Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti

by Ralph R. Frerichs

Overview

In October 2010, nine months after the massive earthquake that devastated Haiti, a second disaster began to unfold—soon to become the world's largest cholera epidemic in modern times. In a country that had never before reported cholera, the epidemic mysteriously and simultaneously appeared in river communities of central Haiti, eventually triggering nearly 800,000 cases and 9,000 deaths. What had caused the first cases of cholera in Haiti in recorded history? Who or what was the deadly agent of origin? Why did it explode in the agricultural-rich delta of the Artibonite River? When answers were few, rumors spread, causing social and political consequences of their own. Wanting insight, the Haitian government and French embassy requested epidemiological assistance from France. A few weeks into the epidemic, physician and infectious disease specialist Renaud Piarroux arrived in Haiti.

In Deadly River, Ralph R. Frerichs tells the story of the epidemic, of a French disease detective determined to trace its origins so that he could help contain the spread and possibly eliminate the disease, and the political intrigue that has made that effort so difficult. The story involves political maneuvering by powerful organizations such as the United Nations and its peacekeeping troops in Haiti, as well as by the World Health Organization and the U.S. Centers for Disease Control. Frerichs explores a quest for scientific truth and dissects a scientific disagreement involving world-renowned cholera experts who find themselves embroiled in intellectual and political turmoil in a poverty-stricken country.

Frerichs's narrative highlights how the world's wealthy nations, nongovernmental agencies, and international institutions respond when their interests clash with the needs of the world's most vulnerable people. The story poses big social questions and offers insights not only on how to eliminate cholera in Haiti but also how nations, NGOs, and international organizations such as the UN and CDC deal with catastrophic infectious disease epidemics. Learn more at http://www.deadlyriver.com

Product Details

ISBN-13:	9781501703621
Publisher:	Cornell University Press
Publication date:	05/01/2016
Series:	The Culture and Politics of Health Care Work
Sold by:	Barnes & Noble
Format:	eBook
Pages:	320
File size:	2 MB
Age Range:	18 Years

About the Author

Ralph R. Frerichs is Professor Emeritus of Epidemiology at UCLA.

Table of Contents

Preface
Introduction
1. Upheaval
2. Vibrio Cholerae
3. Rumors
4. Stealth
5. Hypotheses
6. Maps
7. Altered Reality
8. Journalists
9. Secrecy
10. Obfuscation
11. Speculation
12. Pandemics and South Asia
13. Report
14. Vodou and Cholera
15. Inquiry
16. Politics before Science
17. Nepal
18. Concealed in the Field
19. Quarantine and Isolation
20. The Wall Cracks
21. Answers
22. Sanitation, Water, and Vaccination
23. Struggles and Elimination
24. Rapprochement
Epilogue

What People are Saying About This

Dr. Raymond Richard Neutra

Deadly River tells two fascinating stories. One is about epidemiological and molecular biology detective work. This work justified the growing certainty that defective United Nations procedures had allowed Nepalese peacekeepers to start a devastating cholera epidemic in Haiti. The second story is about how the UN, the WHO, elements of the Haitian government, and the CDC did their best to prevent these facts from coming to light. They told themselves that they did this to serve what they thought was the greater public good. They pushed forward scientists with an academic ax to grind who had theories congenial to their agenda. We are used to industrial interests 'manufacturing doubt' about 'inconvenient truths.' This second story shows that governments do it as well.

Philip Alston

It is beyond the scope of the present report to recount the analyses and conclusions of the various studies, but this task has been undertaken systematically in Deadly River. Its author, Ralph R. Frerichs, is Professor Emeritus of Epidemiology at UCLA and the book provides a painstaking and even-handed assessment of the scientific debates that have taken place. For present purposes, it must suffice to note that the book concludes that the peacekeepers were responsible for bringing cholera. In doing so, it systematically vindicates the conclusions reached by one of the first international experts on cholera to investigate the outbreak in Haiti, Dr. Renaud Piarroux. It also deplores what it describes as a 'misinformation campaign to protect the UN and the peacekeeping program.'

John J. Mekalanos

Deadly River tells the story of how the lethal disease cholera found its way from the high valleys of the Himalayas to the tropical landscapes of Haiti, months after the devastating 2010 Port-au-Prince earthquake. This knowledge didn't come easy but was acquired through the dogged efforts of many investigators (a dedicated French epidemiologist, international infectious disease experts, molecular biologists, and journalists) all of whom were focused on finding the truth rather than accepting speculation or unproven theories. Ralph R. Frerichs's book is a fascinating read that also provides many insights into the strengths and weaknesses of human nature—curiosity, skepticism, stubbornness, ignorance, pride, denial, deception—all framed by a tragic event that has changed the lives of millions of impoverished people.

Editorial Reviews

All public health students should read this book for two reasons: first, for the in-depth story of the scientific investigation of the source of the epidemic; and second, for the story of the political resistance and barriers, both powerful and subtle,that Piarroux encountered.... The description of Piarroux's investigation is fascinating.

International Quarterly of Community Health Education - Laura Price

Frerichs, a retired epidemiologist and professor emeritus of epidemiology at the University of California, Los Angeles, has written a damning account of the political and health professional response to the cholera epidemic that broke out in Haiti in October 2010... He does so from an epidemiologist’s perspective and with a clear focus on the Haiti case. Yet, his account is written for and accessible to a wider readership and also highly relevant for students of global (health) politics.

