Clean Water and Common Sense--June 2014

Wharf Soleil…One Hundred Yards from the Cholera Treatment Center (Photo by John Carroll–May 24, 2013)

The New England Journal of Medicine (May 29, 2014) has an article on the use of the cholera vaccine in Haiti. It is co-authored by Dr. Jean William Pape who is a well-known Haitian physician who has worked with HIV and tuberculosis patients for many decades in Port-au-Prince.

The article reports:

“Cholera is a disease of poverty, linked to poor sanitation and a lack of potable water. Establishment of an adequate sanitation and potable-water system is the most definitive way to prevent and limit its spread. However, the cost of instituting adequate sanitation systems, one of the United Nations Millennium Development Goals, is prohibitive for the countries that are affected by cholera: it would cost an estimated $2.2 billion, for example, to adequately improve access to water and sanitation in Haiti. Water, sanitation, and hygiene (WASH) practices are the cornerstones of cholera prevention and control. The promotion of WASH practices, the creation of rehydration centers, use of antibiotics, and training of health personnel during the first months of the Haitian epidemic led to a dramatic reduction in cholera-associated mortality, from 4% to 1.5%.2 Yet a survey in the slums of Port-au-Prince showed that although people were aware of hand-washing methods, they did not have soap and water to implement them.”

I would ask how $2.2 billion dollars is “prohibitive” if it means improved water and sanitation for 10 million people? Cleaning up the water could prevent many of the deadly water-borne diseases including cholera.

The UN occupation of Haiti since 2004 costs 2 million dollars per day. If we did the math and looked at the morbidity and mortality caused by dirty water and poor sanitation, would we not have saved many more Haitian lives during the last 10 years if we would have invested in Haiti’s infrastructure and improved the water and sanitation?

Let’s start now improving basics in Haiti rather than continuing to talk about what is common sense in the first place.

John A. Carroll, MD
www.haitianhearts.org

Comments in 2021--

I always thought it was funny for us to tell patients to make sure they wash their hands well. With what? Most have no running water. Yes, hands can be washed in water from a bucket, but it is more difficult. 

Blaming the poor for their health problems is a multigenerational scam. It makes us feel better by removing our guilt. 

See this article in the British Medical Journal. 

About a decade earlier we brought to attention that the lack of access to health information is ‘a social injustice that the global health community cannot afford to ignore’1 and argued that governments are morally and legally obliged to ensure access to health information. Since then, a lot of progress has been made in the domain including the recent high-profile statement by the World Medical Association that health information ‘is a major contributor to morbidity and mortality, especially in low and middle-income countries (LMICs), and among vulnerable groups in all countries’.2 Others have also argued that access to health information is a key component of universal health coverage.3 In the backdrop of the COVID-19 pandemic, we have seen significant investments from multinational agencies, governments, non-profits and private actors to disseminate health information. However, a narrow focus on providing access to health information alone, without any investment or thought on how information can be translated by people to meaningful health outcomes, is proving to be counterproductive.