Onearth: Preventing Cholera’s Spread in Earthquake-Ravaged Haiti

By Genevra Pittman, Onearth Magazine, November 18, 2010

When Haiti’s cholera outbreak hit tent camps around Port-au-Prince in early November, Sasha Kramer was ready.

Kramer is the executive director of SOIL (Sustainable Organic Integrated Livelihoods), an organization she co-founded in 2006. SOIL’s mission is to turn human waste in impoverished Haitian communities into fertilizer for agriculture — improving public health and empowering people.

She was working in Haiti even before the January 2009 quake. After the disaster, Oxfam asked her group to build toilets for displaced residents now living in tents. (See “The Virtues of Human Waste” from our Winter 2011 issue.)

The outbreak “is something we talked about for years — how sanitation could be the next big emergency” in Haiti, Kramer said this week by phone. Now that what she and her colleagues feared has become a reality, SOIL has gone into full cholera prevention mode.

How can the organization stop the spread of the disease, which travels from person to person via drinking water contaminated by human waste? Kramer says SOIL is taking the following precautions:

• Checking on managers at each of its toilets every day to make sure they are clean and working well and supplying the managers with plenty of cleaning products. “The concern is that if someone sick uses the toilets and they’re not well cleaned, that can be a vector for transmitting cholera,” Kramer says.
• Providing extra protective gear and personal cleaning supplies to the teams that pick up, transport, and empty drums of waste from the toilets.
• Closing two of its three compost sites so that the organization can focus on safety measures at just one. SOIL employees have fenced it off, rebuilt their compost bins, and found ways to ensure that no waste is leaking out into the environment.
• Hiring 12 local Haitians as “prevention agents” and sending them into the camps and neighborhoods to hand out information about cholera prevention and treatment. These agents are also taught how to help rehydrate cholera victims. One of the best treatments for the disease is drinking lots of clean water.
• Transporting sick people in the camps to cholera treatment centers.

Still, there’s only so much that SOIL and other organizations can do in the short-term, Kramer says. For one, the country still doesn’t have enough essential supplies such as chlorine to curtail the outbreak, and cholera treatment centers are quickly filling up — or don’t exist at all in many areas.

Then there’s the problem of infrastructure, which remains in shambles after the quake. “The real solution is not a quick fix,” Kramer says. “It’s fixing the sanitation situation in the country in general, which is just going to take some time. There are all sorts of safety measures you can put in place, but as long as there are not enough toilets, [cholera] is going to continue to be a problem.”

One positive thing could come out of the devastating outbreak, she says: Haitians could get the message about the importance of clean sanitation. (Friday, incidentally, is World Toilet Day, dedicated to ensuring that more of the world has access to clean sanitation and safe drinking water, and reducing the number of deaths — 1.8 million annually, mostly children — attributed to pollution and waterborne diseases.)

“Hopefully what this will mean in the longer term is that more people have access to a toilet and a safe, dignified means of going to the bathroom,” Kramer says. “It feels like a real push to continue the work we’re doing. We’re overwhelmed and inspired all at once.”