Monday, April 18, 2016

Love And Haiti In The Time Of Cholera

So if Slate writer Jonathan Katz is even remotely correct here, a CDC map in Atlanta on display in the agency's museum actually points out that the epidemiologists there knew full well that the massive cholera outbreak in Haiti following the earthquake there in 2010 was actually caused by a UN peacekeeping mission from Nepal.  Katz has long been on the trail of this story, but the map strongly seems to suggest that the US government was well aware and looked the other way for political expediency.

Which seems to happen a lot these days.

The U.N. soldiers at that base had just arrived from their home country, Nepal, where a cholera outbreak was underway. Thanks to negligent sanitation practices, such as the open dump pits above, there was a multiplicity of ways that their choleraic feces could have gotten from the base into the river, including latrine pipes leaking over a drainage canal that emptied into the river.

However it happened, from that very spot, that cholera strain—the same strain found in Nepal, which had never been seen before in Haiti, ever—spread throughout the country. By January 2011, the date given for the map, it had been well-established—mainly through my reporting and the work of French epidemiologist Renaud Piarroux—that this was the case.

Since the first days of the epidemic, the U.N. has tried to cover up what it did. Everyone from the soldiers on the base to Secretary-General Ban Ki-moon has been implicated. The Obama administration and the U.S. government did not want the U.N. to be held accountable, because doing so might persuade other people elsewhere to hold U.S. peacekeeping missions accountable—and because the U.S. foots about a quarter of the U.N. peacekeeping budget.

The CDC, a U.S. government agency, discouraged journalists from asking about the epidemic’s origin, telling them that pinpointing the source, Dr. Snow–style, was “not productive,” “not central,” and would likely never happen. Its epidemiologists did provide a key detail early on, when they identified the strain in Haiti as having a recent South Asian origin—meaning it could have come from Nepal and not from South America, Africa, or anywhere else cholera was circulating at the time. But after that, the CDC refused to take environmental samples from around the base or test the soldiers during the small window when doing either would have been worthwhile. All of this detailed in a damning new book by Ralph R. Frerichs called Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti.

In the book, Frerichs also makes a good case that the agency used maps as tools of diversion. In one crucial map distributed in early 2011, he writes, the agency scrambled the order of dates for when cholera arrived in Haiti’s different regions, or départements—making it seem as if the disease had appeared on the coast before showing up near the U.N. base. Citing the CDC’s own manual, “How to Investigate an Outbreak,” which in his words emphasizes the “importance of correctly identifying infectious disease cases and then using a frequency distribution of the onset dates to estimate the outbreak’s start time,” Frerichs writes:

CDC had ignored its own standard procedure by using the “first confirmed case” in its Haiti Cholera Outbreak map of mid-February 2011. It based the onset time on laboratory confirmation, which falsely implied that cholera had first appeared on October 21 in downriver Artibonite département, then two days later in Ouest département, and finally a day after that, October 24, in upriver Centre département—findings entirely different from Piarroux’s and the Haitian public health team’s.

The timing of that map was crucial, because a panel of experts appointed, under pressure, by Ban was on its way to investigate the source of the outbreak:

Piarroux suspected that CDC had released the map in anticipation of the UN panel’s arrival in Haiti and was helping the UN shift attention away from the Nepalese peacekeeping base in Centre département. Implying that cholera had started elsewhere served that purpose.

It was the first in a series of online maps from CDC that used the poorest available measure to show when cholera had first appeared in Haiti’s ten départements. The CDC information remained widely circulated through updates in September 2011.

In rare a moment of clarity, as evidence mounted, Scott F. Dowell, then director of the CDC’s global disease and emergency response division, talked openly of political considerations in the agency’s response: “We’re going to be really cautious about the Nepal thing because it’s a politically sensitive issue for our partners in Haiti.”

The map flags the epicenter of the cholera infection, and surprise, it's right at the location of the Nepalese UN peacekeeper camp at the time in late 2010.


So yes, this is something that falls on the shoulders of the UN, and in part the US.  Realpolitik and diplomacy sucks, folks, only in this case thousands have died and hundreds of thousands have been sickened, and the cholera epidemic has been going on in Haiti now for almost six years.

There are a lot of questions that need to be answered by the UN about Haiti.  Quite a lot.

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