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Oxfam takes the fight against cholera to rural Haiti

Oxfam public health engineer Patrick Paul, whose team rehabilitated water networks in four at-risk towns.

In October 2010, cholera broke out in Haiti. Since then, more than 473,000 people have contracted the illness, and more than 6,600 have died. Oxfam responded where the epidemic hit hardest, providing clean water, sanitation facilities, and hygiene supplies to nearly 700,000 people, but the disease eventually spread to all provinces of the country – including rural areas where communities rely on untreated river water for drinking.

“We took eight mules for two hours into the mountains and crossed three rivers, one of them nearly up to my waist,” says Emilie Gassier, the Oxfam cholera response coordinator in southern Haiti. “When we returned, even the mules were exhausted.”

The mission of the Oxfam team that day: deliver supplies to help a rural Haitian community in the province of Nippes prevent and prepare for cholera outbreaks.

Cholera is a treatable disease, but in the southern province of Nippes, there have been too many opportunities for it to run its deadly course.

“Nippes hasn’t had the most cases of cholera,” says Oxfam public health specialist Myra Foster, who analyzes health data from the epidemic as it emerges.  “But the mortality rate there tells us that people who catch the disease aren’t getting the urgent care they need.”

The list of likely reasons for that is long:  contaminated water sources, fierce terrain, and all the things that are missing – information, transportation, water systems, sanitation, and enough government, aid agencies, and funding to make public health a reality.

So, as the rainy season of 2011 approached – and with it, the expectation of a resurgence of cholera – Oxfam stepped in.

Clean water from a tap

A tap that won’t turn on – sign of a water network that has fallen into disrepair – is a common sight in this part of the country. It represents more than an inconvenience: a community that once drew water from a spring-fed tap may now be collecting it from a more hazardous, cholera-infected source.

When Oxfam launched its program in Nippes, the team quickly tackled defunct water systems in four towns, repairing and replacing taps, pipes, and other hardware. But they made an important addition: a simple chlorination system. The chlorinator – provided by aid agency International Action -- is an upright length of PVC tubing attached to a water pipe that secures a stack of fat chlorine tablets in the flow of rushing water. As the lowest tablets dissolve, gravity draws fresh ones into place. The result? Water safe enough to drink straight from the tap.

“The water has improved,” says Eliese Javer, a young mother living in the town of Mathurin, as she washed a basin of clothes at an outdoor water tap. “Where we used to take the water from was bad. The water was not clean, and there was a risk of cholera. Now, it’s safer for the health of the people.”

Not only that, she says, but the tap gives people access to running water in a convenient place. Instead of hauling five-gallon buckets up from a stream three or four times a day, she carries home a gallon now and then.  “If anyone is thirsty, they can just come here. It doesn’t even take a minute.”

A measure of security

But for many at-risk communities - including remote mountain villages - the town water system isn’t so much broken as non-existent. Here, women and children have always drawn their drinking water from rivers – rivers that now carry lethal doses of cholera and other infectious bacteria.

In the village of O’Rouck on the banks of Rivière Froide, there are two new arrivals: sturdy metal stands holding three-liter plastic containers. They are chlorine dispensers – known locally as bwats a clowoks. With the turn of a handle, a bwat releases a measured dose of chlorine solution. One dispenser is designed to disinfect a gallon jug of water; the other is for five-gallon buckets.

Oxfam has placed chlorine dispensers like these in 30 rural communities, and the results have been cleaner, safer drinking water.

“Now, we are less scared about cholera, because with the bwat we treat the water and we know it will bring health,” says resident Louisimene Occean.  “My children have stopped having bellyaches.”

From the porch of her tiny house near the river, eighty-five-year-old Saintalia Denis tells visitors about how losing a neighbor to the disease sharpened her focus on risks her community faces.

“It’s really important to use treated water to avoid microbes and disease,"  she says, and to use good hygiene practices. "After putting in the bwat a clowoks, Oxfam explained to us how to protect ourselves from cholera. Now, after coming from the latrine, I wash my hands. Before eating, I wash my hands. And I drink treated water.”

“The cholera epidemic is still very serious, and chlorine dispensers alone can’t stop it in its tracks,” says Kenny Rae, public health engineer in Oxfam’s Boston office. “For that, people need strong water, sanitation, and health care infrastructure. But the bwats a clowoks are making a difference.”


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