When a massive earthquake struck Haiti a year ago, it was immediately apparent to the world that the loss of life and the suffering would be enormous, and that humanitarian intervention would be significant and long-term.
Such a natural calamity was relatively easy to identify and "diagnose". Deaths and injuries -- and their cause -- were large and quickly apparent. An estimated 230,000 died that January 12th and more than a million are still displaced from their homes.
But what about the slow-moving, quiet, less-noticed disaster that struck Haiti three months ago?
When cases of cholera began to emerge in the Artibonite district in late October, it would prove much more difficult to sound the alarm that a new catastrophe was in our midst and demanded our attention.
On the front lines, recognizing a burgeoning humanitarian crisis required experience and the willingness to push hard for a large-scale mobilization when many others were reluctant to believe.
Recently I received an email from our Country Director in Haiti, Mike Dockrey, that succinctly spelled out what it took to yell "fire!":
Though the "outbreak" and first cases did occur around the 15th-20th of October, in fact, those were originally reported by officials as "intense food poisoning" and "acute diarrhea" from "bad fish" caught in the Artibonite River.
The first two victims were young schoolchildren who had indeed eaten some fish caught in the river. But I watched as our experienced medical staff, led by (Deputy Country Director) Jason Erb and especially (Medical Director) Jojo Cangao, listened to those earliest reports (that really didn't garner much attention that I could see) and argued to me for an assessment visit to the sites up there. Frankly, Dr. Jojo "smelled" cholera, and suspected that due to the absence of experience with it here, local authorities simply didn't know what they were dealing with.
We all sat in a room one evening, after Jason, Nurse Heather Lorenzen and Jojo returned from their two-day site visit to Artibonite and listened as Jojo confirmed that his suspicions were likely, and tragically, true. We organized our first real medical response to the impacted area for the next day -- taking up medical staff, medicines, and other supplies (cots, buckets, chlorine, etc.) I was just the guy in the room listening to their expertise, and agreeing to the consensus opinion that International Medical Corps had to move -- regardless of current programming, budgets, or staffing considerations.
Our ability to recognize a national medical emergency in its infancy, and mobilize so quickly, and appropriately, saved lives. Simple as that.
Despite the large-scale response from International Medical Corps, other NGOs, and UN agencies, in the days and weeks to come, there have been about 170,000 cases of cholera since late October, a number that is expected to triple in the next 10 months. The disease has claimed more than 3,000 lives. As bad as this is, it could have been far worse if we had diagnosed this looming crisis later than we did.
As we reflect on the one-year anniversary of the earthquake here, it is important to remember that this was a country with an extremely compromised health infrastructure even before the earthquake.
Cholera broke out in areas that were unaffected by the quake -- and it was a disease that hadn't been seen here in perhaps a century; local health workers were completely unfamiliar with it. Had there not been a large presence of relief workers in Haiti to respond when cholera emerged, the death toll could have been significantly higher.
Sadly, the World Health Organization and CDC believe cholera will now be a recurrent disease in Haiti, appearing annually with the rains, spiking, and decreasing incrementally each year as the populace develops natural immunities.
Over the long-term, we will continue to treat cholera patients. But it is clear that focusing on prevention and education campaigns in local communities regarding clean water and sanitation -- and training local health workers to address cholera and other communicable diseases -- will save exponentially more Haitian lives.
The international community must help Haitians recover and rebuild, but most importantly must provide them with the skills and know-how to care for themselves, if and when disaster strikes again.