There's never a good time for cholera

As if the chaos surrounding the elections wasn't bad enough, two pieces of news that compound tensions come at a terrible time.

One, which it seems all Haitians are already convinced of, was reported on the very good blog Goat Path. A member of the CEP, fearing for his life, said last night:

“President Preval put pressure on us,” he explained, “we were forced to include Celestin in the second round.” I was shocked, this man was clearly scared for his life, yet he was divulging this huge bomb of information that the President of Haiti forced one candidate out of the run-off, and inserted his own hand-picked candidate into his place. “We kicked Martelly out of the race, and now the people are going to destroy the city,” he said. I prodded further, asking him what the correct percentages were. “Manigat had 39%, Martelly had 27%,” he said, “and Celestin had 15%.”

Added to the report from French epidemiologist Renaud Piarroux confirming with some authority that cholera in Haiti came from Nepalese MINUSTAH troops dumping their sewage into a tributary of the Artibonite River, there is understandably a lot of anger here. Still, many Haitians have a pretty fiery demeanor, but initial anger can quickly subside. Too soon to say if that will be the case on a national scale though.

Elections mean a day off, I guess

Oh, fellow faithless bloggers, I hope the world forgives us. Maybe I’ll make up for it by sharing election riot news.

The elections were held on November 28th, just a couple of days after our great Thanksgiving dinner. Volunteers and our kitchen staff worked all day making a great combination of Haitian and American food, and we invited all our local volunteers, guests, and friends in the community for dinner. I got stuck on door duty for a couple hours, checking that people were on the guest list, but even so it was a warm, loving Thanksgiving with about 120 people. We had stuffing for two days after.

Then on Sunday the 28th and Monday the 29th, we were on lockdown. No one allowed to leave the base. It turned out that Leogane, like in past elections, was quiet, but there were lots of irregularities in the voting and violence or riots in response. Many people reported to the same polling places they’d voted at for years, only to find their names weren’t on the rolls. There were reports of men with guns chasing people out of polling places and people stealing or stuffing ballot boxes. Twelve of nineteen candidates called for the results to be cancelled, though the CEP, the governmental provisional election committee, said only four percent of voters had trouble voting and declared the results valid. Every Haitian I talked to suspected the CEP of rigging the results and ignoring widespread fraud, which, since the CEP is appointed by the president, isn’t so implausible. One alternative interpretation is that the CEP didn’t invalidate the election because, though they can’t change the fraud, they can hopefully cause some calm by encouraging a smooth transfer. I think the truth probably has some of both of these speculations.

Haitians felt cheated, hopeless, angry, and cynical, and rioted. A polling place in Saint Marc, the center of the cholera epidemic, was set on fire by people who couldn’t vote. MINUSTAH, the UN peacekeeping mission, was on high alert. When there’s a security incident, we call MINUSTAH and all these really nice Sri Lankans in blue helmets show up. Since they were too busy to look out for us, we stayed on base. There were riots in Port au Prince, Cap Haitien, Petionville, Petit Goave, Grand Goave, Jacmel, and probably other places all around Leogane, but not in Leogane. We had one noisy march, or manifestation, go by the base, full of a few hundred people who were upset that their candidate for mayor didn’t win, but there was no violence here. Not in November, anyhow.

Since then the whole country has tensed. We first heard reports from friends, ex-volunteers, and other NGOs that people in the countryside strongly associated foreigners, blancs, white people, with cholera. An NGO testing water in a village was chased out by a mob. A group of two current and two ex-volunteers with us were arrested for, essentially, swimming in a stream while white. They were released after a couple of uncomfortable hours, but the experience has made us all cautious. In the last day or two, people in Leogane, who are used to seeing blancs around and have an idea what NGOs do, have, kind of inarticulately if you ask me, started to point at us and shout “cholera!” This is discomfiting, but not dangerous. Not yet. Well, not as of yesterday.

