Cholera in Haiti: This isn't bad luck, this is poverty


Haiti, wrecked by a massive earthquake in January, is now struggling with an epidemic of cholera that has spread through camps of earthquake refugees and into the nation's capital of Port-au-Prince. Dr. Jon LaPook, medical correspondent for CBS News, has probably done the best job I've seen of describing the horrific, disgusting toll this disease takes on the human body and on the societies it moves through.

I spoke to a middle-aged man, Robert Raphael, whose family lives between St. Marc and Gonaives. Over the past week he has lost a brother, niece, nephew, and "five or six" cousins to cholera. Five or six—he'd lost count.

They clearly need more doctors and nurses, but seemed to have enough oral rehydration solution and IV fluids for now. They obviously need specialized supplies like "cholera beds"—cots with holes cut in them for easier defecation. I asked an 8-year-old named Ritchie if it was hard to "faire toilette" in public (it's all out in the open), and he looked embarrassed and said, "Yes." That got to me.

The bug behind this devastation—the bacterium Vibrio cholerae—is a fascinating and frustrating creature. Fascinating, because of its role in the development of epidemiology and what we're still learning from it. Frustrating, because it ought to be relatively simple to treat and prevent infection. We know what to do to help a cholera victim survive. All it takes is access to clean water and the most basic medical supplies. The trouble here isn't science, it's poverty.

Cholera is, essentially, the worst food poisoning you can possibly imagine. In fact, it's related to Vibrio vulnificus, a bacteria that tends to infect people via undercooked seafood.

After you ingest the cholera bacteria, it'll hang out in your gut for a few days before symptoms kick in. Once they do, though, cholera can kill you within hours. How? I'll be blunt: Massive, constant diarrhea that drains the body of fluids and electrolytes and leaves victims looking like glassy-eyed, hollow-cheeked corpses before they actually are.

Nobody knows exactly how old cholera is, but, from a pop-culture perspective, it's inextricably linked to the 19th century, when several pandemic waves took cholera from its roots in the Indian subcontinent to being the first global killer—taking advantage of increased trade and immigration to strike Asia, Europe, the Middle East, Africa and the Americas.

And it was a complete mystery. At the time, disease was thought to spread via "bad air", a pre-germ theory explanation for the patterns left by person-to-person contact. But cholera didn't seem to fit. The doctor could visit a house riddled with the disease, and walk away unscathed. And, yet, at the same time, cholera swept through whole neighborhoods—usually the poor ones—killing hundreds, or thousands.

You probably know the story of Dr. John Snow. During the 1854 cholera epidemic in London, Snow took the radical and now-laughably-obvious step of mapping cholera deaths throughout the city. He found that the outbreaks centered around nexus points, which lined up with public water pumps—specifically, the pumps that sourced their water from the downstream end of the Thames. And that's how we learned a valuable lesson. Preventing cholera is easy. All you have to do is make sure that people don't have to drink water that's been contaminated with sewage.

Today, cholera is all but non-existent in developed countries. Not because we're immune. Not because we have access to a miracle drug. It's simply about money. Money, and the will to build public sanitation systems that treat the poor and the wealthy to an equal level of separation between what we drink and what we excrete. After all, there were water services in Dr. Snow's time, but they were heavily divided by class. The wealthy drew their drinking water from upstream and dumped their sewage below that point, where it made its way to the public wells used by everybody who couldn't afford the better water.

Malaria is often what we talk about when we talk about diseases of poverty. But simple diarrhea kills more people every year. Cholera is only one part of that.

And it is all about the money. What kills you isn't so much the diarrhea, itself, but the loss of fluids and essential salts and minerals. Replace enough of those, soon enough, and people tend to survive. This is a disease that can be cured with Brawndo. (It's got what cholera victims crave!) In fact, one of the greatest public health inventions of the 20th century—and, perhaps, the most underrated—is the pre-mixed Oral Rehydration Therapy sachet—little packets containing dried mixtures of mostly sodium and glucose. Pour a packet into clean water, and you have an instant treatment for cholera. This is pretty much all that stands between a bout of cholera meaning a really bad, gross week, and a bout of cholera meaning death.

