Wednesday, 20 July 2011

The United Nations is to blame for 5,500 deaths in Haiti

Since last October, cholera has so far infected more than 370,000 Haitians and killed more than 5,500 of them. Before I explain how the Haitians got it, I will explain what cholera is.

Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms and signs of cholera are vomiting and a watery diarrhea that often contains flecks of whitish material (mucus and some epithelial cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" and smells fishy. The volume of diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 70 kg adult can occur.

The transmission of this disease is primarily through consuming contaminated drinking water or food. The severity of the diarrhea and vomiting can lead to rapid dehydration and electrolyte imbalance. Electrolytes play an important part in maintaining the internal balance of the body. They help to regulate the body's internal temperature and electrical balance, as well as body pH, fluid levels, and delivery of oxygen to the cells. Without a proper balance of electrolytes, one may experience symptoms ranging from nausea and fatigue, to heart failure and death.

Primary treatment is with oral rehydration solution and if these are not tolerated: intravenous fluids. Antibiotics are beneficial in those with severe disease.

Worldwide, cholera affects 3-5 million people and causes 100,000-130,000 deaths a year as of 2010.

How did it get into Haiti?

It came to Haiti with the United Nations peacekeepers who were supposed to be protecting the Haitians. Since Canada is involved with MINUSTAH, the UN agency that effectively runs Haiti, Canada must share some of the responsibility for inflicting needless suffering and for failing to admit it.

The outbreak started along the Meille River in a rural area in Haiti, downstream from a MINUSTAH peacekeepers’ camp that had just received a contingent of Nepali soldiers. Suspicion of the source of the cholera outbreak fell on them at once.
The soldiers had left Nepal in late September during a cholera outbreak. While they all had medical exams (including some stool tests), they then had 10 days’ home leave before reassembling in Kathmandu. That was an enormous blunder on the part of the Nepalese army. It is akin to sending a nurse into an area where the plague is rampant and then having her report to her hospital back home immediately after she leaves the plague infested area.

The Nepalese army denied its troops were to blame. MINUSTAH also denied the accusations, claiming the Nepalese had tested negative for cholera.

When the UN finally investigated the origin of the outbreak, it indirectly admitted the Nepalese had brought the disease. But it didn’t mention them explicitly. The UN spent more time blaming the Haitians for their lack of clean water and a sewage system.

Meanwhile, a team led by Renaud Piarroux of the Université de la Méditerranée did its own survey. Piarroux has just published a detailed report in Emerging Infectious Diseases, a peer-reviewed journal of the U.S. Centers for Disease Control.
Piarroux’s devastating report finds evidence that “strongly suggests” the epidemic emerged from the Nepalese’ camp.

Worse yet, Piarroux argues that to infect people using water from the Meille and Artibonite rivers, the quantity of Vibrio cholerae bacteria would have to come from at least one seriously sick cholera victim in the camp.

This directly refutes Secretary General Ban Ki-moon’s representative in Haiti, who had claimed “negative” test results on the Nepalis.

Cholera causes spectacular diarrhea and vomiting, so everyone in the base would have known about it. Suppressing information about such an outbreak would have required the collusion of senior Nepali officers, MINUSTAH officials, and at least some health-care professionals in WHO and the Haitian public health ministry.

But MINUSTAH said only that Piarroux’s study had been followed “by many others . . . each with different possible scenarios.” To my knowledge, no such alternate studies exist, and MINUSTAH didn’t cite any. We have only the UN report and that of Piarroux.
So the Piarroux report is an unrefuted indictment of the United Nations and its agents in Haiti, including the World Health Organization. The UN denials and press releases only aggravate the problem.

WHO faces a serious charge of suppressing or denying vital information about the epidemic while it spread explosively through the whole island of Hispaniola, including the Dominican Republic.

When the next serious outbreak arrives, therefore, we will wonder whether the scare is really a scam or a cover-up. Such skepticism could cost lives.

Canada’s credibility is also in question. Many Canadian doctors have worked in Haiti. A Canadian, Nigel Fisher, is the UN’s Haiti Humanitarian Coordinator, supervising UN projects and coordinating with non-governmental organizations. He has said nothing publicly about the Piarroux report.

Nor has our last Governor General, Haitian-born Michaëlle Jean, who is now the UNESCO special representative to Haiti. When Canadian health experts, humanitarian coordinators and spokespersons are silent in the face of a UN cover-up, they look complicit.

Importing cholera looks like incompetence made worse by misplaced political priorities. In September 2010, as many as 5,044 Nepalese troops were serving on peacekeeping missions. The UN was reimbursing Nepal to the tune of $1,028 (U.S.) per soldier per month.

Demand for infectious peacekeepers being zero, Nepal would therefore stand to lose over $5 million a month, and the UN might have trouble finding replacements.
The Piarroux report has embarrassed all concerned, including the Canadians in Haiti who have not protested MINUSTAH’s denials. It’s also a reminder of how little the UN has done to eliminate the squalor that cholera thrives on.

Dr. Rupert Virchow, the 19th-century doctor and politician, famously said that “medicine is a social science and politics is nothing else but medicine on a large scale.” In the case of Haiti’s cholera, Canada and the UN have committed malpractice on a very large scale.

What the United Nations should have done before the Nepalese peacekeepers were permitted to disembark in Haiti, was to quarantine them for a period of at least ten days to make sure that they were not carriers of cholera.

Unfortunately, the UN presumed that since the Nepalese government assured the UN that their soldiers had been tested, they were cleared for their peacekeeping duties. That was a horrendous mistake and that mistake cost the lives of 5,500
Haitians’ men, woman and children as of last October, not to mention that obviously more will have died because 170,000 Haitians were also infected with cholera brought to them by the Nepalese peacekeepers.

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