Haiti: The ugly face of Cholera

By Mofor Samuel

It has been estimated that as many as 80% of all diseases in the world are associated with unsafe water or poor environmental hygiene. Low standards of hygiene, both personal and public, are responsible for a vast majority of disease everywhere in the world and particularly in the tropics where poor living conditions are so common. Recent statistics reveals that over 1.2 billion people still suffer from poor water supply. The percentage of unsafe sanitation (1.7 billion people) and waste disposal is even higher, as they have usually had
The diseases are generally confined to human beings and are maintained in human community by unsanitary living habits. The causative agent leaves the human body in the excreta and the new host is parasitized by ingestion of infected faeces conveyed to his mouth in a number of ways, the most common vehicles of transmission being contaminated hands, food and water.
    
The history of safe hygiene behaviour and understanding of the relationship between diseases and environmental hygiene is rather short. It is often forgotten that as late as during the 19^th century cholera pandemics, thousands died of waterborne cholera in the American cities of New York, New Orleans and St Louis as well as in several European cities. It was only after some pioneering studies on cholera outbreaks that the sanitary revolution started in the 19^th century. The efforts in organizing water supply, sewerage and waste disposal services and their safety were accompanied by improved hygiene behaviour, strongly promoted through public health education.
    
 Cholera is a classic al example of a waterborne disease and it spreads along man’s route of travel from the endemic area as a result of contamination of water supplies along the route. It is an acute specific infection of the alimentary canal caused by vibrio cholerae and characterized by onset vomiting and frequent watery stools resulting in rapid and extreme dehydration.
      
The recent outbreak of the cholera epidemic in Haiti where close to 275 people were reported dead, with over 2000 more affected, brings the ugly face of the disease to the limelight again in that part of the world, and indicates that the danger of spread still exists. Mention should also be made of sporadic cases of cholera epidemics in Benin and Cameroon in West Africa where some lives were equally lost this year. Man is the only reservoir of infection and is thus solely responsible for its maintenance in a community.
    
Diseases associated with poor sanitation and crowded environment decreased in number in the West even without planned medical interventions, curative medicine or immunization and life –span increased.

It may be argued that many developing countries are repeating the Western history of decreasing water- related morbidity as a result of their infrastructural development. However, this process is facing serious constraints in the least developed countries where high population growth, declining economic situation and environmental deterioration are increasing health risks at an accelerating speed which hardly can be followed by development actions.

Therefore, the historical approach where improvements were achieved through sole construction of safe water supplies, sewerage systems and waste disposal services may not be adapted in poorest developing countries- Haiti and Benin are two of such countries. Instead, the actions should be based on beneficiaries’ own initiative and resources, utilizing simple and innovative approaches in problem –solving.