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House by house, latrine by latrine, Haitians fight cholera in Petite Riviere

By Coco McCabe
Altagrace Nicolas says she has always been attentive to the care of herself and her children and is confident that she can keep cholera at bay. Photo: Toby Adamson/Oxfam

Armed with a yellow tool box, a level, a saw, and a determination borne of crisis, Erntz Jean and a team of other volunteers--men and boys--made their way through the yards of a small community near the Artibonite River in Haiti. House by house, they were waging a fight against cholera.

Their mission? To build some of the 700 latrines Oxfam is helping to fund in the Petite Riviere area of the Artibonite province, where the deadly waterborne disease first broke out in October. It has now reached every province in the country, aided in its rapid spread by Haiti’s poor infrastructure: 50 percent of Haitians don’t have access to clean water, and more than 80 percent don’t have latrines.

For some of the families in this rice-growing region, that’s about to change. The latrines are part of a multi-pronged effort, including a public health education campaign, Oxfam has launched to help 125,000 people in this area stop a disease that hadn’t surfaced in Haiti since 1960. By the end of November, cholera had already sent more than 34,000 people to the hospital and killed more than 1,750 across the country.

Oxfam is also tackling the outbreak in Cap Haitien, Haiti’s second largest city, and in Port-au-Prince, the capital. There, intensive efforts to provide clean water, sanitation services, and public health education to people displaced by the January 12 earthquake has prevented any known cases of the disease from cropping up in the camps where Oxfam works.

Along with the household latrines in Petite Riviere and the construction of 50 school latrines, Oxfam is planning to drill 50 boreholes to be fitted with hand pumps and repair three water networks to provide people with greater access to clean water. But as important as those initiatives are, stopping cholera requires education—how to prevent it and how to treat it and to know to seek medical help when diarrhea and vomiting starts.

In coordination with the ministry of health, Oxfam has taken to the airwaves in Petite Riviere, broadcasting information on how to prevent cholera. It has trained government community health workers as well as peer educators on key messages and they are fanning out to spread the word. Equipped with battery-powered bullhorns, Oxfam health promoters are trekking through fields and across canals, sharing vital information with farmers as they work.

“Members of the community are very keen about what is being said,” said Mario Guerrero, the cholera program manager in Petite Riviere. “They have the feeling when they go into the trainings that there’s no way out if you get it.”

But after people have learned something about the disease and its transmission?

“They have the idea you can do something,” said Guerrero.

‘We help each other’

Doing something is what Erntz Jean and the team of volunteers were all about: With materials provided by Oxfam—wood for walls and a roof, and a slab to cover the pit—they were helping their neighbors build the first latrines many of them have ever had.

“That’s how we do things here,” said Jean, standing near the just-built wooden structure covering the latrine of Lozina Cena. “We help each other.”

The team picked up their tools and wove between the hedges and small houses to their next location: a narrow pit, six feet deep, just beyond the canopy of a giant mango. They got to work sawing two-by-fours, hammering, and preparing the frame for the housing of the latrine.

“Everybody here is very happy about this. Not only me—everyone in the area,” said Jean, who was among those who received materials to build a latrine. A carpenter by trade, he said he never had the money to build one before this.

“As a carpenter, if there was work, I’d be working and I’d have the money to do this. But there’s no activity here—no jobs,” said Jean.

Down the road, Eugene Joseph, a father of five children, had almost completed his new latrine. He spent a part of five days digging the hole—after starting in a different spot in his yard and hitting rock.

“Before, we didn’t use any latrines. We went in the bush or the street,” he said, noting the street—a rough dirt road—was about 40 meters from a canal leading to the Artibonite River from which his family pulls its drinking water.

“We were never sick,” said Joseph.

But the cholera outbreak scared him.

“We thought it would spread around our house,” said Joseph. And so with Oxfam’s help he decided to build the latrine.

“We’re proud of this,” he added.

Fear mixed with confidence

A few houses away, Charite Estimable, echoed Joseph’s fear. But she wasn’t really worried about herself: She had been treating her water in a sand filter for most of the past year and had received some chlorine tablets from Oxfam to purify it further. It was her children—she has 11—whose health she was fretting over.

“I was afraid for my children in Port-au-Prince,” she said, noting that six of them were now living in the crowded capital.

Estimable’s neighbor, Altagrace Nicolas, also voiced confidence in her ability to keep cholera at bay.

“I’ve always been careful with myself and my children,” she said. “I’ve never been negligent. The reason it spread in some places is because people were not careful.”

To help everyone become more vigilant, Oxfam has been sending out teams for random monitoring of the water families collect and treat with the chlorine tablets the organization has been distributing.

Toting a bucket loaded with a couple of pitchers and a chlorine testing kit, George Van Vulpen and Elie Saint-Cyr, public heath engineers for Oxfam, hit the dirt roads of Akacite and Trankilite, two communities near the Artibonite River. Stopping at one house here, another there, they took a scoop of drinking water, tested it for residual levels of chlorine, and discussed the results with the householders—all with an eye toward encouraging proper use of the tablets. Had they been adding the tablets to the water? When? Were they dropping in the right number of them?

“For sure they’re using them,” said Van Vulpen, packing up the gear after the last sample of the day. “Most of them (the samples) have residual chlorine.”

That was a good sign—and so was the news he picked up along the way.

“In Akacite, they didn’t know of anyone who was sick anymore,” said Van Vulpen.

“We have a feeling that we are doing better than other parts of the country,” said Guerrero, the program manager for Petite Riviere. “Reported cases are going downward—slightly. But downward.”