Zero cholera!

By Chris Hufstader
Margarite Dénéus, 24, is a public health promoter in Petite Rivière, Haiti. Chris Hufstader/Oxfam America

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Margarite Dénéus is a strong voice in a small package. At about five feet tall, she has a lot to say and her message is an urgent one: Cholera can kill you, but if you understand the risks and follow easy steps to avoid them, you can beat the bacteria.

Dénéus works for Oxfam in the commune of Petit Rivière in the department of Artibonite in Haiti -- an area recently plagued by cholera. She sets out in the morning in a four-by-four truck, seeking out farmers in the fields who may not have heard the radio programs Oxfam has recently broadcast about proper hygiene and sanitation measures to stop the cholera, avoid infection, or the basic steps to help stricken people survive.

Spotting a crew of five men preparing a field to plant potatoes, she asks the driver to stop the truck, and she bounds out the back, moving across the road, down a well-worn path, jumping across an irrigation ditch, to the edge of the field.

It’s best for those accompanying Dénéus to stand behind her when she gets into action: she routinely uses a battery-powered megaphone to greet the farmers, and her words are loud and carry a long way. She asks them if they have already been trained on how to avoid and treat cholera and proper hygiene and sanitation practices. If they seem unsure or say no, she launches into the routine: she explains that cholera is a bacterial disease, can be passed by drinking contaminated water, and can be controlled by washing your hands before putting anything in your mouth. She encourages them to chlorinate water before drinking it, and to take early action to treat people showing symptoms of diarrhea and vomiting with an oral rehydration solution.

Some of the farmers stop, lean on their hoes, and listen, while others keep piling the moist earth into long mounds, in preparation for planting. But even the ones who keep working shout questions as they go: Where can we get soap? What about helping people who are sick? Where do we get the chemicals to treat our drinking water? Dénéus responds to all the questions: She refers people to centers where oral rehydration solution is available in their village, so they can ensure sick relatives can survive. And where to get one of the 35,000 cholera kits Oxfam is distributing, which have all the things they need to keep clean and treat their drinking water.

The elusive loo

One topic dominates discussion in each of the 10 or so fields she sees this morning: she urges the farmers, “avoid going to the toilet right on the ground!” This is a major, longstanding problem in rural Haiti since well before the January 12th earthquake hit Port-au-Prince nearly a year ago: with no sewage system, running water, or proper latrines, many rural households must answer nature’s call in the open. Not all households have a latrine, so the farmers ask for advice: it’s simple, Dénéus says, dig a hole and bury the excrement. But Oxfam is also deploying a team of engineers to help farmers with simple materials to build their own latrines as an important step to reducing vulnerabilities to water-borne diseases like cholera. They plan to help install 700 latrines in Petite Rivière.

Dénéus is relentless, she repeats her messages with the same enthusiasm for each group she encounters toiling in the hot December sun, sweat running down the side of her face. “If you don’t think cholera can kill you, go to the hospital, go to the morgue, and see for yourself,” she tells any skeptical farmers.

Passing by a group she spoke with earlier in the morning now taking a lunch break, she stops and poses a question: “Did you wash your hands before eating?” Of course the answer is yes, but when she asks if they used soap, a few look down, but most of them make no excuses: soap is expensive and they are not accustomed to bringing it to the fields with them. Another form of behavior for Dénéus to change: With Oxfam distributing free soap, expense is not an issue in the short term, and eventually she hopes that farmers will improve their hygiene practices in the fields as well as at home.

After a productive morning tour of the fields, Dénéus stops by a few oral rehydration centers in the community of Marqès. These are simple tables stocked with clean water, mixing bowls and cups, and small packets of oral rehydration salts. These tables are staffed by trained volunteers who can teach people how to mix the life-saving solution, and ensure that anyone with a sick family member has access to this essential therapy. Cholera can kill in just a few hours by completely dehydrating a victim, so oral rehydration is essential. Dénéus checks the supplies, and coaches the volunteers on preparing solutions, how to answer frequently asked questions, and asks if there has been any activity at the centers as part of the monitoring Oxfam is doing in the community.

Right to life

Dénéus has a law degree and is working for Oxfam because she says the right to life is one of the most basic. “I came here to save lives; that’s what Oxfam is doing here,” she says as she leaves the fields after a busy morning.”I’ve only been working here a month, but I’ve seen Oxfam doing good work, and it is saving lives. The rate of mortality is reduced, and the rate of people getting sick is also lower thanks to Oxfam.”

The work of Dénéus and other public health promoters is reaching out to 125,000 people in the region, using the radio and in-person visits to push key messages about good hygiene and sanitation habits. Mario Guerrerro, Oxfam’s program manager in Petite Rivière, says this effort is proving essential. “The training for people to change their habits is making the difference,” he says in his office, looking over the declining mortality figures in a report from the health ministry. “Once people understand, they do their best to treat their water.”

Toward the end of Dénéus’s rounds this one morning, she encounters nearly 40 farmers in a relatively small area she can hit in one stop. She moves through her presentation, answers a few questions, and concludes her visit with a phrase, a promise, and a wish: “Zero cholera!” she shouts, her final words to the farmers.