Cholera in Cuba: From Kathmandu to Havana

Graham Sowa

Graham-1HAVANA TIMES — Some people said the arrival of Cholera to the island was an overdue failure of Cuba’s much acclaimed public health system.

Others said it was an unavoidable consequence of the Cuban Government sending its doctors on medical missions abroad and inviting foreign students, such as myself, to study on the island. Others had no comment.

As usual many stories were lost in excitement, rhetoric, and official silence that almost always accompany news headlines.

I’m going to try to recover some of that insight we might have skipped over in those first few weeks by offering a broader perspective and some more personal stories to what happened when Cholera returned to La Havana.

It probably came from Nepal, via Haiti. The United States Center for Disease Control says the current strain of cholera ravaging Haiti, Cuba’s neighbors to the east, came from United Nations troops from Nepal. The Nepalese troops, like most people in Haiti, let their human waste drain into a river (the Artibonite) where it flourished and spread throughout the countless mountain streams in the western half of Hispaniola.

Then one day someone, maybe a doctor, student, tourist or fisherman, brought the disease to Cuba. It is a story as old as the arrival of Columbus. New world, meet old world. Play nice.

In December we heard about Cholera in eastern Cuba. The government didn’t say anything at first. Then they said there were some cases, and a few deaths, but everything was under control.

Interestingly before Cholera ever arrived to Cuba it had arrived various times to the Dominican Republic, Venezuela, and Miami (which, geographically, happens to be in the United States of America).

Cuba probably avoided being in the early group of recipients due to travel restrictions of individual Cubans (which changed January 14th), and the “National Epidemiological Control Program” which places doctors and most foreign medical students in a 5-14 day quarantine after arriving to Cuba from abroad.

Graham-2Of course I could be off base, and maybe the Cholera in Cuba came from an indigenous reservoir. Or maybe it was an act of bioterroism. But both of these ideas are more ridiculous than probable.

So while Cholera made its debut in Eastern Cuba the residents of La Havana talked about yet another problem coming from “el oriente”.

Cholera’s arrival to La Havana probably happened around the First of January, the biggest travel holiday for Cubans. Someone traveled from the eastern end of the island to the Capital and they brought Cholera to La Havana.

I heard about the first suspected cases the second weekend of January. I say “suspected cases” because the confirmatory diagnosis of the disease is done at the Institute of Tropical Medicine in Municipio Playa, where all patients were quickly transferred too.

Anyway, the word on the street, and in the hospital hallways, was that these early cases all originated in Cerro. This is the same neighborhood where I live and where the hospital I work at, Hospital Salvador Allende, is located.

Before you know about Cholera in Cerro you need to know about Cerro. Cerro is not well looked upon by anyone who doesn’t live here. It is considered a marginal and dangerous neighborhood that is dirty and overpopulated. I don’t agree with that assessment. However that is pretty much the only review of the neighborhood I have heard by people who live in other parts of La Havana.

So it made sense to most of Havana that Cholera would show up first in this poor part of the city. But what really scared people was that the lifeline of the city’s water supply “el canal” runs through Cerro. Therefore pretty much everyone in Havana, including those fine, upstanding residents of Vedado, drink water that passes through Cerro.

The administration and workers at the Hospital Salvador Allende reacted quickly to the arrival of these cases of “acute diarrhea”. A small part of the hospital was converted to an “acute diarrhea” ward within a few hours.

Restrictions were put in place on who could enter the “acute diarrhea” ward. Only attending nurses and doctors, dressed in protective gear, could go in. The familiar smells of the hospital, which consist of various human bodily fluids, tropical humidity, and cigarette smoke, were replaced by the irritating, yet somewhat comforting, nasal burn of chlorine.

Chlorine was all of a sudden as popular as the British Flag. People were squirting it onto our hands before we ate lunch. We had to rub our feet on chlorine soaked cardboard before entering the hospital and dorms. Every glass of water I have drank since that second week of January tastes like it came from a swimming pool.

But amidst the chlorine doused spree of newfound hygiene in this dirty part of La Havana the government still wasn’t saying anything to the populace. At least nothing that I heard.

Then one day in the middle of January I couldn’t buy food on the street anymore. All of the cafeterias were closed. At first I thought the cuentapropistas got fed up paying their taxes and had decided to form their own workers union and strike. But I was wrong.

The government decided to try to limit the risk of spreading the disease by decreasing sources of contamination. A good move by epidemiological standards.

I think here it is important to point out (and I know I’ll sound like an apologist but whatever) that even though the Cuban Government was not saying anything publicly about Cholera in La Havana they were moving relatively quickly to put control measures in place.

It is true in any epidemiological emergency there is a protocol for protecting the population and a protocol for informing the population. This is to avoid disorganization and panic created by people who react to danger by being hysterical fools.

Graham-3On the contrary I did notice that things really improved when the Government started talking publicly about the Cholera outbreak. By this point, maybe a couple of weeks after we saw the first cases, there were public service announcements and long, boring, discussions taking place on Mesa Redonda.

But even though the Government was now talking publicly about the outbreak I think the situation was anticipated to get worse before it got better. At the hospital there were more “cholera beds” installed. Basically military cots with a hole in the center for the diarrhea to run through.

But the patients never arrived. Within another week the “acute diarrhea” ward of the hospital was converted back to its previous function of the Observation Room and a small section of the emergency department was kept isolated to receive the infrequent cases of “acute diarrhea”.

I imagine the situation will remain like this for the foreseeable future. Like Dengue, Cholera will now become another disease we will work to eradicate from the island for a second time.

