Almost a year ago 230,000 people died in Haiti after a devastating earthquake struck the country. Today more than a million survivors remain displaced. And in recent weeks, a worsening cholera epidemic has killed more than 2,000. Many Haitians feel angry and frustrated – and helpless to improve their lives. This has fueled riots that have plagued the capital, Port-au-Prince, since a disputed presidential election was held in November. We’ll talk about efforts to address the cholera epidemic and the political crisis in the beleaguered Caribbean nation.

Guests

  • Dr. Anthony Fauci director of the National Institute of Allergy and Infectious Diseases/NIH.
  • Sebastian Walker Haiti-based reporter for Al Jazeera English.
  • Robert Fatton Jr. professor of politics and government affairs, and associate dean for graduate programs, University of Virginia. He is the author of "Haiti's Predatory Republic: The Unending Transition to Democracy" and "The Roots of Haitian Despotism."

Transcript

  • 10:06:54

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. A worsening cholera epidemic in Haiti has claimed more than 2,000 lives since mid-October. That nation of 9 million also faces a political crisis. Key candidates in last month's presidential election have rejected a recount proposed by Haiti's election council. Joining me here in the studio to talk about Haiti, Dr. Anthony Fauci of the National Institute of Health. Joining us from a studio in Virginia, Robert Fatton Jr. of the University of Virginia. By phone from Doha, Qatar is Sebastian Walker of Al Jazeera English. And throughout the hour, we'll welcome your questions, comments. Join us on 800-433-8850. Send us your e-mail to drshow@wamu.org. Feel free to join us on Facebook or send us a tweet. Dr. Fauci, good morning to you.

  • 10:08:17

    DR. ANTHONY FAUCIGood morning, Diane.

  • 10:08:18

    REHMI want to start with you and get you to tell us what is known about this cholera epidemic.

  • 10:08:27

    FAUCIWell, it's a serious situation, obviously. There have been now -- it was first recognized just a couple of months ago in October, and, now, we have approximately 100,000 hospitalizations, about 2,200 deaths. Really, in a situation in which the infrastructure with the poor sanitation, the lack of easily accessible, drinkable, clean water -- and that's how this disease has really spread, is from contamination of the water through fecal material, contamination of food. It is a very serious outbreak, hitting a country that already has so many other areas in which they're suffering.

  • 10:09:10

    FAUCIThe cholera is a bacteria, as you know, that causes very profound, acute, profuse, watery diarrhea. The difficulty with it is that it's so acute and so dramatic that if you don't get help fast -- by help, we mean fundamentally rehydration, getting fluid back into you -- people have been known to die literally in a couple of hours from the time the symptoms are -- it can go for a few days. But some people with a severe form, if they don't get into a medical facility where they can be rehydrated, either orally or through intravenous, it becomes a very serious disease.

  • 10:09:50

    REHMSo where is the bottled water coming from that everybody else seems to be drinking?

  • 10:09:57

    FAUCIWell, if the -- as you know, the United States, particularly USAID, PAHO, Medecins Sans Frontieres, some of the facilities that are being used for PEPFAR are all working in overdrive down there to try and not only get water to these individuals but also to provide better sanitary conditions, so that you don't have even further spread of this very difficult situation.

  • 10:10:22

    REHMNow, what about the reports that this particular strain of cholera was brought to Haiti by UN Peacekeepers from Nepal?

  • 10:10:35

    FAUCIWell, you can't say who brought it there. But the molecular fingerprinting that was carefully done by a number of investigators -- some from California, including several from Harvard -- that was just recently published in the New England Journal of Medicine, have been able to make some definitive statements about where it came from. You can't say who did it. You can't be pointing fingers at this time at all. When cholera epidemics -- we're in the seventh historical cholera epidemic right now, and the cholera that began -- the seventh epidemic began in 1961. And then by 1991, it got to Latin America, and it has a particular molecular fingerprint.

  • 10:11:16

    FAUCIBy that, Diane, it means that if you look at the makeup of the DNA, you can tell exactly what that particular cholera is. And we know that the cholera that's making people sick now in Haiti is not the cholera that has been in Latin America since 1991. It's molecularly identical to the cholera that we know is in South Asia. That's all we know.

  • 10:11:41

    REHMThat's all we know.

  • 10:11:42

    FAUCIWe can't say that this person did that or this group did that. We know that it didn't come locally from Latin America.

  • 10:11:49

    REHMDr. Anthony Fauci is director of the NIH's National Institute of Allergy and Infectious Diseases. Turning to you, Sebastian Walker, I gather you were one of the first reporters to arrive at a hospital near the initial outbreak. Tell us what you saw.

