Haiti, Cholera, and the Downhill Flow of Blame

On two visits his year, I have been working out of an office in a beautiful colonial era villa in Petion-ville, Haiti.  From the 2nd floor terrace, I can drink coffee and enjoy the vista of Jalousie, spilling down the steep hillside behind Port-au-Prince. A jumble of bright Carribbean pastels, from my vantage point the community looks cheery, dynamic, and pretty. The cinderblock homes were painted in 2013 by the government as a homage to Haitian artist Prefete Duffaut. The cost: $1.4 M.

Saved mostly from the devastation of the 2010 earthquake, Jalousie swelled afterwards with those displaced from elsewhere in the city.  The crowded settlement is prone to flooding in its steep ravines,  has poor water services, and has little electricity. And residents have suggested that perhaps the money spent painting the houses could have been better spent of improving their basic water or electrical services… rather than this effort to improve the view from the hotel windows and refurbished colonial villas in upscale Petion-ville next door.

It isn’t just people in Jalousie struggling to get enough safe water. In Haiti, getting sufficient clean water is a daily challenge with potentially deadly consequences. In mid 2017, we did 4000 surveys, 70 interviews, and 24 focus groups in some of the most remote and underserved communities in Haiti.* Some 60% of the households surveyed were water insecure. With people forced to use contaminated water sources, there is a major cholera epidemic raging across Haiti. Over 30,000 people have died since 2010, and some 1 million have been sickened (noting estimates vary by source).

The infection proved to be introduced by UN peacekeepers from Nepal, when their improperly handled sewage ran into a river. The UN hasn’t accepted much if any responsibility, or paid any compensation for the resulting illness and loss of life. But they have made attendant policy changes — like mandatory cholera vaccinations for UN peacekeepers, management of wastewater in their camps, and so on. Public health experts do absolutely blame the UN though for the outbreak however, and rightly ask: “Would these policy changes instituted by the UN have taken place if the source of the Haiti outbreak had not been identified?”

House to house surveys, Haiti 2017. Photo: DDG
Interviewing in Haiti, mid 2017. Photo: DDG.

Knowing all this background, I was greatly struck by what people said in interviews about cholera.  People don’t mention the UN.**  They blame the water for the illness. For example, consider how responsibility for the widespread illness is apportioned in the words of Haitian woman living in the rural area of Cornillon: “Cholera came and killed so many people, so many people, because there was no good water to drink.”

This month, a detailed ethnographic study has come out from colleagues working in the wealthier neighboring Dominican Republic (DR). The DR is where many Haitians migrate (without legal status or protections)  to earn money to feed their families. They face dreadful racism and other forms of discrimination – not just name calling and other humiliations, but direct physical violence too.  Our interviewees told many stories of murders of Haitians in the DR or along the border that went unprosecuted by the DR government, and were triggered by nothing more than being Haitian.

Cholera has now spread into the DR, with some 500 deaths to date.  In the DR, the blame isn’t placed on a dirty UN, dirty rivers, or dirty water. It’s dirty Haitians. As one Dominican man explained: “Over there [in Haiti], they live underneath trash. They do their necessities; they do everything, and that’s why they get sick. And besides, they don’t have hygiene.” As Hunter Keys and his co-authors go on to explain in this new study, the stigma of cholera feels inevitable to the migrants. Just really more of the same. As a Haitian woman living in the DR told them: “When cholera was just affecting Haiti but hadn’t yet come to the Dominican Republic, the Dominicans were always humiliating the Haitians, [but] after it finished ravaging Haiti, it came to the Dominican Republic, and they said this illness came along with the Haitians.”

And, the Haitians in the DR feel powerless to fix either the disease they are blamed for or the stigma it engenders, layered as it is with dirty work conditions, lack of water, lack of health care, and lack of legal status in the DR. The DR government’s stigma-motivated efforts to control Haitian documentation and migration as part of their cholera response has just made things worse, spurring new cholera outbreaks along the border in the forced deportation camps.

And so goes the disease blame-game.  It always flows downhill — like the peacekeepers’ sewage. And with death trailing behind in the wake.

* Our ASU Global Impact Collaboratory is providing technical support to baseline study for the USAID-funded Justice Sector Strengthening Program. Our fantastic parters include Chemonics International and DDG (Diagnostic and Development Group). Here is a grainy pic of the team together in Haiti in November 2017.  

** Some 30% of those we surveyed are illiterate, which may be part of the explanation here.