How to prevent and treat cholera

Many thanks to Mark and Monika at Naturehealingnature.org for providing advice on how cholera works, water filters and rehydration. We have compiled info on natural soaps, moringa filters and sanitation from a number of sources. Please forward this info as it could save lives! If someone wishes to translate to Kreyol, I will post it!

Here are some simple methods, which anyone can use, to prevent and treat cholera.

HOW CHOLERA WORKS

• Cholera does not kill directly; you die from the dehydration that intense diarrhea inflicts.

• People with cholera-induced diarrhea pass many gallons of water a day.

• You get cholera from eating tiny amounts of poop from someone who has it. It is not airborne. That’s why clean water and effective sanitation, and hygiene keep it from spreading in “developed” countries. Cholera can survive in standing water and can be transmitted in bilge water of ships and other water sources. It is essential to filter or otherwise decontaminate water before using it.

• Cholera spreads more during the rainy season. As water sweeps through villages and other settlements, it takes the pathogen to rivers, lakes and streams where it can survive and spread. Most people get cholera from contaminated water, not directly from other people.

• 80% of the people with cholera have no symptoms! Imagine how hard it is to stop when people are traveling all over Haiti without symptoms. Even if you quarantine those with symptoms, there are a lot more people spreading it that feel perfectly healthy – like the one that traveled to Florida last week.

• Cholera does its deed very fast. There are many reports of people getting symptoms in late afternoon and dying before morning. Most deaths are within two days of the onset of symptoms.

• If you can quickly get water back into the blood, most of the people with cholera-induced diarrhea will live. A percentage will survive even without treatment – this is especially true if you are healthy and eat a good diet.

HOW TO PREVENT CHOLERA FROM SPREADING

• Human waste must be kept from entering any water supply. That would include wells, other groundwater, streams, lakes, ponds and rivers. It can continue to live in most water once it gets into the supply. The diarrhea caused by cholera is very runny and if not contained, can easily end up in a water supply somewhere. Fish and shellfish can carry cholera and must be thoroughly cooked.

• If there are no sanitary latrines in the area, dig emergency latrines immediately at least 30 meters from any water supply and ensure it is not in marshy ground nor does it penetrate the water table. Ensure all people use the latrine. Cover human waste with dried grass, soil or other brown organic material after each use. While you are building a latrine, make sure that all human waste is buried so that flies cannot access it and it cannot run into water supplies when it rains.

• A better solution than a pit latrine is to find out how to use a compost toilet and use fully composted human waste as fertilizer (correctly done, composting kills all pathogens). Here’s one method being used in Haiti successfully – Cite Soleil: http://www.youtube.com/watch?v=9NCuawEqPCc&feature=related

• Flies can spread cholera. It is important to keep food covered to prevent them from transmitting cholera. Flies are attracted to garbage and human waste, so keep garbage far away from food, and cover it if all possible. Ideally, toilets will be sealed so that flies cannot enter into them. The seating area can be sealed so that when the lid closes, flies cannot get into the toilet area. It is well worth taking the time to do this to keep the fly population down as they spread many types of diseases in the tropics.

• Create a “tippy-tap” to wash hands in after using the latrine, and educate people how to use it. A tippy tap is a large plastic jug and a soap container filled with water and hung next to the toilet. A foot pedal allows one to put soap and water on one’s hands without touching either bottle. Washing hands after going to the bathroom is vital to preventing spread of cholera

o If you don’t have soap, you can make some from the moringa plant: http://kalanke.web.officelive.com/MoringaSoap.aspx.

o Yucca root can also be used as soap – just put some of the root directly in the water bottle that you are cleaning your hands with, shake it up, and remove root. The saponins in the root are what create the soap quality.

o Soap nuts can also be used as soap – boil a few nuts in water, pour in a jar and then seal the jar tightly – it will spoil after a bit.

o The fruit, leaves and bark of Acacia concinna can be dried and made into a soap paste – used in India for centuries as soap and shampoo.

• Contaminated clothing, bedding, etc (that human waste has gotten on), must be buried or boiled. Solarizing it (heating it up in the sun) can also kill cholera.

• Cooking food will kill cholera. Shellfish should be cooked at 160 degrees F or higher for at least 10 minutes. If the bacteria is not killed in the food, it will multiply rapidly as the food cools.