  • 10:12:13

    MR. SEBASTIAN WALKERWell, that's right. We were the only TV crew who actually arrived on the scene where the rumor was that the sewage spillage from the base where Nepalese UN peacekeepers were located was actually seeping into a nearby river. Now, this is -- I think it was about a couple of weeks after the outbreak actually appeared. So there were cases just downstream -- dozens of cases, in fact -- in the nearby town of Mirebalais. And what we saw when we arrived at this base, which was located right from the bank of the main river that flows into the town, was a group of Nepalese Peacekeepers, UN Peacekeeper soldiers, working furiously to try to contain what appeared to be a spillage of sewage that appeared to be coming from latrines.

  • 10:13:03

    MR. SEBASTIAN WALKERNow, we asked the soldiers who were trying to dig some ditches to -- it seemed like contain the runoff from these latrines. We asked them, you know, are these toilets right there? And they confirmed to us that they were. There was black liquid in pools on the ground that was running from just inside the base down the bank and right into the river, and it certainly looked and smelled like raw sewage. The smell was overpowering. And there were lot of UN soldiers furiously trying to clear this up. Now, they wouldn't tell us what was going on at that point. It came just after rumors on the local Haitian radio stations that there had been a spillage. And the rumors were that, you know, this is possibly a source of the contamination.

  • 10:13:47

    MR. SEBASTIAN WALKERAnd it's actually been backed up by the conclusions of a report by a French epidemiologist, who has also suggested that the base, this particular base outside the capital, Port-au-Prince -- it's actually in a rural area near the actual hearth of where the disease is raging -- could actually have been the source of the contamination. So, I mean, I think a lot of questions remain, and we may never actually find exactly what the source was. But, certainly, what we saw at this base was really just an example of how little oversight there often is in terms of sanitation. You know, this liquid was just flowing into a river where Haitians living downstream use the water for drinking and washing. And they really depend on this source of water as many Haitians do across the country. The fact that there was this liquid seeping into the river was certainly worrying.

  • 10:14:44

    REHMTell me about how the hospital itself was able to handle those first patients who were showing up.

  • 10:14:55

    WALKERWell, it, frankly, wasn't able to handle just the sheer volume of patients who were arriving. We arrived at the main hospital in the town of Saint-Marc, which is in the rural Artibonite region, where the disease first appeared the day after reports of dozens of people dying of this mystery disease which was shortly confirmed afterwards as being cholera. And the scenes were certainly some of the most affecting that I've seen since arriving in Haiti in the aftermath of the earthquake. Just, you know, streams of patients arriving in appalling conditions -- had often driven for hours on the back of trucks from remote towns and villages across the region in a state of severe dehydration. We walked into the grounds of the hospital, and the scenes in there were horrific.

  • 10:15:42

    WALKERThere were patients, you know, lying everywhere across the grounds of the hospital being treated outside. People were dying constantly. With the short time that we spent in the hospital, we saw, you know, patients dying every 15 minutes or so. It was really a very concerning sight and really an indication of just what's to come. And now, as we know, the disease has spread around the country, and Haiti is facing a nationwide outbreak of this very serious disease, which as your doctor was saying is really just the worst possible development in a country where sanitation standards were already bad, even before the earthquake. And now there's this very vulnerable population of more than 1.5 million Haitians living in these very basic IDP camps with hardly any sanitation and very little access to drinkable water.

  • 10:16:38

    REHMSebastian Walker, he is a Haiti-based reporter for Al Jazeera English which opened a news bureau in Haiti shortly after the Jan. 12 earthquake. Dr. Fauci, back to you, how long has it been since Haiti has experienced cholera?

  • 10:17:02

    FAUCIThe last full-blown outbreak of a cholera epidemic was literally a century ago, so it's been quite a while since they've had any serious epidemic of cholera.

  • 10:17:17

    REHMAnd hearing what you've just heard from Sebastian Walker, it would seem that somehow there was a failure of sanitation somewhere along the way.

  • 10:17:29

    FAUCIWell, there's no question that you don't get a cholera outbreak. You can have a sporadic case here and there. But to have an outbreak of this magnitude, it would have to be what we know from the textbooks going back years and years and even historically, is poor sanitation, contamination of drinking water, and water that gets into food through fecal contamination just as was mentioned here. So, clearly, the whole idea of sanitary conditions is an absolute sine qua non to have a outbreak of cholera.