Cambridge Review of International Affairs - Tine Hanrieder

The CDC discouraged journalists from asking about the epidemic's origin, telling them that pinpointing the source was 'not productive,’ ‘not central,’ and would likely never happen. Its epidemiologists did provide a key detail early on, when they identified the strain in Haiti as having a recent South Asian origin—meaning it could have come from Nepal and not from South America, Africa, or anywhere else cholera was circulating at the time. The CDC refused to take environmental samples from around the [UN Peacekeepers] base or test the soldiers during the small window when doing either would have been worthwhile. All of this detailed in a damning new book by Ralph R. Frerichs called Deadly River..

Slate - Jonathan M. Katz

Ralph R. Frerichs' compelling Deadly River tells the story of Haiti's 2010 cholera epidemic, the worst in recent history. The book is a detective story that documents how epidemiologists and others sought to quantify, decode, and combat cholera, and provides a firsthand look at the politics of medical humanitarianism.

PoLAR

Ralph Frerichs’s Deadly River is, in no small part, an object lesson on the manner in which maps make sense of chaos in the midst of complex world events.... Frerichs’s focus, and indeed his passion, lies with the microbial world and its periodic attacks on humankind.

Cartographic Perspectives

All public health students should read this book for two reasons: first, for the in-depth story of the scientific investigation of the source of the epidemic; and second, for the story of the political resistance and barriers, both powerful and subtle, that Piarroux encountered.... The description of Piarroux's investigation is fascinating.

--Laura Price "International Quarterly of Community Health Education"

Frerichs, a retired epidemiologist and professor emeritus of epidemiology at the University of California, Los Angeles, has written a damning account of the political and health professional response to the cholera epidemic that broke out in Haiti in October 2010... He does so from an epidemiologist's perspective and with a clear focus on the Haiti case. Yet, his account is written for and accessible to a wider readership and also highly relevant for students of global (health) politics.

--Tine Hanrieder, Dr rer pol, University of Bremen "Cambridge Review of International Affairs"

Ralph Frerichs's Deadly River is, in no small part, an object lesson on the manner in which maps make sense of chaos in the midst of complex world events.... Frerichs's focus, and indeed his passion, lies with the microbial world and its periodic attacks on humankind.

-- "Cartographic Perspectives"

Ralph R. Frerichs' compelling Deadly River tells the story of Haiti's 2010 cholera epidemic, the worst in recent history. The book is a detective story that documents how epidemiologists and others sought to quantify, decode, and combat cholera, and provides a firsthand look at the politics of medical humanitarianism.

-- "PoLAR"

The CDC discouraged journalists from asking about the epidemic's origin, telling them that pinpointing the source was 'not productive, ' 'not central, ' and would likely never happen. Its epidemiologists did provide a key detail early on, when they identified the strain in Haiti as having a recent South Asian origin--meaning it could have come from Nepal and not from South America, Africa, or anywhere else cholera was circulating at the time. The CDC refused to take environmental samples from around the [UN Peacekeepers] base or test the soldiers during the small window when doing either would have been worthwhile. All of this detailed in a damning new book by Ralph R. Frerichs called Deadly River..

--Jonathan M. Katz "Slate"

From the Publisher

"Ralph Frerichs’s Deadly River is, in no small part, an object lesson on the manner in which maps make sense of chaos in the midst of complex world events.... Frerichs’s focus, and indeed his passion, lies with the microbial world and its periodic attacks on humankind."

cartographic perspectives

"It is beyond the scope of the present report to recount the analyses and conclusions of the various studies, but this task has been undertaken systematically in [Deadly River]. Its author, Ralph R. Frerichs, is Professor Emeritus of Epidemiology at UCLA and the book provides a painstaking and even-handed assessment of the scientific debates that have taken place. For present purposes, it must suffice to note that the book concludes that the peacekeepers were responsible for bringing cholera. In doing so, it systematically vindicates the conclusions reached by one of the first international experts on cholera to investigate the outbreak in Haiti, Dr. Renaud Piarroux. It also deplores what it describes as a 'misinformation campaign to protect the UN and the peacekeeping program.'"

Philip Alston

"Deadly River tells the story of how the lethal disease cholera found its way from the high valleys of the Himalayas to the tropical landscapes of Haiti, months after the devastating 2010 Port-au-Prince earthquake. This knowledge didn't come easy but was acquired through the dogged efforts of many investigators (a dedicated French epidemiologist, international infectious disease experts, molecular biologists, and journalists) all of whom were focused on finding the truth rather than accepting speculation or unproven theories. Ralph R. Frerichs's book is a fascinating read that also provides many insights into the strengths and weaknesses of human nature—curiosity, skepticism, stubbornness, ignorance, pride, denial, deception—all framed by a tragic event that has changed the lives of millions of impoverished people."

John J. Mekalanos

"Deadly River tells two fascinating stories. One is about epidemiological and molecular biology detective work. This work justified the growing certainty that defective United Nations procedures had allowed Nepalese peacekeepers to start a devastating cholera epidemic in Haiti. The second story is about how the UN, the WHO, elements of the Haitian government, and the CDC did their best to prevent these facts from coming to light. They told themselves that they did this to serve what they thought was the greater public good. They pushed forward scientists with an academic ax to grind who had theories congenial to their agenda. We are used to industrial interests 'manufacturing doubt' about ‘inconvenient truths.’ This second story shows that governments do it as well."

Dr. Raymond Richard Neutra