Latin America Reels From Cholera Plague
by Eric Jackson
In the next year, cholera will strike six million Latin Americans, 42,000 of whom will die, predicts Dr. Carlos Guerra of the Pan-American Health Organization (National Public Radio, 4/20/91). The first cholera epidemic of the Americas this century appeared on January 23 on the Pacific coast of Peru. It rapidly spread to the capital and to towns in the Andes and the Amazonian jungle. From Peru it went to Ecuador and Colombia, then to Brazil and Chile.
By mid-April, Peruvian health officials reported nearly 150,000 cases and over 1,100 deaths. In mid-April the Ecuadoran Medical Federation reported 5,000 infections and 100 deaths, mostly in Ecuador's largest city, Guayaquil. Colombia reported cases first in Pacific coast towns, then inland at Bogotá, the capital. From its Peruvian headwaters, the disease swept down the Amazon into western Brazil. It was diagnosed in northern Chile in the third week of April.
The culprit is vibrio cholerae, a bacterium that looks like a comma when viewed under a microscope. It produces a toxin which attacks the lining of the small intestine, such that the body can't hold water. Vomiting and diarrhea ensue. A cholera victim may lose twice his or her weight in water during the course of the illness. Salt loss creates a chemical imbalance in the body. Untreated, cholera kills about half of those affected by it. With prompt treatment by oral rehydration and replacement of body salts, however, victims usually recover.
Cholera is a disease of poverty. lts germs are carried in human feces, then passed on through tainted water or food. Most people who ingest vibrio cholerae do not get sick, because digestive acids kill the bacteria. Malnourished people, however, typically have lower levels of gastric acids, and thus are most vulnerable.
The shanty towns of Lima, Peru's capital, are a perfect breeding ground for the disease. A city of seven million, Lima provides sewer service to less than half of its people. Residents live in makeshift shacks amid garbage and sewage and most slum dwellers draw water from unsanitary wells.
Guayaquil, a city of 1.5 million, has slums like Lima's. Francisco Plaza, head of the Ecuadoran Medical Federation, denounced government officials in charge of sanitation for "the criminal laziness that they have committed against Guayaquil." The initially-affected area of Colombia not only lacks water and sewer service but has no telephones to alert authorities.
Brazilian health officials expect cholera to spread from the hinterlands to modem cities. Although much of Rio de Janeiro is equipped with running water and flush toilets, the city pours untreated sewage into the ocean. Not far from the gleaming skyscrapers and comfortable neighborhoods where the rich live, Rio has some of the world's most squalid slums.
According to doctors, Peruvian President Alberto Fujimori has aggravated the crisis. Fujimori and other officials, discounting warnings against eating ceviche, (uncooked pickled seafood that can carry cholera germs), ate the delicacy on camera in a series of TV commercials produced to promote the fishing industry. The fisheries minister spent a week in the hospital after one such ceviche promotion, reportedly stricken with cholera, but officially due to "laryngitis." The health minister resigned to protest Fujimori's ceviche videos.
The region's seafood industry has been devastated. Most countries have banned Peruvian seafood imports, causing one million lost jobs. Colombia's fish sales have declined more than 50%. The traditional river-fishing economies of Brazil's indigenous peoples have been destroyed.
The conditions which allow cholera to spread are partly created in the United States. Last summer Fujimori and the U.S.-controlled International Monetary Fund (IMF) reached an accord by which taxes were tripled, spending on water and sewer systems was cut, and food prices rose five-fold or more. Even before these measures, 2.2 million percent inflation over the previous five years had left over 80% of Lima's slum dwellers eating less than the minimum calories prescribed by the World Health Organization (WHO) for a subsistence diet.
The health crisis hits hardest in countries like Pau and Colombia, which are torn by civil wars. Dr. José Nájera, head of the WHO's tropical disease program, says that wars which disrupt health care and sanitation make the problem worse.
Public health experts fear that cholera will affect the entire Third World, adding to an already severe health crisis. WHO reports paint a grim picture: one person in ten in the world suffers from a tropical disease, most people in underdeveloped countries lack clean drinking water. The WHO estimates that it would cost $50 billion to provide proper water and sanitation systems for Latin America.