  • 10:18:02

    REHMDr. Anthony Fauci, he is director of the NIH's National Institute of Allergy and Infectious Diseases. Sebastian Walker is a Haiti-based reporter for Al Jazeera English, which opened a news bureau in Haiti shortly after the Jan. 12 earthquake. When we come back, we'll talk with Prof. Robert Fatton Jr. He is associate dean for graduate programs at the University of Virginia. We'll talk about the Peacekeepers, the election and what's to come for that beleaguered nation of Haiti. Stay with us.

  • 10:20:03

    REHMWelcome back. We are talking in this hour about what's happening to Haiti and in Haiti, both medically and politically. Here in the studio, Dr. Anthony Fauci. I wanted to ask you one more question about how quickly cholera travels.

  • 10:20:25

    FAUCIYeah, well, cholera can travel very quickly if you have contamination of water supplies, if you have poor sanitation. It can spread -- as it did, it started off in one relatively remote area in Haiti. It was in a -- what they call a district or a component. There are 10 of them in Haiti. Now, it's spread literally throughout the country and in Port-au-Prince in a very short period of time. So it has two aspects of it. One, it can spread rapidly. And, two, within an individual, they can get sick and die breathtakingly rapidly. I mean, if someone comes in and starts to feel badly, if they just happen to live a few hours from a hospital where they can get rehydration, and they don't make it, they could literally die on the way to the hospital. And that's what they're seeing in such a tragic way in Haiti right now.

  • 10:21:16

    REHMSebastian Walker, how many hospitals are there in Haiti?

  • 10:21:21

    WALKERWell, the number of hospitals is obviously being severely restricted due to the devastating earthquake in January. It really had a huge impact on infrastructure throughout the country. What they've been doing, now that the disease has really taken a toll, is building temporary treatment centers known as CTCs -- cholera treatment centers -- to actually provide beds for the increased number of patients that they are expecting, especially in the capital, Port-au-Prince.

  • 10:21:55

    WALKEROne of the biggest concerns all along has really been the disease not only reaching Port-au-Prince but starting to spread in those very large IDP camps where those large number of Haitians are still living more than 11 months after the earthquake. So one of the priorities the authorities have had is to try to get these centers up and running as quickly as possible to cope with the sheer number of patients that they expect. Now, during the whole political unrest period that's been going on since just shortly before the elections, which were held on the 28th of November, that's had a knock-on effect on the ability of health officials to try to deal with treating the disease.

  • 10:22:41

    WALKERSome of those cholera treatment centers actually were forced to shut down over that period while, you know, there were demonstrations and even the election itself was held. So it's had a severe impact on the treatment of the disease. And one of the things many Haitians have been saying is that, you know, this is not an ideal time to hold that kind of event while they're trying to deal with this full-blown humanitarian emergency. It's really set back the treatment of the disease somewhat. And...

  • 10:23:11

    REHMI want to ask Prof. Fatton about that political dispute because in the midst of this enormous concern about cholera, you have this incredible dispute about a presidential election. Robert, if you would explain what's going on for us.

  • 10:23:37

    PROF. ROBERT FATTON JR.Well, good morning.

  • 10:23:38

    REHMGood morning.

  • 10:23:38

    JR.What's happening is, indeed, that you have an electoral crisis. It is not something that is really surprising. If you look at past elections in Haiti, most of them, during the election day itself and after the elections, you've had demonstrations. You've had protests because the winners don't -- accept, obviously, that they won, but the losers do not. And in the past election -- in particular, as you put it, in a time of cholera and in the aftermath of an earthquake -- the disorganization of the elections were massive. There was very low participation, even in terms of the numbers given by the electoral council, barely 25 percent.

  • 10:24:19

    JR.What happened is that during the election itself, on Sunday, Nov. 28, at around 1:00 or 2:00 in the afternoon, all the candidates -- except the candidates supported by President Preval, the governing party and the governing regime, as it were -- decided that the elections were fraudulent, that they would not put up with that kind of elections, and they refused to continue to proceed. And suddenly, on Monday morning, two of the candidates -- Michel Martelly, who's well-known as Sweet Mickey, and Mirlande Manigat -- decided, actually, that the elections were okay. There might have been irregularities, but they were fine. So you had three candidates who were ultimately accepting of the electoral process.

  • 10:25:11

    JR.But once the results were published, then you've had that crisis. And you have to put it in the context of the electoral system in Haiti. There is a first round, and the top two candidates, if no one gets 50 percent, will go to the second round. And here you have Mirlande Manigat, who was the leader of the pack. She had about 30 percent of the vote. In second position came Jude Celestin, the candidate of the governing party. And in third position came Michel Martelly with barely 14,000 votes separating him from Jude Celestin. And Martelly has decided that that is not going to be something that is acceptable. He sees himself as at least one of the two who's going to go to the second round.

