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Ezili's HLLN Tell the Truth About Haiti Forum

A message to Paul Farmer, the Senate Foreign Relations Committee, James Dobbins and Rony Francois

We are the Haitians

The Slavery in Haiti the Media Won't Expose

HLLN Relief Fund

Massive Earthquake Devastate Haiti

Haiti has its own rebuilding plan: US/UN Stop blocking Relief

Oil in Haiti, reasons for the US occupation, Part 2

Haiti's Riches

Did mining and oil drilling trigger the Haiti earthquake?

Sarkozy's visit to Haiti: A Buzzard Looking For a Free Meal? But Haitians Demand Back The Independence Debt and Claim Haiti's Sovereignty

Haiti and the Aid Racket : How NGOs are Profiting Off a Grave Situation

Rebuilding Haiti - The Sweatshop Hoax

Travesty in Haiti: A true account of Christian missions, orphanages, fraud, food aid and drug trafficking

Poverty Pimps Masturbating on Black Pain: Monsanto Joins the Pack

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Earthquake Haiti, 2010
The deadliest disaster in modern times

Hold on Ayiti, Kenbe La

Ezili Dantò's Vodun presentation to honor Earthquake Victims
before Haiti panel on Haiti-led Relief/Rebuilding with Human Rights, Healing and Dignity

HLLN Relief Delegation to Chicago
mobilizing for Haitian-led earthquake relief/rebuilding

Fritz Pean and Margaret Mitchell Armand
February 27, 2010 at Saviour's Day in Chicago

Ezili HLLN's 14-Points for the Voiceless in Haiti: For a Return of Haiti's Sovereignty and for Disaster relief, Rebuilding with Human Rights, Healing and Dignity

Photo Credit: Erick Hyppolite

February 27 and 28, 2009 - Haiti panel and HLLN tribute performance for Earthquake Victims

Conscious Disaster relief with human rights and dignity

Interview transcript (34:03) on Mining of Haiti Resources and Riches (Listen to interview on mining in Haiti) NEXT  
  2 of 40

Ezili Dantò of HLLN on Gorilla Radio with Chris Cook, Feb. 8, 2010 (mp3)


Health experts say UN troops could have caused Haiti cholera outbreak, call for investigation
By: JONATHAN M. KATZ Associated Press, November 4, 2010

See: UN responsibility to Haiti for importing cholera by Ezili Dantò, May 6, 2011

PORT-AU-PRINCE, HAITI — Researchers should determine whether United Nations peacekeepers were the source of a deadly outbreak of cholera in Haiti, two public health experts, including a U.N. official, said Wednesday.

The U.S. Centers for Disease Control and Prevention found that the strain of cholera that has killed at least 442 people the past three weeks matches strains found in South Asia. The CDC, World Health Organization and United Nations say it's not possible to pinpoint the source and investigating further would distract from efforts to fight the disease.

But leading experts on cholera and medicine consulted by The Associated Press challenged that position, saying it is both possible and necessary to track the source to prevent future deaths.

"That sounds like politics to me, not science," Dr. Paul Farmer, a U.N. deputy special envoy to Haiti and a noted expert on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. "Knowing where the point source is — or source, or sources — would seem to be a good enterprise in terms of public health."

The suspicion that a Nepalese U.N. peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection fueled a protest last week during which hundreds of Haitians denounced the peacekeepers.

John Mekalanos, a cholera expert and chairman of Harvard University's microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere — and public health officials need to know how it spreads.
Interviewed by phone from Cambridge, Massachusetts, Mekalanos said evidence suggests Nepalese soldiers carried the disease when they arrived in early October following outbreaks in their homeland.

"The organism that is causing the disease is very uncharacteristic of (Haiti and the Caribbean), and is quite characteristic of the region from where the soldiers in the base came," said Mekalanos, a colleague of Farmer. "I don't see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred."

Cholera, which had never before been documented in Haiti, has killed at least 442 people and hospitalized more than 6,742 with fever, diarrhea and vomiting since late October. It is now present in at least half of Haiti's political regions, called departments.