Right now, people are dying in Haiti not because we don't know how to save them, but because of a lack of access, both to clean water and to Oral Rehydration Therapy. In other words, they are dying not because of a disease, but because of poverty.

How You Can Help:
• Donate to Doctors Without Borders and help get Oral Rehydration Therapy to people who need it.

• Donate to World Vision, which does both medical work, and helps bring clean, safe drinking water to communities around the world.

• Donate to Water.Org, a charity devoted to water infrastructure projects.

Some Other, Related Links:
• Fault activity indicates that Haiti is at risk of more, and possibly larger, earthquakes

• Fascinating piece explaining how cholera can hide, dormant in a population for years, waiting for a sanitation crisis to attack

• Cholera at The Bacteria Museum

• The Climate Connection: How warming oceans can influence the spread of cholera

• Interesting information on what the toxin produced by cholera bacteria does in the human body and why it causes diarrhea


  1. A lot of the world’s ills could be eradicated if we only diverted some of our attention and effort away from destruction and toward humanity.
    But our attention is short and we’re constantly being bombarded by marketing, teaching us to be selfish and ambitious.

  2. Great post. Thanks very much for this. I’m off to donate. Convenient timing too as I just found out I got a promotion.

  3. Thank you, Maggie. You cover the story well. And I particularly appreciate your taking the next step to give us some ways we can help.

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  5. Oh, luck most certainly is involved. After the devastation and death it has experience, Haiti has been quite lucky to avoid rampant disease as long as it has. Unfortunately, this small grain of “good luck” is over. As you pointed out, poverty overcame it.

  6. “At the time, disease was thought to spread via “bad air”, a pre-germ theory explanation for the patterns left by person-to-person contact.”

    I’m fascinated by the way that theory gets dismissed, because it’s actually a proto-germ theory, albeit wrong (or at least, too limited) in this case. They had managed to figure out the broad overstrokes of the mechanism for a lot of diseases. Pity “bad water” escaped their notice, especially given the ‘elemental’ understanding a lot of them held to.

  7. Thanks for this article – we need constant reminding in the West that things as simple as clean water are a privilege for us.

  8. An huge amount of aid promised by the US federal government has yet to be provided due to partisan bickering and political wankery in the House and Senate. The delay is shameful, and hopefully Congress will do something after the mid-term elections. Elections are such an impediment to democracy! Unfortunately there’s a good chance that the political divisions in the US will continue to hold back good policy such as aid to Haiti. Clearly, then, it is necessary for all compassionate people with some means of helping to do so, despite whether or not one’s tax dollars will supposedly be used for aid.

  9. Great post! This is exactly right: cholera happens because there’s no political will or awareness to respond to the conditions in which it spreads. So I hope you won’t mind if I make a plea to also help out here in Benin, which is experiencing the worst flooding in its history and faces the real possibility of a cholera outbreak that could dwarf the one in Haiti now, with 800 cases already reported. CARE International would be one worthy recipient if you want to fund relief efforts. Haiti’s disasters may not make the news until after they happen, but at least they get reported. In Benin, we have the chance to respond to this epidemic now, before it gets too far out of control.

    1. Sure, if there are any trees left for them to make into charcoal for their stoves (most people can’t afford any other fuel). You’d also have to boil the water used for washing.

    2. Boiling and chlorine both kill it. Boiling water takes a huge amount of energy, and chlorine is cheap and light to transport, but requires good training to use safely and effectively. So chlorine is the main tool used to fight cholera in the health care setting.

      In the community, the main tool to combat cholera is information (how to recognize the illness, how to get clean water, where to take sick people) and efficient transfer of potential patients into Cholera Treatment Centers, where their waste will be correctly treated, instead of infecting more people from their community.

