MIREBALAIS, Haiti — An old man with sunken cheeks is so dehydrated he must be carried down the dirt lane to a clinic where the air is thick with the odor of bleach. Minutes later, a worried father enters, carrying a 2-year-old girl in a frilly white dress, her eyes sunken and unfocused.
Such scenes are once again common in Haiti, where a deadly cholera epidemic that swept the country last fall has returned, fueled by weeks of heavy rains that have helped spread the waterborne bacteria that flourish in the country’s rivers and rice fields.
The treatment center in Mirebalais, a dusty crossroads town a one-hour drive north from the capital, Port-au-Prince, is seeing dozens of new patients a day. Many arrive at the edge of death from dehydration.
The center saw a fivefold jump from April to May, and it hasn’t let up since, said Louise Ivers, senior health and policy adviser to the U.S.-based Partners in Health, which runs the clinic in association with the Health Ministry.
“When people come here, they’re in critical condition, ready to die,” said Francole Adonis, who registers the new arrivals at the center. “They’re collapsing in the yard. The situation is horrible.”
The number of new cases each day spiked to 1,700 in mid-June, three times as many as sought treatment in March, according to the Health Ministry. The daily average dropped back down to about 1,000 a day by the end of June but could surge again as the rainy season develops.
The epidemic began in rural Haiti last fall, likely brought by U.N. peacekeepers from Nepal. It swept through the countryside of an impoverished nation already overwhelmed by a January 2010 earthquake that left hundreds of thousands homeless and by political instability following disputed elections.
Cholera has sickened at least 370,000 people and killed more than 5,500 since the outbreak started in October, according to the Health Ministry. The precise total is unknowable because many Haitians live in remote areas with no access to health care.
The disease is relatively easy to treat if people can get help in time.
When the outbreak began, foreign volunteers descended on Haiti to staff rural clinics and help provide access to clean drinking water. Many feared it would devastate Port-au-Prince, where hundreds of thousands of people were living in refugee camps. But people in the capital had access to latrines and potable water, thanks to the huge international aid effort, and it was spared the worst of the disease.
The disease faded in winter and spring, when rain is less frequent. Many aid workers moved on. U.N. troops in Haiti turned their attention to the country’s many other pressing problems.
Now there is a fear among aid workers that there won’t be enough resources if the latest surge gets much worse.
“If the cases continue on the same path, we could see a lot of health-worker fatigue,” said Cate Oswald, a Partners in Health coordinator. “The health care force is already stretched thin.”
Oswald recalled how volunteers were everywhere during the first response to the outbreak, providing supplies such as bleach, which is sprayed on shoes and throughout the centers to prevent the spread of cholera.
“At one point we were worrying about too much duplication of efforts,” Oswald said. “Then the rains started coming.” Oswald paused. “And cholera was still here.”
Though the number of new cases is again rising, Health Ministry statistics show the number of deaths is far less than what it was during the initial surge. On a single day in mid-December, about 110 people died, compared with almost 20 in a single day in mid-June, according to the Health Ministry. The mortality rate is now under 2 percent, half what it was when the outbreak started.
Numbers
1,700 Number of new cholera cases each day in mid-June
5,500 Cholera deaths in Haiti since the outbreak started in October. At least 370,000 people have become sick.
2 percent Mortality rate for the outbreak in mid-June — 20 deaths in a single day, as opposed to 110 in a single day in December
