Haiti's Epidemic: The Failure Of Treatment Over Prevention

At the Peligre Dam in Central Haiti
At the Peligre Dam in Central Haiti

Once again, international news has turned to Haiti as another disaster hits the country. Ignoring the fact that little has been mentioned about a relatively peaceful lead up to Haiti’s elections on Oct. 9, which are funded entirely by the country’s public treasury fund, these news stories highlight persistent problems in Haiti, denying there exists more than one story to the country.

Hurricane Matthew raises a number of issues about the state of the country today. Flash floods, mudslides, wind damage, and a spike in the number of cholera cases will all occur in the aftermath of the storm. This last problem, though, is one that could have been prevented had the millions of dollars of aid donated to Haiti in the past six years been used properly. Hundreds, if not thousands, of nonprofits operate in Haiti, many with projects in the WASH (Water, Sanitation & Hygiene) Sector. There is no doubt in my mind that each of these projects were well intentioned, albeit misinformed.

The majority of the WASH projects in Haiti over the past few years have consisted of simple, low-cost solutions, great for the donors and aid agencies but not so great for the recipients of the aid. Cholera treatment centers and oral rehydration salts do wonderful things for those infected with cholera, but wouldn’t it have been more cost effective and rational to invest in programs that would prevent people from contracting cholera? Among the projects that were meant to prevent people from contracting cholera, there were community bloc toilets, water wells with a limited lifespan, and toilets with no connection to septic tanks or sewage systems. Much like the U.S. health care system, the WASH sector in Haiti focused on the treatment of disease rather than prevention of contracting the disease itself, an approach that has proved to be ineffective and deadly, especially in the aftermath of Hurricane Matthew.

What Haiti needs to prevent a spike in cholera and other waterborne diseases is a proper sanitation system. Not hundreds of low-cost portable squat toilets or life straws that filter water or cholera vaccines or porcelain toilets. But a real, effective sanitation system that collects, transports, treats, and properly disposes of waste.

Obviously, this won’t be an inexpensive investment. A proper sanitation system requires mechanisms for containment and collection, proper and working toilets and septic tanks, a method of transportation, whether that be people or pipes, centers and systems to treat waste and a way to ensure that the waste, once treated, is properly disposed of as waste water, compost or agricultural sludge. Cost is the primary deterrent for organizations to invest in a proper sanitation system in Haiti.

But imagine the cost that went into USAID’s program ($200 million) that distributed water purification tablets, a temporary solution that requires constant distribution and payment to populations all across the country – wouldn’t it be more effective to build one treatment center to treat the waste contaminating the community’s water source? What of the UN tracking communities that are “open defecation free,” which could mean individuals are simply defecating in a bucket and tossing it into a river? Instead, shouldn’t they focus on helping communities become entirely free of feces in the rivers, on the roads and beneath bridges? And what are your thoughts on the Pan American Health Organization’s WASH program ($2.2 billion dollars) that includes plans to install cholera treatment centers and toilets in hospitals rather than focus on projects that would keep people out of hospitals?

Each of these projects, and the hundreds of others like it fall into a range of $10 million to over $2 billon, amounting to billions of dollars of aid to improve water and sanitation in Haiti. According to Jonathan Katz’s article, a nationwide sanitation system would cost approximately $1.6 billion dollars. So it seems that if these organizations were truly intent on helping Haiti as they so valiantly claim to do so in their social media presence and pleas to funders, they would combine their funding and work together to build septic tanks, underground pipes to transport the waste, multiple treatment centers in each of Haiti’s 10 departments and mandate safe disposal sites in close proximity to the treatment centers. Ideally, of course, this would all be done under the surveillance and management of DINEPA, who, given that Haiti is a sovereign country, should have the final say in all things water and sanitation on the western half of Hispaniola. But the refusal of international organizations to acknowledge the authority of the Haitian government is simply the continuation of a centuries’ long pattern of denying the sovereignty of the Haitian government.

If though, these aid organizations change their intentions and choose to do what is best for Haiti rather than what is best for their annual newsletter to donors and project statistics, they need to work to achieve one thing and one thing only: a sanitation system. Not disjointed projects across communities with wells that work for one month or toilets that block up after a year because there is nowhere for the waste to go or monthly shipments of chlorine tabs. No, instead they need to partner with the government and go from department to department, giving their funding as well as their knowledge to the municipal sanitation departments who will then construct treatment centers, install septic tanks and coordinate waste pick up and transportation methods.

If though, donors and international organizations choose the traditional route, of working independently on disjointed projects with little cooperation or respect for Haiti’s sovereign government, it will only be a matter of time before another storm hits Haiti and another spike in cholera follows.