• Filter and disinfect all water before using it to drink or wash vegetables or dishes. This is vital to prevent spread of disease as it is very difficult to keep the germ out of the water supply especially in the rainy season. Any water that could end up in the mouth should be treated, including water used to wash vegetables.

• How to disinfect water:

o Place water in clear plastic bottles and ideally set them on dark surface that collects heat, or shiny metal, and leave it in full sun for at least six hours. This kills water borne pathogens. The bottles should no bigger than 1.5 liters. This is the fastest and one of the most complete ways to kill all pathogens. If you do not have full sun, the bottle should be left out as long as two days. This method is called the SODIS (solar disinfection) method.
http://www.sodis.ch/index_EN
In Kreyol: http://www.sodis.ch/methode/anwendung/ausbildungsmaterial/dokumente_material/flyer_c.pdf
o If the water is cloudy, filter water through sand or cloth that has been folded several times. This is important as cholera and other disease germs can hide in sand particles or other particles and survive SODIS. Filtering with cloth or sand alone will not kill all the cholera – you must use SODIS or boil the water too.
o Boil water to a hard boil (many bubbles coming fast to the surface).

o Solarizing water is another option. You can build a fairly large solarizer that will handle lots of water.
http://www.paceproject.net/UserFiles/File/Water/Solar%20pasteurisation.pdf
o Here is a way to make a more complete filter, for a more long term solution. This takes 2-3 weeks before you get clean water from it: http://www.naturehealingnature.org/resource_pages/pictograms/1_kaf_construction_manual_jan2006.pdf

If your water supply is filtered and human waste is composted and protected from flies, you will interrupt the disease vectors and will have no more cholera. Correct handling of human waste (keeping it isolated from water and flies and composting it), and filtering water is the only way to eliminate the disease from an area. Washing hands before preparing food is essential as well. If you do these three things, cholera cannot gain a foothold in your area. You will also eliminate dysentery, typhoid and other diseases.

TREATMENT

• Dehydration kills. Rehydration will save lives. Drinking water is not enough – too much salt and potassium is lost in the diarrhea to absorb the water.

• Immediately upon getting symptoms, add one teaspoons of salt and 8 teaspoons of sugar to one liter of treated water and drink it. It is important you start rehydrating as early as possible.

• Continue to drink this preparation throughout the course of the disease.

Coconut juice has very complete electrolytes in it and if available should be consumed liberally by anyone with cholera symptoms during the course of the disease.

• If you have access to it, drink water mixed with oral rehydration packets.

In Kreyol… (www.naturehealingnature.org)


Haiti – Donate Now…

Permaculture Disaster Relief in Haiti

Camp at Delmas - this is only a small portion of it

Camp at Delmas - this is only a small portion of it

It’s been a while since we’ve updated about Haiti – below is a summary of what occurred from the time of the earthquake forward. We’re in planning stages now on the next phase and will post information about that as soon as plans are implemented. Our main focus currently is getting education out about how to prevent and treat cholera, using low tech methods and inexpensive or free resources. We’ll post that here too, in the next couple of days. We are deeply grateful to all of you who donated and made this journey possible – your donations did save many lives and they continue to do so. Here is the summary report:

***

When the earthquake hit Haiti last January, I was teaching a permaculture course in Little Haiti, Miami, and there seemed to be no choice but to get involved. After assessing what was most needed, I assisted six permaculturists and sustainability experts to get to Port Au Prince shortly after the earthquake and this is their story.

After receiving reports on the ground, we determined that the major life threatening situations were water and sanitation. There were no city wide water or sewage systems in place before the earthquake, and water borne disease had always been a situation but in the chaos after the quake, the risk became dire. We knew that resources would be almost non-existent in some areas and rescue organizations might not reach those areas for weeks. Permaculture had solutions, using local resources, that others didn’t have for handling human waste and unfiltered water.

Port Au Prince airport, the only international airport near the quake zone was closed to everything but military and rescue planes, and other ways into the quake zone, such as the road from Dominican Republic, were unpredictable – many roads had sustained damage in the quake. I arranged for the teams to fly into Port Au Prince via planes chartered by Church of Scientology Volunteer Ministers disaster relief organization to bring emergency medical teams there from the US. They would stay at the Volunteer Minister camp and have a relatively safe, established base camp to operate from (though conditions were very primitive and harsh, at first). They would also have ready access to other disaster organizations, military personnel, and government officials, which would allow them to be more effective. This worked out well with the teams rapidly creating connection with major hospitals, UNICEF, US Army, ACTED and other major organizations – all of them needed their specialized skills.

