Philip Alcabes discusses myths of health, disease and risk.

In the mouth of death

The Miami Herald‘s article yesterday on cholera reaching Port-au-Prince quotes a homeless resident of the Haitian capital, fearful at the approach of the disease:  “Of course I’m scared — we’re in the mouth of death.”

Haiti today: in the mouth of death.  Not just Haiti, of course.  Deadly, gruesome, and hard to stop, cholera seems emblematic of the many failures that preceded the earthquake and have been exacerbated since.  We Americans are paying attention to Haiti lately — because of the earthquake; because of proximity; or because however bad things are here, what with high unemployment and poor economic prospects, Haiti conveniently reminds us of what we’re not.  But really much of the world, of the dollar-a-day world, is in the mouth of death much of the time.

With cholera, the relief agencies are hard at work.  Ansel Herz, a freelance journalist who blogs at Mediahacker, writes that there have been five cholera deaths in Port-au-Prince as of this morning, although the authorities say those people came to the capital from elsewhere and that cholera isn’t yet spreading in Port-au-Prince.  Still, cholera mortality is over 200 nationally.   Herz describes the earnest efforts of aid workers.  But his reportage, along with that of the Miami Herald, the NY Times, and others, also reveals the shortcomings of relying on aid organizations to contain the complex problems — of which cholera is the latest.

Partners in Health, to my mind the most earnest and committed of the aid organizations, is compiling reports on the spread of cholera and, of course, trying to do something about it.  But here’s the problem: if it’s the aid workers who are trying to stop cholera, it’s too late.  I don’t mean that they’ll fail; I mean that there should have been infrastructure in place to make sure cholera doesn’t break out at all.  And if there’s no such infrastructure, cholera will happen again, however well it’s halted this time.

It’s hard to escape the image, provided by Herz, of a new water tank installed near Cité Soleil by the International Organization for Migration — which stands empty, because nobody has provided clean water to fill it.

This is the problem with aid:  of course there must be organizations, like Partners in Health or MSF, that provide relief to the suffering.  But if there’s no support, or demand, for permanent public health infrastructure, the aid workers will always be scrambling to keep up with crises, and the crises won’t stop happening.

In the New Yorker this month, Philip Gourevitch takes a skeptical view of humanitarian aid (abstract here; full article requires subscription).  He summarizes the message of Dutch journalist Linda Polman sympathetically:

The scenes of suffering that we tend to call humanitarian crises are almost always symptoms of political circumstances and there’s no apolitical way of responding to them – no way to act without having a political effect.

Now, Gourevitch is talking specifically about crises created by political conflict.  But something of this dilemma pervades the problem of relief.  Public health is political.  It takes political will — not just oral rehydration therapy — to install water supplies and sewage systems, and housing with running water even for the poor.

Canada is going to send a million dollars to Haiti to help with the cholera problem (thanks to Crof at H5N1 for picking that up).  No doubt the U.S. will outdo its neighbor in looking mournful and concerned, and donating even more money.  But where’s the support for good government, and real public health, and necessary infrastructure?

What are we doing to promote the implementation of good public health? What are we doing to generate the political will to install even just the ordinary civil engineering works that we take for granted in America, but which would make a difference to the people who are living in the mouth of death?

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This entry was posted on Sunday, October 24th, 2010 at 3:58 pm and is filed under epidemics, News, Outbreaks, public health. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.