Disasters, discord, poverty. What hardened heart doesn't ache for Haiti? Fifty years after Columbus's arrival, Hispaniola's natives were decimated by disease; by the mid-1700s, French overlords were exploiting Haiti's African slaves. Then came revolution, independence, and more upheaval. Finally, in 2004, after its first democratically elected president was ousted by a coup, the United Nations sent an international force to Haiti.
Six years later came the double whammy from hell. In January 2010, an earthquake killed or injured half a million Haitians; in October 2010, a massive fecal spill sowed Vibrio cholerae in the Artibonite River.
Today, no one denies that Haiti's modern epidemic stemmed from that tragic leak of sewage from a UN peacekeepers' camp. But it was not until August 2016 that UN Secretary General Ban Ki-moon admitted the fact. When he did, retired University of California, Los Angeles epidemiologist Ralph Frerichs was ready. Having recently published Deadly River—Cholera and Cover-up in Post-Earthquake Haiti, Frerichs wrote in the Boston Globe: “It is not enough that the United Nations is finally beginning to acknowledge its involvement in the lethal cholera epidemic in Haiti. Now it must urgently do everything in its power to eliminate cholera in Haiti before thousands more die.”
(The comments were sadly prescient. In the wake of Hurricane Matthew, cholera's grisly toll of withered, gray corpses can only continue to rise.)
In Deadly River, Frerichs largely channels Renaud Piarroux, a French infectious diseases doctor who previously battled cholera in Comoros and the former Zaire. Days after cholera's Caribbean touchdown, Piarroux flew from Marseille to Port-au-Prince at the request of the Haitian government. And here the story begins.
In addition to Piarroux's personal investigations and uncensored thoughts, what distinguishes Deadly River is its deep dissection of cholera and the bond of its two main spokesmen. With equal parts of compassion, analysis, and sometimes strident outrage, Frerichs and Piarroux present timelines, maps, and reports illuminating the truth. Yes, it really was “a large septic plume” emanating from the Nepalese camp near Mirebalais, they show us time and again, that first sullied the Artibonite and later, due to Haiti's woeful lack of sanitation, engulfed the entire country—“not,” as others at the time proposed, an influx of free-living Vibrios from brackish waters near the port of Saint Marc. By the end of the book, we are also convinced that several key actors and pundits conveniently sidestepped this truth. For readers who long to see the underside of a fast-moving epidemic including sins of omission and realpolitik, Deadly River does not disappoint.
Which is not to say it is perfect. For one thing, it contains a lot more “woulda, coulda, shoulda” than empathy for health workers coping with chaos. Some of the good guys are members of the Brigada Médica Cubana who rehydrated thousands at the height of the crisis; the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and respected nongovernmental organizations (NGOs) receive far fewer plaudits. Also missing are voices of everyday Haitians.
Looking back with 20/20 hindsight, of course it would have been smart to screen Nepalese troops for cholera before they ever set foot in Haiti, just as it would have been prudent to better control their compound and sewage. “The UN meant well but boy did they screw up and has the world learned its lesson ….” is one commonly held sentiment Deadly River never quite concedes.
That said, no scientific history can speak for every opinion or stakeholder. In its quest for justice for Haiti, Deadly River serves a virtuous cause. In its staunch pursuit of truth, it also feels heroic. And talk about timing! Now that the United Nations has finally said it will strengthen its anti-cholera efforts in Haiti and compensate victims, that Portugal's Antonio Guterres has succeeded UN Secretary General Ban Ki-moon, and that a new natural disaster has seized our attention, what better moment to reexamine the past and push for redress?
For further perspective on cholera in Haiti, the American Journal of Tropical Medicine and Hygiene (AJTMH) turned to Louise Ivers, senior health and policy advisor for Partners in Health (PIH). Following the 2010 earthquake, Ivers oversaw PIH's on-the-ground cholera operations and also partnered with GHESKIO (a Haitian NGO) in pioneering studies of oral cholera vaccine, a new, cost-effective tool that is rapidly gaining adherents. Ivers now divides her time between Haiti and Boston, where she is a faculty researcher in the Division of Global Equity at Harvard Medical School and a practicing infectious diseases clinician at Brigham and Women's Hospital.