The goal was to save lives by getting low tech, sustainable solutions out there rapidly, while establishing relationships with both Haitians and NGOs that could be developed in the future for longer term design projects.

The first team that arrived was Mark Illian and Monika Cikhart, from Nature Healing Nature (naturehealingnature.org), a non profit organization that specializes in teaching villages around the world how to filter water via low tech methods, using locally available materials such as sand and plastic bottles. The second wave was made up of Rodrigo Silva, a permaculturist and sanitation specialist from Portugal who has built compost toilets for 30,000 people at a time at European festivals; Nicole-Klaesener Metzner, another compost toilet specialist from Austria, and Andrew Larsen, a systems engineer and sustainable sanitation expert from Salt Lake City. They were flown into Haiti within a few days of responding and were in high demand immediately. Hunter Heaivilin, a permaculturist and tropical plant expert, arrived a few weeks after the quake and stayed for several weeks.

Andrew, Rodrigo and Nicole bound for Haiti

Andrew, Rodrigo and Nicole bound for Haiti

The “water team” of Nature Healing Nature immediately set to work educating people on how to filter their own water. They worked with the sanitation team, but also on their own when it made sense to do so, traveling where the need was greatest, such as to Leogane which was getting little assistance or relief. Because water filtration has traditionally been poor in Haiti, their educational work had quite a lot of potential to save lives – the death rate from dysentery and other water borne diseases, especially of children, was high even before the earthquake. In addition to helping provide a clean water supply, they set up showers for rescue workers, such as medical personnel who hadn’t been able to shower for days, they helped Haitians link up to organizations that had funding and resources, they helped organize emergency food and water distribution, and did whatever was necessary to facilitate the process of Haitians getting back on their feet as sustainably as possible.

Many people who survived the quake but were injured were losing limbs or dying because of the horrible sanitation in the makeshift hospitals. All the hospitals in the area were damaged and operations were occurring in makeshift tents with improvised instruments. There were not enough doctors so rescue workers with no medical background or experience were instantly deputized to act as surgeon assistants. There was so much chaos that it is hard to comprehend. Piles of garbage were heaped near the operating theatres and recovery areas, and it was difficult to keep the areas clean or sterile because of lack of medical supplies or any other supplies.

The sanitation team’s first major project was the main general hospital in Port Au Prince, where sanitation was almost completely out of control. Huge piles of garbage surrounded the hospital with everything from human feces to body parts to needles to toxic substances in the mass. The toilets were backed up, filthy, and unusable. Our team worked out how to clean the area and arranged for trucks to haul the trash (it was a major feat at that time to get fuel, never mind a truck to put it in); they set up proper disposal systems, and got funding to pay local Haitians to clean the trash sites so that tents could be set up to treat patients in a clean environment. They were not able to set up compost toilets there, as the hospital was under great pressure and staff didn’t want to risk anything but known elements like portapotties, but they were able to educate a number of disaster and rescue personnel on the advantages of composting human waste.

Clean up at the General Hospital

Clean up at the General Hospital

Hospital tent is on clean ground with sanitary conditions established

Hospital tent is on clean ground with sanitary conditions established

As a result of their work, an inspection of the site found almost no garbage anywhere in the vicinity of the hospital. This most certainly contributed to saving lives and limbs.

Their next target was sanitation for a nearby camp. A huge handicap was lack of materials – there was almost no wood or organic material available anywhere. Andrew had brought in material to create a compost toilet system, but they ended up using different models because there simply wasn’t enough building material available. They improvised, using shipping pallets and whatever material they could find.

Their initial target was to isolate human waste so it wouldn’t contaminate water. In the process, they taught Haitians how to build compost toilets and explored how organic material could be created by growing fast growing plants like vetiver grass and bamboo (both of which grow readily in Haiti). In between, because of the extreme need, they helped distribute food and water, and did anything else that was needed. They inspected wells with the US Army, they taught rescue workers how to build safe latrines for their camps, they built showers, they worked with UNICEF to assess sanitation needs for orphanages. Feedback from rescue workers were that their skill sets were perceived as very, very valuable, they were quite grateful they had come, and they would welcome permaculturists and low tech, sustainable solutions at any disaster site.