  • 10:26:03

    JR.Jude Celestin, for his part, has already declared that he is in the second round. And, moreover, Jude Celestin says that the count was completely fraudulent, that he won the election outright with 52 percent. So you have positions that cannot easily be bridged. And you've had also very confusing signals from the international community. On the one hand, you hear the elections have been irregular. They have been gross -- fraud, in some parts -- but the elections are okay. Then you have the Organization of American States claiming that, well, this is a political crisis.

  • 10:26:42

    JR.Maybe there is a political solution to that crisis. The top three candidates should go forward to the second round. Then there is this business of the electoral council recounting the vote. But two of the candidates -- Martelly and Manigat -- have decided that they were not going to accept that procedure, so there doesn't seem to be ground for a compromise. And if there is no compromise, one might fear that each of the candidates will start to put their people out in the streets, and that might escalate, unfortunately, into serious violence. So...

  • 10:27:16

    REHMWell, it sounds as though, given the situation in Haiti at the time of the election, with so many people living in squalid circumstances without true access to voting places, the question becomes, should the election have been held at all?

  • 10:27:40

    JR.Well, I think that's a good question because we knew way before the elections that there would be logistical problems. We knew way before the elections that the pattern in Haiti has been that elections are moments of great political volatility and that those -- that any elections might, in fact, weaken the very weak institutions that we have. But the decision was made by the international community and by the government and ultimately accepted, very reluctantly, by most of the candidates to participate in those elections. And the additional problem is that all the parties of the opposition have always looked at the electoral council as a vehicle of the current government -- in other words, that the electoral council was biased. So we had a recipe for a real disaster, and this is exactly what we've had.

  • 10:28:37

    REHMExactly.

  • 10:28:38

    JR.And it's almost impossible to understand why the decision was made in those circumstances, especially after the epidemic of cholera.

  • 10:28:50

    REHMAll right.

  • 10:28:50

    JR.But -- yeah.

  • 10:28:52

    REHMAnd we have an e-mail question which concerns both the medical and the political outlook there. The question is directed to Dr. Fauci. She says, "I've been offered a job in Haiti, and I'm considering it. However, I'm a single parent with a 4-year-old child. I'm really worried about the cholera epidemic. I know it's manageable. But I'm worried about caring for my child while I would be at work all day and she would be with a caretaker. I was told there is a cholera vaccine. I've never heard such a thing before. Is this true? If so, is it safe? How could I ensure my child would be safe in such a context?"

  • 10:29:49

    FAUCIWell, first of all, putting things in context, there's an acute serious situation right now in Haiti. How long it will go on and whether it will taper down to be under better control for -- the CDC right now is putting out a travel warning for Haiti, which essentially says that only do essential travel. So if she's offered a job that she doesn't have to be at next week, I would consider that that's something that is not essential at this time. The question regarding vaccine, there is not a vaccine approved here in the United States for cholera, but there are two vaccines that are being considered for usage.

  • 10:30:28

    FAUCIOne of them has been prequalified by the WHO, and it is available in 60 countries. Another one is from India and in fact has been used in India, but is not yet -- but is awaiting prequalification from the WHO. So there are vaccines that are available, and there has been a push to start using vaccines. But there was first a consideration that there was a low supply of it, but now we know there's likely more than we thought there was.

  • 10:30:57

    REHMHere's an e-mail from Ramon in Cape Coral, Fla. who says, "You could say that I just don't understand all the facts -- and I would agree -- but how can this be happening so close to our own shores and a very large Haitian population in South Florida? How can they not have enough water to hydrate? How is it that medicine so desperately needed is not being distributed and used? Is it the Haitian government does not care? Is it the UN inability to manage? I just do not understand." Sebastian, how do you see it?

  • 10:31:45

    WALKERWell, I think that's a very good question, and it's a question that many Haitians are asking all of the time. I mean, if you think about what the threat is here of this very serious disease raging around the country, and really -- I mean, cholera is a treatable disease. If you have access to clean water, drinkable water, then it's not a life-threatening situation. If you can rehydrate yourself, then there -- the chances of actually dying as a result of cholera go right down. But the thing is that in these large IDP camps, people have very little access to any kind of potable water. We did a story recently, looking at the accessibility people have to fresh drinking water, and, I mean, there are deliveries of water that go on.