Yesterday, the election results were announced by the CEP at 6 pm. Madame Mirlande Manigat, the former first lady and a known front-runner, received 31.37%. Jude Celestin, the son-in-law and first choice of outgoing president Renee Preval, received 22.48%. Michel Martelly, a former pop singer known as “Sweet Micky” and the favorite here of everyone I talked to in Leogane, got 21.84%, less than a percent difference from Celestin. A runoff is scheduled between Manigat and Celestin for January 16th. As of this morning, there were gunshots, riots, roadblocks of burning tires, and street protests all over Port au Prince. Especially since the results were inconsistent with what the national Election Observation Council, the US embassy, and other monitors saw on election day, because Celestin wasn’t a front runner before the election, and because everyone believes the vote was rigged, people are rightfully angry. In Leogane, which was very calm on election day, in contrast to other parts of the country, there was a “manifestation,” or march last night with drums and singing. We’re not sure how many people were involved. There are two known roadblocks in town, one near the bus station and one in a part of town where we also had a chaotic distribution of sanitation supplies last week. Outside of town, in Carrefour Dufort, the market stalls have been pulled into the street, and in Grand Goave, burning tires have blocked the bridge.

Naturally, we’re on lockdown, confined to base for at least the morning, though I think likely the whole day and maybe more. This is the third or fourth time we’ve been on lockdown since hurricane Tomas, and the mood is a lot lighter than during the storm.

And oh yeah, we finally started machine demolition and rubble trucking in association with our cash-for-work rubble clearing program. This post is too long already, so I’ll post photos and observations about heavy equipment in Haiti in my next blog.

Mud, and what it holds

Hurricane Tomas has been hard on Leogane, hardest on the tens of thousands in the Ouest department, which Leogane is the capital of, still living in crude, homemade shelters in IDP camps. All Hands spent about a day and a half in lockdown, no one in or out of the base, watching the steady rain. The winds didn’t pick up. It didn’t even rain very heavily, certainly nothing like the torrents we saw during the rainy season, but it rained for days, and flooded a lot of the town. All Hands has, historically, arrived on site with just a small assessment team a week or so after a disaster. Big volunteer operations usually don’t start until a month after a disaster. Here we were in the middle of a disaster, and there was some concern about what our response would be, or if a big group of volunteers of widely varied skill sets could do any good.

Turns out, we can do tons of good:

Hurricane Tomas Flood Response; Episode 1 from All Hands Volunteers on Vimeo.

Shoveling mud out of peoples’ homes is one of the most draining, wrenching things I’ve ever done. The flood response mud teams are brought into aching intimacy with how the hurricane wrecked these peoples’ lives. Shoveling, bucketing, or sweeping mud in a small, dank, reeking, windowless concrete room that was once a man’s bachelor apartment, or a family’s living room, is heartbreaking. Their soiled linens, furniture, cookware, keepsakes, and clothes stand in the mud because families didn’t have the heart to pick them up, and didn’t know how or have the tools to clean up for themselves. Clearing mud is also one of the best things I’ve ever done. It is the most direct good I can imagine doing for people in need. Despite the mud being at least a little, and maybe quite a bit toxic with disease, fuels, battery acid, overflowing sewers, and god knows what, our volunteers are passionate about clearing it. Neil, one of All Hands’ very long-term volunteers who works harder than a team of Clydesdales, thrives on it. When the team he was leading finished mudding Hospital Saint Croix, which was closed due to flooding, he said, “It’s the best thing I’ve ever done.”

There’s a place for heavy equipment in mudding, too. I spent a day in one of our Bobcat skid steers clearing streets that were knee-deep in watery mud. Driving a Bobcat flat-out and pushing a giant wave of a couple hundred gallons of mud is a bit mind-blowing. It sure impressed the neighbors, who were the most appreciative of any crowd I’ve seen in Haiti. One man spent ten minutes just thanking us in great English. Another, with an irrationality that’s common here, stopped me to yell at me to help clear their street. At least, I think so. My Kreyol is pretty bad.

“Stop! Help us! Move the mud!”

“That’s what I’m here to do.”

“HELP! MUD! MOVE!”

“Um, okay. I’m going to move the mud now. Could you stand back a bit please?”

“Thank you thank you thank you thank you.”

The Bobcats’ current project is clearing the grounds of Lekol Saint Croix, a school next to the hospital, which is an acre-sized mudbath, and mildly nightmarish, even for machinery. Both machines are finally working today (I’ve fixed a broken hydraulic coupling and a broken engine mount this week), so we ought to be able to knock it out, hopefully for the school to re-open on time on Monday. I don’t know when the mud will dry, but some of it is three feet deep and untraversible by people or vehicles. We could be moving mud with Bobcats for some time.

I called it a mud pit, right?

The mud dump. 

Landon, Bobcat, mud. Sublime in its simplicity.

Nothing to do for mud but scoop it out.