1500 people line up for supplies, Jean Lucho assists the team

1500 people line up for supplies, Jean Lucho joins the team

The first few weeks were filled with chaos and triage situations. It took courage and dedication to deal with the conditions they operated under – these guys are tough! But even under the most extreme conditions, many seeds were planted and beneficial connections were made. And lives were saved! Most of the long term design work to create sustainable systems started many weeks after the disaster, however.

Cooking for 3000

Cooking for 3000

As systems become more established in Port Au Prince, Rodrigo started organizing and attending meetings to create recycling in Port Au Prince. The waste streams are impressive – millions of plastic water bottles shipped in during rescue efforts, cardboard, tent material, etc. He experimented with paper brickets, which replace charcoal in the ubiquitous open cook stoves that are destroying forests in Haiti.

Results of recycling class

Results of recycling class

Nicole started working for an NGO and got them to use arbor loos in one of the camps. Andrew connected with the Give Love project (givelove.org) in Cite Soleil, and helped build a compost toilet system for a camp of 2500 people , with a team made up of Joe Jenkins, Rodrigo, and other humanure experts. PDC student from Little Haiti in Miami, Paule Jacques, hooked the project up with her contact, Minister of the Environment of SE Haiti, Jean Ked Neptune, who connected Mark and Monika, Hunter and Rodrigo with Haitian non-profits, so they could “teach the teachers” sustainable methods of growing food and handling water and waste with workshops. Rodrigo, who is still in Haiti, has continued to build compost toilets, teach people about composting and set up recycling systems for various organizations.

Compost class with Hunter

Compost class with Hunter

Rodrigo teaches compost toilet class to Haitian non-profit group

Rodrigo teaches compost toilet class to Haitian non-profit group

At first, these were made of pallets and whatever could be scrounged. Rodrigo inspects

At first, these were made of pallets and whatever could be scrounged

Kids are first in line to use the compost toilet

Kids are first in line to use the compost toilet

I traveled to Haiti in May 2010 to assess the projects and the situation in Port Au Prince at that point, and to connect with Jean Ked. I felt that training Haitians in permaculture was key, and was able to fund a trip to Pine Ridge for the Minister of the Environment and his associate to do the Permaculture Design Course there. We felt Pine Ridge was a very appropriate venue because of similar conditions of watersheds, economics, and degraded landscapes. Ked has started a vermicomposting project that will link into creating a stable local economy as well as revitalizing degraded lands, and intends to do village sized permaculture projects. We continue to work with him and others in the area to help facilitate their projects.

Haitians assess the site at Pine Ridge PDC

Haitians assess the site at Pine Ridge PDC

Because of the connections we made through this project, we’ve been able to link up several permaculture resources across the country with each other so they can exchange energies, and we’re currently assisting in the organization of a database of all things permaculture in Haiti, so that more beneficial connection can be achieved.

All in all, the project was a success, with a number of things coming from it that will continue to propagate and fruit. It is likely, for instance, that the low tech methods of purifying water, and education on how to prevent water contamination from human waste may be saving lives as the cholera epidemic unfolds. We continue our efforts to educate people on these techniques.

Though the chaos of the immediate aftermath of a disaster of this magnitude is not conducive to design and planning work, the rescue team is glad that they could be there to help when it was so desperately needed. Many seeds have been planted that will continue to fruit into more sustainable systems.


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Impressions of Haiti

(from a visit in May, 2010)

Four months after the earthquake, the streets of Port Au Prince are filled with people selling things, repairing things, walking somewhere, doing something. There is a semblance of normalcy in the city, a mixture of passion for life, purpose and perhaps resignation. But signs of the earthquake remain obvious.

Driving through Port Au Prince at night, the broken houses and rubble and garbage in the streets appear ghost like and ethereal. The people stay vibrant and real, colorful in the headlights, enjoying the respite from the hot sun.