      Cholera, more than any other intervention made by humanitarian aid workers, is a logistical problem more than a health problem. The quantity of saline solution, irrigation sets, and chlorine and cleaning equipment that must be moved is just enormous, we are talking 100’s of tonnes of it, so it can only be moved via heavy trucks and big airplanes. It takes a long time to get it gathered and ready, so it has to be pre-positioned in emergency stocks.

      This is why I always ask people, if they want to give money, they need to give it unrestricted, not for “the cholera in Haiti”. Aid agencies have long ago spent the money for the materials they are using today in Haiti. They need your unrestricted money today to refill their emergency stocks for tomorrow. If you really feel like you need to say what you donation is for, call it “emergency relief”. That means they can use it either for salaries today, or for backfilling the warehouse tomorrow.

      And if you are trying to decide who to give to, please consider MSF. They are the worldwide leader in innovations in cholera care, and they have undoubtedly emptied their warehouses to help Haiti.


  10. Oral rehydration packets? This doesn’t make much sense to me…

    Is it naive of me to say that reducing reliance on (comparatively expensive) prepackaged things like that might be better in the long term?

    That is: if the ORP’s are mostly glucose and salt, wouldn’t it be better to facilitate access to glucose and salt and let people make their own at home?

    I would think that sugar and salt’s availability would be more widespread (and cheaper?) than little packages imported from Western countries…of course, you run into the information issue here, I suppose. But I would think a rough recipe wouldn’t be too hard to disseminate.

    Then again, everything is harder than it should be at this level of crisis, I suppose.

    1. Partly: Cholera tends to surface during disasters, at which time a lot of people don’t have the necessary ingredients on hand. Trying to treat a lot of people, in the same place, in a hurry, when supplies are scarce is easier with a pre-packaged mix.

      Partly: It’s not just tossing some sugar and salt into water. There’s an best ratio of several different ingredients that will get you the most rehydration, fastest, for the least amount of resources. You can teach people to do it. And public health experts do disseminate that information. But it is often a lot easier to disseminate the packets.

      Finally: This doesn’t have to be imported from a Western country. In fact, I doubt the factories that make ORT sachets are in Western countries, to begin with.

  11. The ultimate issue is that Haiti is an island with limited resources and surface area. Unlimited population growth means deforestation until the island is denuded and soil washes away, people overwhelming public utilities, more people than jobs, low wages, etc. As long as you have Chrisitan busy-bodies sticking their noses down there and discouraging people from using birth control everything that is done down there is delaying the inevitable. No form of life on this planet has escaped this law of nature or ever will.

    1. There are plenty of other Catholic islands that are much smaller than Haiti and are not suffering from these problems. As the article says it’s POVERTY. A lot of people keep saying Haiti is overpopulated. It is not. It’s cities are, but this outbreak did not begin in the city it began in the countryside, so that was not the cause here. The deforestation of Haiti was partly caused by it’s obligation to pay reparations to France, not because of “too many people”. Most of Haiti’s resources have been taken by colonial powers.
      Spreading these myths about Haiti does not help.

      Re: the article

      Haiti has lots of Oral Rehydration Packets. They are sitting at the port and are not being distributed because the person in charge seems to be more concerned with filling out the right forms. It makes no sense to donate more if it’s just going to sit there. We need to put pressure on whoever is in charge there to distribute them.

  12. Maggie has answered this, but I want to stress that the proportions matter. Too much sugar, and it would actually encourage diarrhoea — and you know how people like things sweet? Especially as the ORT mixture has a rather unpleasant flavour!

    So it is better that it is premixed, and comes in pre-packed dosages. It is also supposed to be mixed with an exact quantity of water to each packet.

    I can tell you… the stuff is bliss, even after sitting on the loo with a bucket in your hands, on and off for a couple of days. Short of a drip, this is the best way to get life back into your veins and you can feel it doing it.