The real consequences of Hurricane Tomas for Leogane are just beginning, though. MSF has reported six cases of cholera in Leogane, at least some of which, apparently, originated here instead of the Artibonite region where the outbreak originated. None of which, however, are “confirmed.” Despite MSF doctors making confident diagnoses of cholera, these cases may never be confirmed. We’ve found out that confirming cholera is a myth, or maybe just a bald lie, though. All patients with suspected of cholera have samples sent to the MSPP, the Haitian Ministry of Public Health, which is responsible for the official confirmation and reporting. It’s now widely said, by various people in the Health or Water, Sanitation, and Hygiene (WASH) “clusters” of UN agencies and NGOs, that the MSPP dramatically underreports cholera cases to avoid panic. This is shocking and incredibly stupid. For one, people are already freaked out. Two, underreporting will under-mobilize the humanitarian response, which is the only thing stopping this from spreading like a California wild fire. MSF are no fools though. They’re the designated entity for cholera response in Leogane, and they’re going ahead and treating these six people for cholera whether the MSPP “confirms” them or not. For those of you worried, cholera is eminently preventable by simple hygiene. It has a very low incidence of transmission from patients to health care workers, because it’s so avoidable. We’re buying materials for 500 household sanitization kits, which we hope to distribute in the next day or two, and designing informational material in Kreyol about how fucking preventable this disease is. The outbreak in Leogane is frustrating, worrisome, and sad, but it will certainly keep the job from being boring.

Tomas Is Upon Us

In the spirit of updating concerned friends and family, here’s my latest on Hurricane Tomas.  All Hands’ base is wet, but fine. Our drainage is good and we’ve been making preparations for days. Work has been mostly halted since yesterday;  we’re now just biding out time, reading books , playing cards, doing the last little details of storm prep, and writing blog entries. Leogane isn’t so lucky. Marc and Stef, our indefatigable leaders, scouted from base to National Highway 2. They report flooding up to a couple feet in a lot of central Leogane and out onto the highway, and, we have to assume, beyond. Haitians, I’m told, don’t like rain normally, and most people are staying indoors, but no one’s panicking and there are people on foot, motorbikes, and in SUVs going about what I assume is essential business. The coffee and frite ladies across the streets are open. Rain is constant, but varying between very heavy torrents and a drizzle. That part actually reminds me of Seattle.

In a way, it’s a relief that Tomas is finally here. We’ve been having multiple meetings a day, moving or securing, as Landon described, “obscene quantities of stuff,” and generally fretted since the storm formed in the Atlantic almost a week ago. If it’s this bad, or even a fair amount worse, we’ll be fine. As always, we’re more worried about Haitians, especially the 1.3 million still living in shelters made from 10 month-old tarps, scraps of wood and tin, and whatever scrounged materials they could find after the earthquake in January. The camps were thrown together in haste, without a thought to drainage, sanitation, or the long-term occupation that is becoming their reality. Even people in relatively sturdy homes are being flooded out, though, and their normal refuges in hurricanes, churches, schools, and public buildings, have largely been destroyed.

Stolen from Marc’s twitter, here are photos of central Leogane:

Place Anacaona, by the bus station downtown:

On Rue La Source:

A UN patrol on the National Road:

Even with crude drainage ditches, the Pinchinat IDP camp in Port au Prince has been “destroyed,” reports twitter user gwennmangine, via Paul Clammer, the writer of Lonely Planet Haiti, who’s spent time volunteering with us:

Base is tidy though. We’ve nailed the plastic shower doors shut:

Tied down shelves:

Filled sand bags:

Shielded the bunks:

Largely evacuated the roof:

Pulled the skin off the meeting/eating tent in the front yard:

Tomas

Hurricane Tomas is now just tropical storm Tomas, which doesn’t sound too bad, does it? There’s still a chance it could strengthen back into a hurricane by the time its center reaches us, early Friday morning. And we’re still in the “non-navigable” semi-circle of its track, where the winds are highest and mariners don’t go. We could see winds up to 65 miles an hour, but probably won’t. What we will see are heavy rains.

Last night was clear and cool, about as nice a night as we can have in Haiti. I was greeted by a group of drunk, face-painted, singing, dancing revelers carouse past the corner bar in their holiday finery, celebrating the Day of the Dead in Voudoo style. Then I lay on the roof watching shooting stars until way past my bedtime. Right as I fell asleep I thought, Man, this is the most cliché calm before the storm I could dream of.