  • 10:32:37

    WALKERYou know, four times a day, there are trucks coming around to IDP camps -- certain IDP camps, not all of them. Many people actually don't even get that. But the water that's being delivered -- and this is delivery from major NGOs who are organizing this -- NGOs like the American Red Cross, for example. The water that's being distributed isn't good quality enough for people to drink. We spoke to the country director for the American Red Cross, who told us that, yeah, look, if the families in these camps want to drink this water, they have to boil it first. There's so much chlorine that they have to put in these supplies of water that by the time it gets distributed in camps, it's not potable water. You were saying that the only way...

  • 10:33:18

    REHMWow.

  • 10:33:19

    WALKER...the nation is to have access to potable water is to buy bottled water, and the cost of that is about half a dollar. Many Haitians are living on less than $2 a day, so it's simply not possible. And given the amount of resources that have been available, and the time that these major NGOs have had and the donations that many people across the world have actually given to help improve the situation in Haiti, the question of why the situation in terms of delivery of water that people can actually drink isn't happening, I think, is a very valid one. And it's one that many Haitians are asking all the time as this disease threatens the country.

  • 10:33:55

    REHMSebastian Walker, he's Haiti-based reporter for Al Jazeera English. You're listening to "The Diane Rehm Show." And let's open the phones to West Chester, Ohio. Good morning, Elizabeth.

  • 10:34:15

    ELIZABETHGood morning. My son and his two oldest sons, aged 16 and 14, are going to Haiti to help build houses on Dec. 28, and I'm very worried about them. If cholera is a bacterial infection, are antibiotics not effective against cholera?

  • 10:34:43

    REHMDr. Fauci.

  • 10:34:45

    FAUCIAntibiotics are effective in decreasing the length of time that you're sick and decreasing some of the excretion of the bacteria. But, really, the primary way to treat cholera is to -- as we've said several times on the show, is to replenish their lost fluid by rehydration. It is not recommended at all that people who go there take prophylactic antibiotics…

  • 10:35:11

    REHMOh, I see.

  • 10:35:11

    FAUCI...which may be what the caller...

  • 10:35:13

    REHMYeah.

  • 10:35:13

    FAUCI…is referring to.

  • 10:35:14

    REHMYeah.

  • 10:35:15

    FAUCIThat is not recommended. People who go down there are recommended by the CDC to bring bottled water to be able to have chlorine to...

  • 10:35:26

    REHMChlorine tablets.

  • 10:35:27

    FAUCIAnd to have a prescription with you for antibiotics in case you get sick…

  • 10:35:31

    REHMBut how are you going to get a prescription filled...

  • 10:35:33

    FAUCINo. No, no, no. Getting...

  • 10:35:34

    REHM...down there?

  • 10:35:35

    FAUCINo, no, no. Get a prescription. Bring it down.

  • 10:35:36

    REHMOh, okay.

  • 10:35:37

    FAUCIGet a prescription.

  • 10:35:37

    REHMGot you.

  • 10:35:38

    FAUCIBring it down, but don't use it prophylactically.

  • 10:35:40

    REHMRight.

  • 10:35:40

    FAUCIUse it if you get sick.

  • 10:35:41

    REHMBut how much good is it going to do once you get sick?

  • 10:35:46

    FAUCIWell, once you get sick, the best way to counter that is to rehydrate. It is clear that antibiotics can be part of the regimen of treatment by lessening the duration of being sick, but it's not the primary way. It's rehydration.

  • 10:36:02

    REHMBack to you, Robert Fatton. From a political point of view, how safe will Elizabeth's sons be?

  • 10:36:13

    JR.It is difficult to tell because if there is no resolution of the current impasse, one can envisage a certain amount of trouble. On the other hand, traditionally, Christmastime in Haiti has lead to some sort of weakening of protest. But we are in a very different historical juncture where, obviously you have the elections. You have discontent with the elections. You have discontent with the government after the earthquake.

  • 10:36:44

    REHMAnd what about the Peacekeepers? Might they be at risk because of the suspicion of where the cholera has come from?

  • 10:36:54

    JR.Yes, I think that's part of it. And I think it's also part of a growing nationalist feeling in Haiti that the international community, that the Peacekeepers, have been in Haiti for a number of years, and the situation has not improved. So the question is -- from Haitians in Haiti -- what in the heck are they doing? So there is great suspicion about the ultimate motivation of the international community.

  • 10:37:23

    REHMRobert Fatton, he's politics professor, associate dean for graduate programs at the University of Virginia. He's the author of "Haiti's Predatory Republic" and "The Roots of Haitian Despotism." We'll take a short break. More calls when we come back.

  • 10:40:03

    REHMWelcome back. We'll go right to the phones. Let's go to Coby (sp?) in Utica, N.Y. Good morning, you're on the air.