    And I’ve never had cholera. Just the thought of having a hole cut in the bed so you don’t have to stop when you lie down. My god!

  13. Indeed, cholera is a disease of poverty. I’m surprised you don’t mention that earlier this decade, the United States blocked $54 million in loans from the Inter-American Development Bank that would have gone directly towards development of clean public water supply in the central Artibonite region – precisely where this cholera epidemic started and is concentrated. Access to potable water actually got worse for the population in recent years. The loans were blocked as part of the Bush administration’s campaign to undermine the government of Jean-Bertrand Aristide. It was arguably illegal. All this according to a 2008 report by Partners In Health (, a medical group that’s worked in Haiti for over thirty years and is one of the leading responders to this latest cholera outbreak.

    And of course, Artibonite is known as Haiti’s “rice bowl,” but rice farmers’ livelihoods have been devastated over the past decade by imports of cheap US rice. President Clinton pressured Aristide to lower tariffs on imported rice as part of deal to restore him to power following a 1991 military coup d’etat.

    -Mediahacker in Port-au-Prince

  14. You got it exactly right in the ten words of that headline, Maggie K-B. Thank you for the lucid and astute report and for including the action links. Was going to post a mention of Partners in Health/Zanmi Lasante Haiti, but see that mediahacker has already done so.

    What the headline does so pithily, and the post elaborates, is what the Dr. Paul Farmer, who founded Partners in Health, calls “narrating Haiti” — explicating the human/historical context and causation of the centuries of suffering of the Haitian people. Mediahacker clearly nows well exactly how to do this, too. Now it’s up to al of us to both do whatever we can to aid immediate relief efforts and also get involved in putting pressure on our own government to do the right thing.

    Maybe I would add; “This isn’t “Poverty,” it’s centuries of oppression and exploitation.”

    Thanks for providing such a valuable forum and clearinghouse for information, BoingBoing!

  15. Asking the simple question:

    What happened to the money pledged by governments? Seems it has not materialised…

  16. I want to say thank you for all of you for helping my country.I would like to ask an additional help: you prayer for asking grace for Haiti from God.To much to handle! We have sin! We are guilty!
    But God is Mercy!
    Past. Cher-Frere

  17. Maggie, coming from an someone working with USAID on Cholera in Haiti, Cholera currently originates from a town 50miles north of Port-au-Prince. The are no cases of Cholera originating in tent camps in Port-au-Prince.

    Cholera is a bacteria that must be carried by a host to a location. Even in extreme poverty without a carrier host this would of never happened.

    A hint of what caused this outbreak can be found reading this article.

    Lets hope for the best,


  18. The cause is not lack of money, it is lack of power. The customs officials demand bribes before anything is let into the country. Humanitarian aid, which has a low economic value, is kept out until the money is found. The government is killing people, not poverty.
    Even a free water purifier still sits at the dock.

    Rick Jost, director of Solar Oven Partners in South Dakota, has four pasteurizers waiting on the docks of Port-au-Prince, Haiti, right now. is a good organization. What would be better would be if we stopped propping up the government that is there to serve only themselves, and the charities.

  19. UN and MINUSTAH need global currency to import and export cholera.

    CDC had established that the cholera strain in Haiti was the South Asian strain. Nepal lies between 80 degree 12′ east longitude and 26 degree 22′ and 30 degree 27′ north latitude which place it in Asia.
    Nepal is experiencing a cholera outbreak since July 28th 2010. The outbreak of cholera in Haiti occurred where the Nepalese troops are stationed in Haiti. Haiti did not have the disease prior to the outbreak of cholera in Nepal. Therefore, the evidence suggests that the UN troops are the culprit. This assumption has been reinforced by Claes Hammar, the Swedish ambassador in Haiti,who said that the cholera is from Nepal.
    So far the UN denies the accusation but no one will expect the UN to concede that its particular soldiers are the culprits because it would be too politically damaging to the UN.

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