When I woke up today the sky was cloudy, and a cool breeze was blowing. Everything felt ominous, but it may have been the mounting tension among the 75 people on the base. Almost all field work was suspended today in lieu of tying down or stowing everything that could blow or float away. If it comes down to it, we can shut ourselves into rooms that are as weatherproof as we can make them for a day or so.

What we’ve all learned from constantly checking stormpulse.com, the National Hurricane Center, and the Weather Underground is that people can’t predict the weather very well, and big storms are very fluid. Tomas has gone from a category two hurricane down to a tropical depression, almost dispersing, then coalescing back into a tropical storm.

The only thing we’re sure of is that, as always, it will be the poorest people, the 1.3 million people still living under tarps and bedsheets, that will be the hardest hit. After the storm passes, the IDP camps will be everyone’s highest concern. Sanitation, food, water, and medical care will be critical over the next week, and the cholera epidemic, which hasn’t gone away even with a hurricane menacing, could worsen.

Despite the potential for further disaster, big storms are completely humbling:

Oh, I almost forgot. In the midst of all this, I’m actually making progress on the reason I came back to Haiti in the first place. I’ve written or co-written proposals for funding for heavy equipment, one of which, to IOM, the International Organization for Migration, looks like it could be accepted quickly and we could be start moving a lot of rubble. Tomorrow, Marc, Nate, and I are going to observe Samaritan’s Purse’s heavy equipment demolishing houses for the Spanish Red Cross’s shelter program, which will hopefully be very educational.

The annual appeal

I'm working for All Hands Volunteers, which used to be Hands on Disaster Response. Our media team put this together essentially entirely here in Leogane, which is impressive enough, but I think it's also a good video and overview of the organization. Yes, it's a shill for money, but it gives you a pretty good idea of what I've been doing here much of this year.



Annual Appeal for 2011 from All Hands Volunteers on Vimeo.

Cholera

The cholera outbreak in the Artibonite valley is far from us here in Leogane. Well, far by Haitian standards, where the 40 kilometer trip from Leogane to Port au Prince routinely takes up to four hours. I don't know much more than what's on the news; Thursday night we heard rumors of sickness from contaminated food or water that was in the North but might have spread. Today, there are 254 confirmed dead and over 3,000 sick. Cases have been reported outside of the Artibonite valley, despite what seems like a large WHO, PAHO, UN, Government of Haiti, and NGO effort to contain the epidemic. From Leogane, there's not much All Hands can do besides watch. If you're thinking of helping, Partners in Health is probably the best situated to treat and contain the outbreak.

I've learned a lot about cholera in the last two days. It kills, and spreads, by intense diarrhea and vomiting. Maintaining sanitation and clean drinking water are the best ways to prevent its spread and are basically impossible in Haiti. It's a country of nine million people with no water or waste water treatment plant. Ditches full of fetid water, overflowing pit latrines, and tainted wells are common. In the IDP camps, which are everywhere in a large radius around Leogane, conditions are much worse. This map is a day old, but shows two key facts about this epidemic: Saint Marc in the Artibonite division, which is the area of the outbreak, and the location of the main IDP populations. The cholera is still, probably, miles and hours from the camps around Port au Prince. If it reaches those camps, though, it will be very difficult to treat and stop.

From Biosurveillance, where the IDIS scale is also explained

Update: 

Blogging about this is tough because news changes so quickly. When I wrote the above paragraphs last night, there were no confirmed cases of cholera in the capital. A few hours later, there were five. It doesn't sound like there have been any more in Port au Prince since last night, and Alert Net says the outbreak may be stabilizing. The rates of new infections and deaths are much lower. People are concerned but not at all panicked, at least, not in Leogane. Yesterday we took the afternoon off of work, as scheduled, and had a super relaxing barbeque for lunch, with the best food I've had since I returned, three weeks ago today. The mood has changed from anxious planning on what to do in variously escalating scenarios, to a calmer wait-and-see. I admit, watching the updates on Twitter that are tagged #Haiti #cholera didn't help my nerves. Of course, it's as much a stream of inaccuracies and speculation as information.

Here are some links that I've found useful on the situation:

MSF's Definition and Treatment of Cholera

The US Embassy in Haiti's Warden Message on the outbreak

Twitter's semi-literate babblings, in which people apparently make up random facts, like "How did u let this hapn when u nu hait wud have cholra!!!" but, once in a while, has useful links.

And if you want more fodder for worry, and occasional hope, go ahead and google Haiti & cholera twenty times a day like I do.