cholera at 1

Cholera arrived in Haiti last October 12th, the runoff from the Nepalese UN camp fouling the Artibonite River, flowing downstream to St Marc’s in the central plateau, and from there it was Katie bar the door. Initially, the treatment was chaotic, and widespread panic wasn’t just a doper’s band. The morgues filled way beyond capacity, people were afraid to bury their dead, and riots closed Cap Haitien. Many doctors and hospitals opted out. The great flood of earthquake sympathy and earthquake dollars dwindled to a trickle, more easily stanched than the disease. Before long, that river ran dry. The UN is still here in force, but NGOs squabble over ever smaller biscuits.

Sewage treatment, the grand grotesquerie underpinning all modern civilization, is unknown in Haiti, where roadside gutters are a stinking disgrace. The disease is on board for my lifetime, at a minimum.

St Damien’s, a high quality pediatric hospital, grew new divisions- I washed up at St Luc’s, which didn’t even exist before the quake, and mostly worked St Philomene’s, the cholera hospital, which of course was also brand new- both a couple hundred beds now, full fledged institutions.

We got good at it. Eventually, things settled down. Severity was ranked A,B and C- the treatment became algorithmic, a nurse’s checklist. Now they just call when they bleed or have fever, TB or HIV, or something besides. Over the summer, the numbers declined.

Lately, the rains have been intense, unseasonal. It’s coming back with a vengeance.

But first, let’s do the numbers.

20,000 patients came through St Luc’s this year. Some, “A” patients, where treatable with ORS alone. “B” and “C” patients also required Lactated Ringer’s, at $2.50 a bag, and an IV, or more likely 3-4 IV’s over 3-4 days, at a dollar fifty a pop. The NG tubes were free, since I stole them, but the intraosseous lines were high at $25 bucks each. Some of the C patients required 25 bags the first day- the fluid shifts amaze me still. Combining all, each cholera patient averaged 20 bags of Ringer’s.

We poured it in, and they poured it out, down the drain.

It was hot, so we ran some fans. We fed some families, mostly MREs, but beans and rice, too- had to buy that.

All in, a million 5.

A coupla FIKI Cirrus.

A large load carried cheap, if you ask me.

But they don’t. At least, they don’t ask about that.

Haiti’s too depressing, too close to home, a failure in too many ways. You can’t look at it hard without feeling worse about yourself, all of us, about humanity.

We should blame them.

So when people ask “Is anything really getting better down there? Where did all that earthquake money go?” They don’t really want details.

They want confirmation of widespread corruption.

They want absolution- forgiveness- what we all want, in case we skip an important moral step as we cruise through our blessedly sunny lives, at a safe altitude, our heading on autopilot.

In case our way of life is somehow integrally related to this penury.

In case this Jungian sense of connection, always felt, and reinforced by the net and global smalling, is real, and we really are meant to be our brother’s keepers.

But Hell, I like people.

I skip moral steps all the time- and never more than since I started coming to Haiti, for some reason.

So I let them off the hook.

I tell them I think it all went down the drain.

Quite a bit of it did.

Apart from the constant dissing on the poor Nepalese, sideswiping nurses, and shamelessly ripping off APR’s Marketplace, your poetry is great. And even more so, your continuing work in Haiti. Careful though. Any more evidence of social conscience and someone’s going to ask for your birth certificate.


Any chance of seeing y’all over the weekend (or whenever) at Casa de Campo or La Romana? There are at least three people who want to buy your dinner there. So for two of them you could just take the cash.

I tried to work that out, but the timing doesn’t look good. They figured out how to use a GI lab, and we got busy.

Of course, had I known of this ready availability of cash, I’d have bumped up my bid for those nifty speed skates you moved at Dutch auction. I was foolishly waiting for price to fall to my range, although I admit there was the fascination of watching a coin in a funnel, swirling down, waiting to see it fall out. It seems to take an eternity.

It was fun to watch.


Not to mention that the UN and the NGOs in Haiti bought local food, which caused prices to rise, making it even harder for Haitians to scrape out their meager subsistence. No good deed goes unpunished, and sometimes the punishment goes to the deed’s intended recipient.

When we learned about Science™, we learned about the conservation of mass/energy. It’s easy to think that money is the same. We spend a dollar in Haiti, we should get about a dollar’s worth of results, right? Nope. Unlike mass/energy, money can be destroyed. Or wasted, or lost. You can easily demonstrate this principle with a Bic lighter and a hundred dollar bill. (In fact, this is one of the most realistic aviation simulators that I know of.)

When we think of the wealth of the United States, we think of the money in our banks and our mega-corporations. We don’t usually think about our infrastructure, our roads, bridges, our systems that deliver water, electricity, telephone, entertainment and internet, and take away sewage. Haiti has damn little of any of that. That’s their poverty at a grass roots level.

In my opinion, money we send to Haiti would be better spent hiring Haitians to build roads and sewers than spending it on UN officials driving around in brand new Nissan SUVs. The UN officials could use the tap-taps like the locals.[:)]



Here’s an interesting article about the role Cuba has played in the Haitian cholera epidemic:

I knew that a lot of Haitian medical personnel had gotten their training in Cuba, but I didn’t realize that Cuba had boots on the ground.


There are at least two at St Damien’s, both pretty good. I get the feeling their training is more organized than the Haitians’.

One of them, oddly enough named Castro, a sharp eyed old guy with your sense of humor, puns in various languages, etc, and a spectacular wife maybe half his age, was up on the third floor of the old St Damien’s hospital, up in Petionville, finishing his charting, when the earth quaked. The building pancaked, and he found himself, who knows how, under an upended rocker from the nursery on the 5th floor, so only his legs were crushed, took them 18 hours to get him out. He was a mess by then, but there was chaos everywhere, so nothing for it but to take him to the Cuban embassy, “hey, here’s your guy.” They said no we can’t help, we’re crushed, too. Rick argued awhile, then said OK, somehow we’ll airlift him to Miami, let the emigres there care for him and take control of the story, They said…uh wait a minute til we call the boss on the satphone…and they fixed him up in Havana.

Now he walks with a moderate limp, believes angels control rockers and everything, and misses his wife (no argument there), who can’t visit him here- flight risk.