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.
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.
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.”
]]>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.
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.
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.
]]>We know some aid, including from Oxfam, has been getting through in recent weeks and months. But we also know the international aid effort has been too slow – funds from donors have been committed late, and aid on the ground isn’t coming through fast enough. As the people here face their toughest three months until harvest time in October, there’s a desperate need for international political engagement to ramp up the speed and the scale of the response.
In Niger’s capital Niamey, a gentle-seeming city of sandy-mud colored low houses and a population of around 800,000 people, there are few immediate signs of the food crisis. There are small food stalls along many of the tree-lined, dusty streets and the “petit marche” – or small market – is crammed with stalls selling food and other items. But even in the capital, many people are too poor to pay for sufficient food and the picture in the countryside is much much worse.
We drove two hours from Niamey, along a rough dirt track through the semi-arid, mostly flat and desolate landscape. It’s stony and sandy with a few short dry-looking trees and bushes, though some are turning green where a bit of rain has started to fall. We see painfully thin cattle, goats and donkeys, their ribs visible as we drive by. Men, women and children are hard at work in some patches of land, planting seeds by hand to take advantage of any rain that has fallen. It’s hard work, and often undone again by sudden harsh desert winds.
We stop briefly in the main town in the area, Ouallam, and talk to a serious, welcoming official there, who explains that more than 200 of the 300 or so villages in this area are facing severe food shortages. Due to the drought, thousands of animals have died or are too thin to be sold for a decent price or even to provide a good meal for the herders.
The situation is as bad as the deep crisis of 2005, our host tells us—and worse, even, because people have less money now than they did then. But at least speculators have not managed to drive the prices as high as they did five years ago. And, importantly, this time around the new Nigerien government has recognized the crisis and invited donors and aid organizations like Oxfam to support them in tackling the problem. Now, some aid has arrived – but much more will be needed in the coming months.
Driving on to the nearby village of Tondi Kiwindi, we find a small muddy river flooding the road into the village. Our driver wades across to make sure our vehicle won’t get stuck and we plow through. Tondi Kiwindi is a small community of mud-brick rectangular houses, quiet in the midday heat. The local village leader welcomes us and tells us about the difficulties here and in the surrounding villages.
He talks about how many animals have died, about how little food villagers have, about the difficulties of surviving the next three months until the harvest. The rains here are a month late, though further north they have started.
The village leader thanks us for the work we’ve done with a local aid group to buy sick and thin animals at better prices than villagers can get in the markets, and to provide animal feed and other support such as cash for work programs. He tells us that the women, especially, have taken advantage of the opportunity to earn some income through the programs as many of the men have migrated away to towns to look for work. They’ll return to till and plant the fields when the rains start.
But when the rain really comes, says our host, the river we crossed to get into the village will rise and there will be no access to the community. Can we help, he asks us.
It’s a story across a lot of the region: rains are desperately needed to ensure a good harvest this year, but until October when the crops are ripe, rains can block access and make delivery of aid much harder or impossible. And the rains lower the temperature a little—bringing death to thousands of weakened animals.
In a five-mile ride across the desert from Tondi Kiwindi, we come to a smaller village called Ko Kaina. The situation we find here is utterly desperate: The villagers talk to us of famine and question whether they can survive to the autumn.
We sit with four women who tell us they have nothing left to eat at all. They say that this year is especially bad. Last year at least the animals had enough to eat, but now the cows and goats are dead or dying. In hard times, their tradition is to share—neighbors helping neighbors—but now no one has anything to share.
“Everyone is down, down, down,” they say. “Our stomachs are empty.”
Their last source of food is a small, hard round green pea called “wanza.” It has a bitter taste, but villagers eat it when there is nothing else to consume. To find the wanza, the women set out from the village at 5 a.m. walking miles in their hunt. They ask me to taste one of the peas to see how bitter and sour it is; the unpleasant taste stays in my mouth for an hour. The peas first need drying in the sun then soaking several times in water before they become at all possible to digest.
They show us their only other food – a small bowl of cooked leaves from short small trees that grow in the dry earth nearer to the village. A woman puts a small amount in her mouth and mimics being sick, to show me how ill and malnourished they are on this diet. A short distance away, a small group of children stares at us hoping, I think, that we have brought relief. They are thin and listless.
