Cholera in Haiti

World Vision is one of the many aid organizations trying to stem the spread of cholera, which has claimed more than 900 lives and infected some 15,000 people in Haiti. Deutsche Welle interviewed World Vision spokesperson Michelle Rice on the ground in Haiti via email about what is being done and what further help the impoverished island nation needs.

Deutsche Welle: How much of a connection is there between the earthquake in January and the current cholera outbreak?

Michelle Rice: There is no causal relationship between the earthquake on January 12 and the cholera outbreak. The majority of people affected by the outbreak have been from Artibonite/Central Plateau, which is about 60 miles away from Port au Prince – the area directly affected by the earthquake. The current thinking, although not conclusive, is that the cause of the outbreak was contamination of the Artibonite river – after recent heavy rains and flooding.

What problems do you encounter as an aid organization in terms of governmental structures?

Government ministries have been affected by the earthquake. Government buildings were destroyed and many lives were lost. Even before the earthquake the public sector was strained and in great need of support and strengthening. One of the roles of the aid sector is to work alongside government ministries to help build capacity. This happens across all levels from the local level up to the departments.

Despite the need for major capacity building, the government has shown leadership with the UN working with international agencies responding to the cholera outbreak. Collaboration has been a focus, not just for the cholera outbreak, but also for the earthquake response. With cholera, rapid action is critical to prevent the spread. Containment – through widespread hygiene promotion and treatments – has to be done cooperatively because it's a huge job to reach out to all of Haiti. Then there's the means to respond. Handwashing is simple enough but it doesn't work without clean water and soap. The majority of Haitians have limited access to clean water and good sanitation. Collaboration with the government has been a critical part of containment and prevention.

The German newspaper Die Zeit recently ran a headline: “Cholera reveals the weakness of aid organizations.“ How true is that statement?

Cholera was always a fear after the earthquake left 1.5 million people displaced and living in camps. But it's been ten months since the earthquake and this is the first occurrence of cholera. It's also surfaced in a rural area along a river away from the earthquake epicenter - where most agencies are working. But given the pressure already on agencies – their response to the outbreak so far shows strong coordination. Despite already having a big job with the earthquake aftermath, agencies have coordinated, mobilized and re-oriented their resources to contain the outbreak. Agencies are reaching out beyond their own program areas to ensure broad coverage of hygiene promotion. For example along the border region response activities are being coordinated between several agencies.

But the outbreak also underlines a much bigger issue for Haiti: infrastructure development. That means access to water and sanitation infrastructure, and water source and waste management. The majority of Haitians don't have access to clean water. In rural areas 51 percent of people have access to improved water and only 12 per cent have access to improved sanitation. We need to support the development of comprehensive infrastructure for water and waste management.

What specifically do you need to be able to better help people in Haiti?

Improving children's lives has got to be priority. At the moment the majority of children do not complete 12 years of schooling. The majority of schools in Haiti are private. Only about 50 percent of children attend primary education and under 85 percent of them finish. Haiti needs support to develop a strong public education system – that means access but also good quality teaching staff. In some parts of the country there are teachers who have not been paid in months. There is a similar problem with the health system. The majority of services are private. We need major investment in creating widespread public health services and really well trained health practitioners who are encouraged to stay in the country.

Finally, we need livelihood development in rural areas particularly so that people are not drawn into cities. And we need infrastructure to support livelihood development – that is to say, services in rural areas. Port au Prince's infrastructure was designed for about 400,000 people. The current estimate is that about four million people are living here. People are drawn to the capital for employment. The government needs a long term strategy to help create opportunities for employment and creation of livelihoods, especially in rural areas.

Interview: Jefferson Chase
Editor: Michael Knigge