The reemergence of Cholera in Haiti, The Dominican Republic, Venezuela, Miami, and Cuba is more than the acute failure of any political ideology. It is the price we pay, again and again, for a highly mobile human existence on a planet rich in biological diversity.



Graham

Graham Sowa: I've been living in Cuba for three years now. I would like to blame my obvious hair loss seen in this updated photo on the rigors of life here and medical school, but it is probably just genetic. I've made some of the strongest friendships during my time in Cuba from other writers on this website. The strength of those friendships has almost restored my faith that the online world can lead to offline and real life change. On that same note I've adjusted to using internet one or two hours a month. In the meantime I have rediscovered things like flipping through the pages of books, writing stuff down by hand, and having to admit that I don't know something instead of rapidly looking up the answer on Google while the teacher isn't looking.

Graham has 89 posts and counting. See all posts by Graham

13 thoughts on “Cholera in Cuba: From Kathmandu to Havana

  • Thanks Griffin. Excellent report. Very thorough. Thanks to UN Developent Fund money (insert US taxpayers) and the Kuwaitis (insert US car owners), the Castros are borrowing the money to replace and repair. Otherwise it seems they would be pooping in buckets soon.

  • The repair work that Graham speaks of is largely done to replace completely disabled infrastructure. Very, very little is done upgrade old, outdated but functioning waterways. The overwhelming majority of the Havana’s main water and wastewater infrastructure is more than 80 years old, a lot of it much older. As a result, the work that Graham sees getting done is to restore decrepit non-functioning systems. Interesting note: the useful life of the iron pipes buried underground in the harsh limestone rock is well past it’s ‘use by’ date. You can imagine the magnitude of the problem. Buildings in Havana fall down every week. The pipes underground are in worse condition.

  • That is new work then, Graham. Good to hear of it. However, when I wrote ‘fraction” I meant a meaningful fraction. If you have any figures on that number, I would be interested to hear it. (no figures are available as far as I can find).

    My guess is the rate of decay still exceeds the rate of replacement.

  • Griffin, agreed that the investment to repair the water system will be in the billions of dollars. and it is in a terrible state of repair. the entire city (many times private residents) work to keep it functioning. However reality is not on the side of your comment that “no evidence that even a fraction of this investment is being made”. New water lines are being put in in Central Hav., Hav. Vieja, and southern playa/mariano. Saw those with my own eyes. They have streets torn up and are laying pipe. The old pipe is cast iron, which they break apart, and then run some type of polyvinyl(?) through those openings in the old pipe.

  • “Truth is proper and beautiful at all times and in all places…”

    Frederick Douglass
    (Oration in Memory of Abraham Lincoln, April 14, 1876)

    My hat off to you, Sowa, for a very objective appraisal of the recent outbreak of cholera in Cuba. And, as the Frederick Douglass quote affirms, you do not have to apologize for telling the truth – giving credit to Cuba where credit is due in its efforts to fight the disease. (Just as we must criticize where criticism is due!)

    I share your belief that the disease most likely made its way from Haiti to Eastern Cuba, and, as others have pointed out also, with Hurricane Sandy possibly playing a role. However, this should not imply that biological warfare agents have never been used against Cuba. The record has long been established.

  • Unless you plan to carry an entire sewage treatment plant in your suitcase, your plumbing supplies are not going to do much good. The entire water and sewage systems on the whole island are in a serious state of disrepair.

  • The problem with public toilets is the tip of the iceberg. The entire water supply and sewage treatment infrastructure in Cuba is in a terrible state of decay. It will require several billions of dollars of investment to bring the systems up to standard plus an operations budget of hundreds of millions to keep it running. There is no evidence that even a fraction of this investment is being made.

  • Graham Sowa, thanks for this excellent examination of a health problem in Cuba. You are right to imply that even an good health care system can do better. After all, health care workers are just people who have learned somethings and are trying to do better with that knowledge. While most people have wished at times that magic was real, dealing with facts and how to protect ourselves seems to work best. I do disagree that the spread of diseases, both epidemics and lesser diagnosed ones, are unavoidable. Like Marianne suggests below, improving Cuban public toilets would be an helpful public health priority. I have a Cuban-American friend who brings Plumbing supplies and skills to Cuba. Maybe with normalization, and more people-to-people exchanges, our two countries could each benefit!.

  • Thanks Graham

    Good solid information.

    Always a REFRESHING pleasure.

  • The lack of concerted and consistent maintenance to public waterway systems is a significant cause of the continued reemergence of the cholera pestilence in Cuba. The developed world, through chlorination and filtration of its potable water and by securing the waterpipes have overcome the threat of cholera pandemics common throughout the world in the 1800’s. By Cuba’s own estimates, more than 50% of the drinking water which leaves the filtration plants is leached from the delivery system before arriving into the home or office. Broken or corroded pipes are openings in which treated water is lost and potentially contaminated ground water is introduced to the water supply. Absent securing the integrity of the water supply, Cuba is likely to continue to face recurring ‘mini-epidemics’ of this otherwise easily avoided disease. BTW, political ideology that values maintaining hordes of secret police over sound waterway infrastructure maintenance is a major cause of this third world dilemma.

  • Thank you for that thorough, factual and sensible report on the origins and progress of the recent cholera outbreak. One point was missing, the effect of the hurricane in eastern Cuba on spreading the disease. The damage to buildings and flooding probably gave the cholera a “kick-start”. After that the spread to Havana was inevitable. I hope and pray the disease has been contained and stopped now.

  • We just visited Cuba again, I think it would be good to reorganize all the public toilets, in the most places there is no water in the toilets and no water comming out of the taps, people can not wash their hands!

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