We stop at a checkpoint in the middle of the street – there has been an increase in kidnappings and NGO employees are under curfew – some must be in their homes or hotels by 6 PM. The victims are always released unharmed – kidnappings in Haiti have their own rules and politics. Injustice, economic and otherwise, often drives such actions.

What strikes me more than anything else about Port Au Prince and surrounding areas is the calm purpose one finds in every neighborhood, every street, to bring order back into the chaos that prevailed after the earthquake.

Tent cities are ubiquitous – in parks, in empty lots, on the rubble of destroyed buildings, or in the streets themselves, blocking already narrow lanes, you cannot drive for five minutes without seeing one. Most people now have real tents, or at least rain proof tarps, but some are still using sheets. Port Au Prince is sheltered by mountains and a bay which mitigates the winds but a major effort was in progress to relocate tens of thousands of people whose tents were likely to be washed away or flooded out in major rainstorm, as the rainy season progresses. Only 100 tent cities are on the list. We visited one city of 2500 in a flood plain that isn’t on the list – there are no plans to move it.

Cite Soleil camp

Cite Soleil camp

A new addition to Port Au Prince is the rubble from thousands of houses which spills onto sidewalks and streets and empty lots as they are demolished to make room for new construction. One of the major agencies is supposed to arrange to pick it up, but there seems to be a never ending supply of it – virtual mountains of urbanite, which landslide in the heavy daily rains and block the roads. The people are cleaning up and rebuilding their city with hand tools and wheelbarrows, piece by piece.

Those that can afford it are building smarter – they have all seen which houses stayed standing in the earthquake and which ones didn’t (the old style gingerbread houses are almost all still standing). Those who can’t afford better grades of concrete and construction materials are rebuilding the same way they did it before, or building shacks made out of scraps or if they’re really lucky, they scored a shipping container.
When assessing needs and resources, the waste stream becomes an obvious abundance that could remedy a number of scarcities. Garbage is everywhere – there are literally mountains of plastic bottles, sawdust, cardboard and other garbage in every neighborhood. Per one person we spoke with, there is only one small recycling facility in Port Au Prince.

DSCN0610

As we landed in Port Au Prince, we flew over thousands of shipping containers that could be used for earthquake and hurricane resistant housing sitting at docks next to several large tent cities.

Driving through the city, we see people carrying logs only 2” in diameter, to rebuild houses (per my Haitian friend, the trees do not get any bigger before being chopped down). I saw hundreds of cookstoves lined up on sidewalks, burning biochar created from the remnants of the jungle, the lifeblood of the land burned to cook imported rice in a country that used to grow enough rice to be a significant exporter, before economic manipulation destroyed the rice industry. Farmers became loggers, and now the mountains are barren and the rivers full of silt, what is left of rich jungle soils.

“What can the people do?” one Haitian woman said to me. “They need shelter! They need to cook their food!”

Millions of cookstoves burn trees of Haiti

Millions of cookstoves burn trees of Haiti

The Director for the Ministry of the Environment in Jacmel, introduced to permaculture by one of our PDC graduates, Paule Jacque, discourages solutions that use wood at all, because of the concern that people will continue to cut trees. Thus sawdust and rocket stoves are perceived as not the best solutions possible though certainly an improvement over what is used now. We plan to experiment with sawdust stoves using rice husks and other material. One solution I found was the high efficiency Lucia stove created by World Stoves and produced in a local Haitian factory. Using a vortex technology, it burns almost anything efficiently (garbage, fruit rinds, rice husks, etc) and produces biochar, which can be used in a program to remediate depleted soils. Another solution being experimented with by some of our team are brickets made of waste paper and other flammables from the waste stream. While not an ideal or long term solution, it can be a transitional program. With few recycling facilities in Port Au Prince, it is better than putting it in a landfill. And it saves trees.

We are driving down a steep road coming from one of the wealthiest neighborhoods in Port Au Prince. The road headed downward is empty except for us, but a long string of newer model jeeps and SUVs is parading up the hill headed for the estate compounds in the hills. “Those are the NGO’s” my friend informed me. “Some Haitians won’t rent to other Haitians because they get more money from the rescue agencies – in some cases $10,000 US per month. They pay US and European rates.” Her Haitian friend, in the car with us, was having trouble finding a place to rent, though she had money. Even Haitians that can afford to pay rent can’t find housing sometimes because they are displaced by foreign employees of foreign NGOs.

