other stories need to be told. There are many Haitians pushing grassroots programs both with outside NGOs as well as amongst themselves to improve their situations. What do you do when you cannot count on the government to pull its weight? People take the imitative as best as they can with what they have. This is the story of Haitian people, a strong people – survivors in the face of insurmountable obstacles. These stories MUST be told.