  • 10:40:13

    COBYGood morning. And thank you for taking my call.

  • 10:40:15

    REHMSure.

  • 10:40:16

    COBYYeah, I just want to take -- make a comment, possibly a question. I have family in Haiti, and I'm hearing widespread reports about supplies through donations actually being withheld from the people there. My question is why are the supplies purposely being withheld which can possibly prevent the spread of cholera? And, also, is it possible that cholera was actually brought into the nation for some means of -- I don't know -- population control or something?

  • 10:40:45

    REHMOh, boy. Oh, boy, what a sad, sad speculation. Robert Fatton, you have actually written that you think international aid groups may be a cause of many of Haiti's problems. Would you go so far as to agree with what our caller has said?

  • 10:41:12

    JR.Now, I would doubt that that would be the case, but there are speculations precisely about the introduction of the cholera epidemic through the Peacekeepers. And that has flamed tensions between Haitians and the international community. On the other hand, I think that there is a point about the unintended negative consequences of foreign assistance. In particular, when you look at what has been happening for the past 30 or 40 years, what the policies of the foreign countries which have been giving foreign assistance to Haiti has been is to really bypass the state and to put their money with NGOs.

  • 10:41:54

    JR.And that has meant that the state has really been weakened to such an extent that it is now a nonfunctioning state, and you can see that with the earthquake and with the cholera epidemic. The state has no longer the capacity to do what it is supposed to do in a society, so that's one of the major consequences of that emphasis on NGOs. And Haitians increasingly see the NGOs, on the one hand, helping to some extent, but in the long term, contributing to deeper problems.

  • 10:42:29

    REHMInteresting.

  • 10:42:29

    JR.And the question that one of your listeners was asking about, how come we can have such degree of poverty in Haiti while we are so close to the United States? I think this question has really captured the essence of the crisis in Haiti. What you've had traditionally is a very sick society, a society in Haiti that is deeply polarized between a small minority of fairly wealthy people and an overwhelming majority of poor people. The poor people have traditionally been excluded from the moral community of the minority.

  • 10:43:10

    JR.In Haiti, there's a word in Creole which says, moun andeyo, which means, the people outside. And the people in the camps, the people in the rural areas which are affected by the crisis are people we -- who are not considered full citizens yet by a significant number of powerful people. And the treatment that that vast majority of people has been receiving is something that is part of that crisis, that exclusionary kind of society, and, not surprisingly, the consequences are dire.

  • 10:43:43

    REHMAnd tell me about the billions of dollars in aid that was pledged to Haiti after the earthquake, Robert. How much of it actually got to the people and the various projects that it was supposed to go to?

  • 10:44:02

    JR.Well, very little of that money has been invested in Haiti. And one of the problems is clearly that if the political situation continues to deteriorate, it's unlikely that you're going to see much of that money. And if you look at many countries that have been affected by similar crisis, the pledges -- and there was a pledge of $5 billion -- it is estimated that, in general, if you get about 55 to 60 percent of that money, you are doing very well.

  • 10:44:32

    REHMMmm.

  • 10:44:32

    JR.So it is highly unlikely, given the political situation, given the problems in Haiti that you're going to have full commitment of that money to the country, and...

  • 10:44:43

    REHMAll right. I'll go back to the phones. To Boston, Mass. Good morning, C.J.

  • 10:44:52

    C.J.Hi, Diane. I was born and raised here in Boston, but I've traveled to Haiti a number of times to do sustainable agricultural work. And one of the things I've always observed is that, for the most part, Haitians do not drink, you know, water out of the streams. They drink these little bags of water or bottled water. And where this cholera did not break in the camps, it actually broke out in, you know, many other areas where I know -- where I've served. And the people always drink these little bags of water. It questions me as to whether the very source of it was in these, you know, prepackaged bags.

  • 10:45:26

    C.J.And the second part of my comment or question is in reference to the election. I'm really surprised that the international community chose to go with the election in this way as opposed to instead, you know, creating the infrastructure necessary for a -- you know, a well-counted election, like maybe doing a country census first, issuing government, you know, IDs or Social Security numbers that could then be easily counted when an election is performed.

  • 10:45:54

    REHMAll right. And, Sebastian, I'll go to you first on those prepackaged bags of water.

  • 10:46:02

    WALKERYeah, I mean, certainly in the urban areas, that's how you see the majority of Haitians are getting their water. But I think, I mean, it's really in the rural areas that a lot of the focus has been on in terms of tracing the source of this disease. In places like the Artibonite region, where most of those cases first appeared, there are many Haitians in these small towns and villages whose only access to water is through those local water systems. And the fact that they have been contaminated with the disease means that, you know, the risks are very, very high for Haitians living in these places.