The women explain that their animals have been weak and dying for months now and no longer produce milk. Some are even too thin to slaughter for food. A few days back, the women tell us, the villagers killed one weak calf before it died. They needed it for food. But four children became ill from eating the meat and had to be taken to a larger village nearby for medical attention. That cost money the families didn’t had and had to borrow—leaving them in debt, too.
People are so weak, the women explain to us, that after a few minutes working in the fields – vital work – they are already too tired to keep going.
“We are weak and dying like our animals,” they tell us. “If it goes on like this, some of us will die and some God will keep alive ‘til the next harvest.”
Oxfam has launched an emergency program to provide support to 800,000 people across Niger, Mali, and Chad. In Niger, the organization is helping 400,000 people by distributing food and supplies to the poorest households. Oxfam is also buying weak livestock at above-market rates to help herders who need to sell some of their animals. Meat from the livestock is being distributed to some of the most vulnerable households. In Mali, the organization will help 200,000 people by distributing food as well as fodder for livestock. And in Chad, distributions of food and seeds are accompanying agriculture support projects, with a goal of helping 200,000 people.
This is the reality of hunger in the Sahel region of West Africa, where more than 10 million people are now in the grip of a food crisis triggered, in part, by patchy rainfall last year thatled to a plunge in the production of cereals. In Chad alone, the cereal harvest fell by 34 percent. And pasture—critical for the well-being of the region’s livestock on which many families depend for food and income—is severely lacking because of the poor rains.
But the increasing intensity of seasonal droughts is not the only source of the problem. A lack of investment in agriculture and herding, and insecure land tenure also play a role in the suffering some of the world’s poorest people endure.
In Niger, where the crisis stalks more than seven million people, the country’s youngest children are among the hardest hit. IRIN, the UN news agency, reported in late June that acute malnutrition rates among children younger than five in Niger had spiked 42 percent higher than they were this time a year ago—to nearly 17 percent. That means almost half a million children are acutely malnourished, according to IRIN. Many others—almost half of Niger’s children—live with chronic undernourishment, said IRIN.
Other countries are affected by the food crisis, too: Mali, Mauritania, Burkina Faso, northern Cameroon, and northern Nigeria.
Early warning systems revealed last fall that the Sahel was headed toward trouble, but the alarms failed to rouse a robust regional and international response. The amount of emergency assistance has, so far, been insufficient to meet the large-scale needs of the region. The West Africa consolidated appeal—a joint humanitarian fund-raising effort by groups working in the region, including the UN—is only 36 percent funded. The appeal includes support for food security activities in Niger, Mali, Burkina Faso, and Mauritania. About $69 million is needed to respond to the emergency in Niger alone. In Chad, the World Food Program needs almost $20 million to respond to rising food needs.
With the next harvest months away, and the approaching rainy season threatening to impede delivery of assistance to more remote areas, concerns of farmers like Fadoul Acheul are growing more acute. He is a 53-year-old father of eight children living on the outskirts of Mongo in Chad and has run out of options that could help tide his family over.
“The mango trees haven’t borne fruit this year, so we can’t sell those,” he said in April. “Also, there isn’t enough water to maintain our family orchard.” The family had used up its store of cereal a month earlier and was relying only on the income Fadoul’s wife made by selling a few items in the market.
The day Fadoul lamented his dry orchard was the day he had to make a decision—the same one many families now confront: selling their livestock. To get food, Fadoul sold his last ram, fetching just enough money to keep his family going for another week.
“Five years ago, the world ignored the warning signs from Niger, failed to act rapidly, and lives were lost,” said Mamadou Biteye, an Oxfam regional director in West Africa. “The international community cannot make the same mistake and again condemn many children to an early death.”
Oxfam has launched an emergency program to provide support to 800,000 people across Niger, Mali, and Chad. In Niger, the organization is helping 400,000 people by distributing food and supplies to the poorest households. Oxfam is also buying weak livestock at above-market rates to help herders who need to sell some of their animals. Meat from the livestock is being distributed to some of the most vulnerable households. In Mali, the organization will help 200,000 people by distributing food as well as fodder for livestock. And in Chad, distributions of food and seeds are accompanying agriculture support projects, with a goal of helping 200,000 people.
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