SAINT-MARC, Haiti – The cholera epidemic that has raged across this country is claiming fewer victims, with a sharp drop in new cases everywhere from the shimmering rice fields of the Artibonite Valley to the crowded urban slums.
It is a welcome development, but tinged with doubt: It's not yet known whether the epidemic that has killed nearly 4,000 people is fading or merely taking a break, only to surge again perhaps with the onset of the next rainy season.
"The general situation is improving. It's clear," Stefano Zannini, chief of mission for the aid group Doctors Without Borders, said Sunday. "The problem is that the possible development of the epidemic is unpredictable. It is impossible to say whether the situation will continue stabilizing."
Any progress on controlling the disease would be a rare bit of good news for Haiti, which is passing through a particularly gloomy period. The country is on edge amid a political crisis over a disputed presidential election, and could see more of the violent protests that paralyzed cities and hampered cholera treatment in December. Meanwhile hundreds of thousands are still homeless from last year's earthquake, and a much-reviled former dictator suddenly returned and took up residence in the past week.
Zannini, whose group is contemplating scaling back its more than 40 cholera treatment centers, was unable to muster even cautious optimism regarding the disease. The best he could say was that he was happy new cases and deaths are decreasing to levels not seen since soon after the disease emerged in October.
"I would not be optimistic," he said in an interview with The Associated Press at his Port-au-Prince office.
For the moment, at least, the statistics are moving in the right direction. The number of new cases has dropped to about 4,700 per week, down from more than 12,000 per week in November, and the trend is downward in all 10 of Haiti's departments, or regions, according to the Health Ministry's latest bulletin, released Thursday. The only places it appears to be still rising are in a few isolated spots in the northwest and south.
Behind the drop is a massive emergency public health campaign in response to the outbreak. A new network of cholera centers staffed by Haitian doctors and nurses, NGOs and international volunteers has made it easier for victims to get oral and intraveneous rehydration treatment, saving thousands of lives.
There have also been extensive efforts to ensure access to clean water, as well as public public health campaigns to teach people how to avoid cholera. Finally the dry conditions of recent weeks have slowed the spread of the bacteria.
Health statistics in Haiti are unreliable, so it's hard to get a precise picture of the situation. World Health Organization spokeswoman Nyka Alexander noted that it's hard to know what is happening in remote regions where many have little or no access to health care.
Some 40 patients a day are still coming to the Doctors Without Borders treatment center in Saint Marc, where the disease first exploded, but that's a third of what it was in December and there hasn't been a death in six weeks, said field coordinator Oscar Sanchez Rey.
"Is this is the end? Nobody really knows, but the situation is better," Sanchez said as he took a break from treating patients, including a family of six that all came down with the disease together. He cautioned that even though fewer people are getting sick, the center's work is still critical: "If no one is treating patients, they are going to die, because it's a lethal disease."
Lilane Estime, 42, tried to sleep on a wooden bench as doctors attended to three of her children. She said all four had piled onto a motorcycle taxi and traveled an hour along a dusty coastal road to reach the clinic. Seemingly healthy, she said she could feel cholera inside her, though she hadn't gotten sick yet.
"If there's a disease going around killing people, you're going to be scared," Estime said.
In Cite Soleil, the dense slum at the northern edge of Port-au-Prince, the number of new cases is now about 15 per week, down from a high of 700, and there are similar reports from nearby neighborhoods. In the hard-hit Artibonite Valley, the weekly new caseload is about 700, compared with more than 4,800 in November.
"We don't want to say, 'OK, cholera is finished,' because it's not," said Cinta Pluma, a spokeswoman for the aid group Oxfam. "But it does seem to be going down."
Caused by a bacteria that spreads through contaminated water, the disease so far has sickened more than 194,000 people and killed about 3,890 nationwide. It can lead to a rapid, painful death through complete dehydration, but is easily treatable if caught in time.
In December, U.N. Secretary General Ban Ki-Moon warned the outbreak could affect as many as 650,000 people over six months, but that seems less likely now. The Pan-American Health Organization still projects cholera will sicken about 400,000 people over a year.
The U.N. Food and Agriculture Organization warned in December that cholera would also worsen hunger in the impoverished nation. Surveys showed workers in the Artibonite, Haiti's main agriculture zone, were afraid to wade into rice fields and the public was shunning the region's produce, causing steep price drops in the local street markets. Jackson Dorgil, an FAO agricultural technician in the area, said prices for staple crops such as onions, tomatoes and melons plummeted — and much couldn't be sold at all.
But that too seems to have improved. At the region's main market in Pont-Sonde on Saturday, prices and sales were back to normal, with hundreds of women selling produce, fish and other products in neat little pyramids spread over burlap sacks. "Life is starting to be normal again," Dorgil said during a tour of the region.
Rice fields there were filled with barefoot workers up to their ankles in muddy water believed to be contaminated with the cholera bacteria, planting the crop under a blistering sun. Most earn about $2.50 for a six-hour workday.
Fresnel Louis, the president of a worker's association in the area, said radio commentators were warning people not to go into the water at the start of the outbreak, but there were few options.
"If you tell people in the Artibonite not to touch the water, you are telling them not to work — because that's what we have here," Louis said.
Those rice fields could lead to a resurgence of the disease. There were no latrines in sight, nor any supplies of potable water — the same conditions that helped spread cholera so rapidly in the first place.
Zannini said any immunity typically lasts six to eight weeks, so people will be prone to catching it again when the rainy season starts in the spring, sending the bacteria coursing through rivers and streams.
"Lack of immunization, lack of access to clean water and a difficult hygienic situation still keep the population exposed to a new outbreak," he said.