  • 10:46:41

    WALKEROne of the biggest impacts of Hurricane Thomas, the very serious storm which passed very close to Port-au-Prince a few weeks ago, was the flooding that it caused in those areas and the fact that rivers that could be carrying the disease burst their banks and flooded into homes, really only served to exacerbate the spread of this disease. So I think the focus really has been on those water systems and just how badly they have been contaminated by the disease. And actually...

  • 10:47:11

    REHMDr. Fauci. I'm sorry, Sebastian.

  • 10:47:14

    WALKERNo, no, it's okay.

  • 10:47:15

    FAUCIYeah, I agree completely. You know, as was mentioned, the Artibonite River region is clearly a major source of what's going on. In fact, if you look at the cases, a high percentage of the cases are coming from that particular region is throughout all of the 10 departments, including Port-au-Prince. But the focus and the concentration was within an area where people actually drink water, literally, from the river.

  • 10:47:43

    REHMAnd, Robert, on that election part of the question.

  • 10:47:49

    JR.Well, I think that the international community was committed to the elections because the current government's term, President Preval, has to be out of office on Feb. 7, 2011. I think that was, obviously, not necessarily the best resolution of the problem. I would have advocated, actually, a national conference immediately after the earthquake, whereby all of the grassroots organizations in Haiti -- the political parties would have come together and, hopefully, generated a government of national unity. That was not the road taken. Once you take the road of the elections, you are bound to have problems, as I have said.

  • 10:48:33

    JR.And I think the international community, which has put a lot of money in those elections -- something like $35 million -- ultimately miscalculated. They had assumed that those elections could take place and that the elections would lead to the creation of a legitimate government.

  • 10:48:49

    REHMHmm.

  • 10:48:50

    JR.And as far as I can see, whomever is elected, given the context of the current crisis, is going to be, to some extent, illegitimate, and it's going to be a very weak government. So we haven't resolved anything with elections that also -- that have been so bad. But this is a problem that we've had for the last...

  • 10:49:08

    REHMYes.

  • 10:49:08

    JR....20 years or so.

  • 10:49:09

    REHMYes.

  • 10:49:10

    JR.International communities says the elections are bad, but they are okay. So you have a standard to judge the elections that is really a standard of mediocrity.

  • 10:49:22

    REHMAll right. And what about, as many people are wondering, what about a chance of a cholera outbreak here in the United States, Dr. Fauci?

  • 10:49:37

    FAUCIThe chances of that are extraordinarily low -- in fact, vanishingly small. And the reason is, as we've heard throughout the discussion on the show, is that, really, the driving force and the fundamental matrix of the causation is sanitary -- poor sanitary conditions and lack of clean drinking water. We have and will continue to see, rarely, a case, a sporadic case of cholera in the United States, usually imported. Someone who comes from a different country has a case, gets sick but doesn't spread it because we don't have the poor sanitary conditions, and we have plenty of access to water. Also, there have been an occasional mini-outbreak from maybe a family that would bring in from food that can get contaminated. But...

  • 10:50:30

    REHMAnd here's a question on that very subject. Scott, I gather you're planning to go to Haiti tomorrow. Is that correct?

  • 10:50:41

    SCOTTYeah, I'm a journalist. And my question was -- I mean, I got four shots last Thursday. I can barely move my arms. But as far as eating food down there, we're flying in with a bunch of our own supplies. But is it even safe to go to one of the restaurants there? I was back there in June, and we ate at a restaurant and, you know, didn't have any issues. I'm very, very aware of, you know, the water and all that. And then we also were given prophylactic antibiotics for malaria. Is that something I even should be taking?

  • 10:51:15

    FAUCIWell, first of all, with regard to cholera, as I mentioned to one of the other callers, that antibiotics can be used in cholera but is not recommended to do it prophylactically. With regard to eating food, you have to really get information locally about the restaurants. I mean, there's no way that I could say or anybody could say over the phone, oh, it's okay to just go to any restaurant and have food because you don't know what the sanitary conditions -- I would assume that you'll get guidance to go a restaurant in which it's very clear that bottled water is used for the washing of food, et cetera, and food itself is not contaminated. But on a case-by-case basis, you'd have to really get information and intelligence while you're down there.

  • 10:51:58

    REHMSebastian, what was your experience eating in restaurants before you left to go to Qatar?

