Geographic Effects on Cholera in Haiti
The spread of cholera in Haiti was the result of improper sanitation infrastructure, and poor land and water usage. The Artibonite River, the longest river in Haiti, served as the main vehicle for the spread of cholera from a MINUSTAH camp to areas around Mirebalais and beyond. The camp was home to Nepalese UN peacekeepers that had recently experienced a cholera outbreak in their home country. The river is controlled at two points: the Peligre Hydroelectric Dam located 10km upstream from Mirebalais, and the Canneau Canal site where the river splits into a series of canals that are used by numerous farmers to irrigate fields (Lantange et al., 2010). Two branches of the Meye Tributary flow north, after exiting the mountains to the southwest and southeast of Mirebalais, and converge just north of the Mirebalais MINUSTAH camp before running into the parent Artibonite river. This network of rivers creates an easy transportation route for cholera to rural communities dependent on Tributary river water.
The sanitation conditions of the MINUSTAH camp initiated the spread of the 2010 Haitian cholera outbreak due to a lack of adequate waste water disposal. Inspection of the camp found that there was only one area with a toilet and shower facilities. Gray water, all waste water that is not sewage (i.e. wash, cooking, and shower water), flowed into on-site soak pits and seeped into the soil (Lantange et al., 2010). Black water (sewage) was collected into six fiberglass tanks that were emptied by a contracting company out of Port-au-Prince. The contractors would transport the empty tanks up a dirt road that was across the street from the camp (Lantange et al., 2010). The waste was deposited in an open-site septic pit in the vicinity of children and animals. Furthermore, the southeast branch of the Meye Tributary, which tends to overflow during the rainy season, is at the bottom of a large hill. The frequent flooding of the open septic pit would spread cholera, as human waste can easily be dissolved. This is one of the main routes cholera could have taken out of the camp, however the pipelines of the toilet and showers could also have contributed. The pipes were leaky and ill equipped to transport waste water. Waste water was spilled when the pipes crossed a drainage ditch that runs from the camp to the Meye Tributary System (Lantange et al., 2010). The contaminated water would take 2-8 hours to reach the intersection with the Artibonite River from which cholera could spread through most of northern Haiti in half a day. During the first two months of the outbreak, cholera was most evident in the central and northern parts of the country.
From the Artibonite River it was only a matter of time for cholera to spread through the rest of the country and infect the main cities. St. Marc, which is downstream from Mirebalais, experienced a high death rate from cholera; Port-au-Prince did not feel cholera’s effects until several weeks later (Paultre, 2012). It only took cholera one month to spread throughout all of Haiti. In 2007 Haiti was ranked last out of 147 countries in terms of water security. Access to and filtration of water in Haiti even before the earthquake was susceptible to waterborne diseases like cholera (Farmer et al., 2011). Before the earthquake only half the population had access to latrines or modern plumbing, and one third of Haitians did not have access to tap water (Farmer et al., 2011). The displacement of citizens into internally displaced person (IDP) camps after the earthquake prevented many from becoming ill. Cases in the IDP camps were relatively low due to extensive water sanitation and health programs put in place by Ministère de la Santé Publique et de la Population (MSPP), Direction Nationale de l’Eau Potable et de l’Assainissement (DINEPA), and partnering institutions.
However, the urban slums, where water is already scarce, also house thousands of displaced citizens. These neighborhoods felt the added pressure of the external population and piped in surface water from rivers and streams. The poor sanitary conditions within the tents aided the initial spread of cholera. The density of the houses helped the virus move as those who are sick and healthy are forced to essentially live shoulder to shoulder.
An alternative hypothesized cause of the cholera outbreak in Haiti is deforestation. 98% of Haiti has been deforested because of excessive logging and poor environmental management. Trees are a natural filtration system for water and provide structural support for soils. Without trees the soil erodes and carries contaminated sediment and mud into drinking water. Erosion on forested hillsides, such as the one where the open septic system from the MINUSTAH camp resides, provide a route for sediment to get into streams and lakes where it forms stagnant pools, which are breeding grounds for bacteria (Budiansky, 2010).