Death occurs when patients go into shock from extreme dehydration. The epidemic has diverted resources needed for the expected strike of a hurricane this week, and could spread further if there is flooding.
Suspicions that the Nepalese base could have been a source of the infection intensified Monday after the CDC revealed the strain in Haiti matches those found in South Asia, including Nepal.

But nothing has been proven conclusively, and in the meantime the case remains politically charged and diplomatically sensitive. The United Nations has a 12,000-strong force in Haiti that has provided badly needed security in the country since 2004. But their presence is not universally welcomed, and some Haitian politicians have seized upon the cholera accusations, calling for a full-scale investigation and fomenting demonstrations.

Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, said it is clear that the disease was imported to Haiti but that it is still not clear by whom or how. She said the epidemic will contain lessons for humanitarian relief work and disaster relief around the world.

"It has to be either peacekeepers or humanitarian relief workers, that's the bottom line," she said.
Mekalanos said researchers might be more aggressive in finding the source of the infection if the case was less sensitive.

"I think that it is an attempt to maybe do the politically right thing and leave some agencies a way out of this embarrassment. But they should understand that ... there is a bigger picture here," he said. "It's a threat to the whole region."

He also cast doubt on U.N. military tests released this week that showed no sign of cholera. The tests were taken from leaking water and an underground waste container at the base a week after the epidemic was first noted and processed at a lab in the neighboring Dominican Republic, U.N. spokesman Vincenzo Pugliese said.

Mekalanos said that it is extremely difficult to accurately isolate cholera in environmental samples and that false negatives are common.

The Nepalese troops were not tested for cholera before their deployment if they did not present symptoms. But health officials say 75 percent of people infected with cholera bacteria do not show symptoms and can still pass on the disease for weeks.

A spokesman for the World Health Organization said finding the cause of the outbreak is "not important right now."

"Right now, there is no active investigation. I can't say one way or another (if there will be). It is not something we are thinking about at the moment. What we are thinking about is the public health response in Haiti," said spokesman Gregory Hartl.

The Harvard experts said more conclusive evidence would be available following closer examinations of the genetic material in the strain.

CDC spokeswoman Kathryn Harben said in an e-mail that the center will make the full genomic DNA sequence available when it is confirmed.

"At some point in the future, when many different analyses of the strain are complete, it may be possible to identify the origin of the strain causing the outbreak in Haiti," she said.

Farmer, who co-founded the medical organization Partners in Health that is a leading responder in the epidemic, said there is no reason to wait.

"The idea that we'd never know is not very likely," he said. "There's got to be a way to know the truth without pointing fingers."
Associated Press reporter Colleen Barry in Geneva contributed to this article.


Study bolsters UN source for Haiti's cholera outbreak
Lisa Schnirring * Staff Writer | Source: CDC - Center for Infectious Disease Research & Policy

(See: UN responsibility to Haiti for importing cholera by Ezili Dantò, May 6, 2011)

May 9, 2011 (CIDRAP News) – An epidemiologic study by French researchers of the initial days of Haiti's cholera outbreak builds a stronger argument linking the importation of the bacteria to the arrival of United Nations (UN) peacekeepers from Nepal than a recent report from the UN's independent experts did.
News of the group's findings was leaked to the media in early December 2010, and the full findings appeared May 6 in an early online posting by Emerging Infectious Diseases (EID). The report details a field investigation conducted by the French researchers and their colleagues with Haiti's health ministry.

On May 4 an independent expert group working on behalf of the UN issued the results of its 5-month investigation into the source of Haiti's cholera outbreak, which stopped short of blaming Nepalese UN peacekeepers. The group said the evidence overwhelmingly supported human activity as the source but that the pathogen couldn't have spread without deficiencies in Haiti's water, sanitation, and health systems.
So far Haiti's cholera count is 285,931 cases, including 4,870 deaths, according to the latest report from the Pan American Health Organization (PAHO).

