Another Way to Die

The sand divers of preval go to work every day in the brown water of the Artibonite River, deep in the rural heart of Haiti’s cholera hot zone. Strong men wearing shorts dive deep under the rushing water, scooping up sand by hand or with small buckets. They dump their gray bounty—the best in all of Haiti for use in making cement—in long wooden boats, held in place in the current by poles. Piles of sand line the shore, and somehow each man knows which one he owns. They also know now that the water might be contaminated. It is “very likely that during the course of their work, these divers could ingest enough water to put them at risk for cholera,” says Eric Mintz, an epidemiologist for the Centers for Disease Control. When the men are asked why they don’t stop, the answer is simple: “This is how we live.”

Unfortunately for the sand divers, Haitians are poor in everything but ways to die. The first case of cholera was confirmed on Oct. 21, and since then 6,742 cases have been reported. More than 440 Haitians have perished from the disease, which anyone can catch by drinking contaminated water, or by coming into contact with the feces of an infected person, or simply by eating food prepared by someone with cholera
National Highway 1 from Port-au-Prince toward the Artibonite Department is the main route into the heart of the outbreak. The mountains loom larger as visitors head north, and the land is mostly denuded, because of years of deforestation dating back at least to when the French made off with Haiti’s prized mahogany. Blue tents and tarps provided by emergency-relief agencies dot the hillsides, but there are fewer of them as the miles click by. Before long, the coast appears, with its blue-water beaches, and the road passes through vibrant villages on the way to St-Marc, eventually reaching the turn to Deschapelles, home of the Albert Schweitzer Hospital. It is one of the main cholera-treatment centers in the afflicted area and serves a region of about 300,000 Haitians.

Young men and women along the road wear T shirts from U.S. high schools that say SPARTANS or REBELS or LITTLE LIQUOR PIGS or CITY OF BOCA RATON HOLIDAY BOAT PARADE, many of them donations that flowed into the country after the earthquake. There are naked boys swimming in brackish streams, and men and women working in the potentially cholera-compromised rice fields. At a popular hotel along the coast, cars cannot enter the grounds until a security guard wearing a mask sprays the tires with a pressure washer. A warning sign on the check-in counter is written in French, but there are two words in English: DANGER CERTAIN.

At Schweitzer, built on the site of an old banana plantation that went under during the great blight in the 1940s, hospital director Ian Rawson recoils from an outstretched hand, offering instead a noncontact fist bump as greeting. What’s most jarring about walking into the cholera wings, which held 31 patients last Monday, down from a high of 90 on Oct. 22, is how quiet and organized they are. Each patient has a caregiver sitting by the bed, usually a close relative. No one yells or shouts or complains. Even though some patients are vomiting or have no control of their bowels, they are courageously—and silently—bearing up under the pressure. Rawson says that’s because they are “the strongest and most persevering people” in the world. Most of these patients live in tiny cement-and-wood houses in the surrounding area and are accustomed to very little privacy. They’ve learned to adjust for the dignity of others.