  • 10:52:07

    WALKERWell, it's pretty fine. I mean, we had no kind of precautions really that we would take. I mean, we've been traveling extensively throughout the Artibonite region, you know, visiting these hospitals at the very center of the outbreak, going around speaking to patients, you know, really getting into those areas where the disease is raging. I mean, we -- it's -- as long as you take the basic precautions of, you know, using hand sanitizer and washing your hands thoroughly, basic hygiene steps that really -- even if you're applying those in these areas where there is poor sanitation, can really help to reduce the disease.

  • 10:52:43

    WALKEROne of the main problems that authorities are facing is really getting the message out to those Haitians who really are the ones most at risk. I think they are the ones we really need to be focused on rather than, you know, foreign journalists and humanitarian aid workers.

  • 10:53:00

    FAUCIGood point.

  • 10:53:01

    WALKERIt's really -- I mean, the threat of this disease taking hold in the camps is huge. But as long as you take those basic hygiene steps of using hand sanitizer, having access to some potable water, it really hasn't been as a huge concern for us. And we've been reporting from around the country in these disease-infested areas for -- I mean, ever since this crisis started.

  • 10:53:24

    REHMSebastian Walker, he's a Haiti-based reporter for Al Jazeera English. He's been there since shortly after the Jan. 12 earthquake. He is joining us this morning from Qatar, and you're listening to "The Diane Rehm Show." Sebastian, when do you plan to go back to Haiti?

  • 10:53:51

    WALKERWell, in about a week's time from now, actually. We've, as you said, had this bureau functioning since January. Really, the decision was to, you know, not only follow this extremely powerful human story but, you know, really monitor how the reconstruction effort has been proceeding. And it's interesting. Some of the questions from your callers kind of -- you know, curious about the effectiveness of where this donated money and the NGO work is going and, you know, why there hasn't been more progress. That's something that we've been really following very closely ever since the January earthquake. And I think it's a huge concern on the ground.

  • 10:54:31

    WALKERThe rate of progress really isn't as good as it should be. And I think a lot of questions have to be asked about not only the work that these major NGOs are doing, but where the money is going. This is something that we've been monitoring on the ground. And, you know, even now, it's a -- more than 11 months after the earthquake, if you go to these camps, you know, some of them are in much the same way as they were in January. There are families who are living under the same tarpaulins that they received back in January, in the same tents. And, you know, these materials are starting to wear very thin, and we're approaching the one year anniversary since this devastating earthquake occurred. I mean, (unintelligible)...

  • 10:55:07

    REHMSo you really have to wonder where has the money gone that they have received, Sebastian.

  • 10:55:15

    WALKERWell, absolutely. And I think, really, it's a problem that's bedeviled Haiti in, you know, years leading up to the earthquake. It's -- most of Haiti hasn't been a recipient of large amounts of foreign aid money in the past. But I think the system whereby you have literally thousands of NGOs on the grounds, all kind of working against each other to some extent, really means that progress can be very slow (unintelligible)...

  • 10:55:40

    REHMWhat do you mean when you say they're working against each other? What do you mean?

  • 10:55:47

    WALKERWell, I mean, the coordination between groups, I think, is not at the level that it should be. And, really, it's a system whereby you have these NGOs stepping into the roles which would traditionally be carried out by the states. The tools of the states have been chipped away in the years leading up to the earthquake. And in their place, you've got NGOs, you know, stepping into those gaps. And, you know, the whole concept that NGOs are going to, you know, take the place of a government system that would have, you know, a coordinated approach to getting things done on the ground really isn't going to work.

  • 10:56:22

    WALKERIf you have, you know, donated money that's been stored up by different groups, and then each of those groups has a different strategy of how the money should be spent, if you're talking about the sheer number of these groups on the ground, there's no way you could coordinate that effectively.

  • 10:56:40

    REHMYeah.

  • 10:56:40

    WALKERAnd it just means that progress is often very, very slow.

  • 10:56:43

    REHMAnd, unfortunately, I think we'll have to leave it there. But people are asking about the best place to donate money. Should it be Doctors Without Borders?

  • 10:56:58

    FAUCIPartners in Health, and they are all...

  • 10:56:59

    REHMPartners in Health? And yet you still got...

  • 10:57:02

    FAUCISure.

  • 10:57:02

    REHM...this conflict among these various groups. Dr. Anthony Fauci, he's director of the NIH's National Institute of Allergy and Infectious Diseases. Robert Fatton Jr., politics professor at the University of Virginia. Sebastian Walker of Al Jazeera English, he is the Haiti-based reporter. Thank you all so much.

  • 10:57:33

    FAUCIThank you.

  • 10:57:34

    REHMAnd thanks for listening, all. I'm Diane Rehm.

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