When the outbreak first surfaced, some public health officials thought the contamination could be related to the massive earthquake that had occurred in January 2010. However, rumors also circulated that sick Nepalese soldiers imported the disease into Haiti and dumped sewage into the Artibonite River. As other theories emerged to explain Haiti's first cholera outbreak in nearly a century, an early analysis suggested that the Vibrio cholerae strain was from outside Haiti, perhaps from southern Asia or eastern Africa.
The investigators reported that Nepal's capital, Kathmandu, reported a cholera outbreak in September 2010, shortly before the UN soldiers departed for Haiti.

In the French and Haitian investigation, researchers built a database early in the outbreak, which began in mid October 2010, to identify clusters and analyze the disease's rapid spread in Artibonite department. They did field interviews with health groups and government officials and explored environmental risks in communities and cholera treatment centers.

They found that the first patients were a family living in Meille, a village that hosted a UN peacekeeping camp located above a stream that flowed into the Artibonite River. Nepalese soldiers began arriving at the location shortly before the family got sick. Haitian epidemiologists had observed that a pipe from the camp discharged sewage into the stream, which villagers used for cooking and drinking.

Soon afterward, cholera illnesses were detected in Mirebalais, where local people used water from the river while their water system underwent repair. Prisoners at a facility that obtained drinking water from the river were also sickened

The researchers noted that cholera cases dropped soon after sanitary problems at the UN camp were corrected, but then spiked again in November.

The outbreak was explosive in communities along the Lower Artibonite River and then spread into the Artibonite Basin, they reported.

The investigators wrote that the remoteness of Meille and the absence of other newcomers "make it unlikely that a cholera strain might have been brought there another way." They added that DNA genotyping suggests the source was point contamination from a distant source.

They suggested that sewage from asymptomatically infected soldiers probably wouldn't have created a large enough infectious dose to cause severe illnesses downstream, and said they believe symptomatic cholera infections occurred among the Nepalese soldiers inside the UN camp.

"Whatever its cause, this violent outbreak in Lower Artibonite provoked the flight of persons and resulted in a wave of epidemics that spread centrifugally and overwhelmed the nascent sanitarian response," the article states. "This wave explains the difference between the delayed and progressive starting of epidemics in the south and the immediate impact of cholera in the north."

The report shows the usefulness of accurate field reporting to help focus response efforts, especially when an outbreak involves a newer pathogen or develops quickly, the researchers said.

Though the epidemiologic report doesn't pinpoint the exact contamination event, the findings serve as a reminder that military camp sewage should be handled properly and that aid organizations should avoid adding risks that don't already exist, they emphasized.

In an editorial in the same issue of EID, Dr Scott Dowell and Dr Christopher Braden, both from the US Centers for Disease Control and Prevention (CDC), wrote that the French and Haitian study provides circumstantial evidence that fecal contamination of a stream initiated the outbreak, and that the Nepalese soldiers might have been the source. Dowell directs the CDC's division of global disease detection and emergency response, and Braden is a medical epidemiologist who directs the CDC's division of foodborne, waterborne, and environmental diseases.

Though the spread within days to remote parts of Haiti suggests travel of infected patients played a role in spreading the outbreak, "there is little doubt that the organism was introduced to Haiti by a traveler from abroad, and this fact raises important public health considerations," they wrote.

Public health experts have noted that Haiti was vulnerable because its population was naive to the disease, but Dowell and Braden said the pathogen did not cause major outbreaks in other countries, such as the Dominican Republic, that reported cases linked to Haiti's cholera outbreak. They wrote that improving water and sanitation conditions is Haiti's best hedge against future cholera outbreaks.

They lauded the public health response, which in about 4 months helped reduce cholera mortality to less than 1%. "Even as we continue to learn more about the intercontinental spread of this ancient human scourge, we are reminded of the continued effectiveness of traditional public health control measures," the two conclude.

See also:
May 6 Emerg Infect Dis study
May 6 Emerg Infect Dis editorial
May 3 PAHO update
May 5 CIDRAP News story "Experts link Haiti cholera outbreak to human actions, foreign strain"
Dec 8, 2010, CIDRAP News story "Experts disagree on Haiti cholera source as cases near 100,000"

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