The barriers to getting things done in Port Au Prince can be complex and formidable. I’ve only been here a few days, but already I’ve been stranded by flooding, which caused me to miss a key meeting, stranded by a fuel shortage (the fuel was available offshore, but not allowed into PaP for some reason – political, per some Haitian friends), prevented from reaching another meeting by a strike, dehydrated, and bitten by plenty mosquitos.

But yet I am struck by a sense of order. In the camps, Comites (committees) have been elected to coordinate needs and resources, flood mitigation, medical care and other logistics. Neighborhoods spontaneously organized themselves shortly after the quake and neighbors took care of each other and their area. Children in impeccably neat school uniforms are seen in most neighborhoods, and I marvel at how impeccably clean everyone is, considering so many are living in camps with shortages of showers, the dust from the rubble can be intense, and the rains turn it into sticky mud. Most of the streets were kept clear enough of rubble, tents and other debris to be passable, which was quite a feat, with the rains especially. Garbage was being collected in some areas, markets were thriving, and the sense of purpose was palpable.

“Tap tap” buses are always evident even when there is little fuel, a symbol of optimism we see in so many places in spite of the grim circumstances.

DSCN0257

Jobs are almost non-existent but everybody is selling something, it seems. I wonder where they get both the goods and the money.

While Haitians are only paid $3-10 per day “cash for work” as part of the rescue effort, to clean up rubble and garbage , money is trickling into the economy via high prices for foreigners (on the street, there is one price given to foreigners, another one for rich Haitians, and another for poor Haitians). I took a 15 minute taxi ride to an NGO meeting which cost $40 US, more than twice what it would have cost in NYC. When I queried the price, the driver firmly said, “This is the going rate for NGO’s”. With $10 billion in aid slated to Haiti and very little of it actually entering the local economy even now, Haitians are tapping into it where they can, via the salaries and operating budgets of relief agencies.
The media states that the World Bank and other major funders of the relief effort will be largely running the country on a de facto basis, bypassing the government and the local business community. No surprise, but disappointing – Haiti is a country as yet relatively untouched by multinational corporate chains and heavy commercial development.

There is much opportunity for permaculture in Haiti – hillsides in Port Au Prince are dotted with the Haitian version of three sisters – corn, pigeon pea and squash or melon, plus various herbs and other vegetables. We found out later this was a result of a successful urban farming program from the early 90’s. We saw many mango and neem trees as well as mangosteen, noni, soursop, moringa and other potential value-added foods. Because it is so mountainous, microclimates abound in Haiti – almost anything tropical or semi-tropical could grow here if there is soil. Haitians are already accustomed to low tech solutions and if something works, its use can spread rapidly through grassroots.

Beans with overstory of banana, breadfruit and coconut and mulch of sawdust and coconut coir

Beans with overstory of banana, breadfruit and coconut and mulch of sawdust and coconut coir

In the countryside, housing is similar to traditional quincha mejorada houses in Central America – made of sticks and earth, the houses can withstand weather and even earthquakes. If bamboo is used instead of sticks, this type of housing becomes sustainable and easy to build. With the right earth plasters, it can be made to resemble the popularly accepted concrete housing in Port Au Prince.

Earthen house

Earthen house

Broadscale reforestation and erosion control is vital – at one time Haiti was the breadbasket of the Caribbean, supplying food for many other countries. Now it imports much of its food and continues to deplete its soils by cutting trees. Many reforestation projects have failed because they did not include human systems in the design process. By incorporating economic solutions, we can ensure that forests remain, once planted. There is opportunity in disaster because systems need to be rebuilt, and can be rebuilt sustainably.
DSCN0570

We are in planning stages on a Haitian reforestation project that incorporates sustainable human systems (financial and social permaculture, self-sufficient food, water, shelter and energy), and are interested in networking and cooperation with other projects. One of our projects is to assist in putting together a database of permaculture resources in or connected with Haiti. For more information on the database, write to: Olivia Jeanne, oj@veya.org

There is much work to be done but many hands to do it. Perhaps what touched me most of all was the optimism I encountered. In spite of the suffering Haitians have endured, when offered channels to improve their condition, interest and enthusiasm rise to the surface.

Country street

Country street

Jacmel

Jacmel


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