Tagged: infectious disease

How to Start an Epidemic

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A cholera epidemic was just one of the unnintended consequences of UN health workers

In 2010 there was a terrible earthquake in Haiti that caused unprecedented destruction. Thousands of people died, homes were destroyed, and what infrastructure existed was decimated.

Shortly after the earthquake, the country experienced a devastating cholera outbreak. There had never been a case of cholera on the island before.

Cholera is a nasty disease that can kill a healthy adult in as little as three hours. It is easy to treat, but thousands of people in Haiti died before health workers were able to control the  epidemic.

How can this be?

Yes, Haiti is poor and the infrastructure was in disarray. But surely the people who planned the response knew that cholera was a possibility?

It bears repeating that although infectious disease is spread from bacteria and viruses, there is always, always a social component to disease. As Charles and Clara Briggs wrote in their excellent ethnography about a cholera outbreak in Venezuela,  Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare: 

Epidemics are ‘mirrors held up to society,’ revealing differences of ideology and power as well as the special terrors that haunt different populations[…]

Cholera created a charged, high-stakes debate about the lives of the people it infected, and competing stories bore quite different policy implications.

So what stories were being told about the cholera outbreak?

At first, the international aid community including the UN tried to blame poor infrastructure.  Health workers stepped up education campaigns about clean water use (which is kind of a joke in a country that was completely ravaged by the earthquake). The response tended to emphasize   existing problems with the water delivery system, poverty, poor hygiene, and living conditions that were ripe for this type of epidemic. The UN launched a major cholera aid package that some say was just repackaging an aid effort that already existed.

But in the end, they had to own up.  It turns out that UN aid workers brought it with them. Not on purpose. But still. They were actually the vectors.

It’s fitting, I suppose, that this is the conclusion. After all, the history of Haiti is an endless story of outsiders bring poverty, violence, disease, devastation.

So how do you create an epidemic? Act first, think later. Don’t ask for advice. Don’t consult an anthropologist. Hope for the best. Rely on old worn-out narratives. Emphasize feeling and emotion. Charge  in to save the day.

Cholera was the most vivid example of the latest tragedy visited on Haiti, but surely there were more. What about the American aid workers who went to save the day, like this guy, but came back feeling disappointed when people on the street just wouldn’t stop begging for money:

It’s very frustrating because, again, it’s this strange combination of being dependent, but also expecting it. And that can be very disheartening because the reality is no aid project is going to work if you don’t have people that you’re trying to help bought into it in wanting to help themselves.

Or the  foreign aid that often benefits companies from the US while at the same time undermining local economies.  Or that fact that medical aid organizations can sometime swoop in without trying to integrate themselves into the existing medical system, with the unintended consequence of leaving the local healthcare system in worse shape than they found it.

Haiti is trying to sue the UN for damages. Here’s hoping that they win.

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