issue 222 - August 1991
My daddy's dead
Modern Latin America has suffered many ills, but cholera has not
been among them - until now. Suzanne Timmons reports from the shanty
towns of Peru where the bacteria gained a foothold
- and relays a message to the politicians.
Four-year-old Percy Ripas kicks his bare feet in the sand floor of his mother's one-room straw shack and watches his older brother spoon sugar into six tin coffee cups. The coffee, mixed with water stored in a tub on the floor amidst dirty pots, pans, plates and yesterday's leftovers of beans and rice, is the Ripas family's only breakfast.
Clutching a grimy paperback dictionary as if it were a teddy bear, Percy looks up as his mother, Maria, tells about the nights his father spent in the local cholera ward with Percy's older brother Freddy. Freddy recovered but his father, a 35-year-old cobbler, went down with cholera and died shortly after walking for 45 minutes to the nearest hospital for treatment.
'My daddy's dead,' Percy says simply, opening his brown eyes wide and chewing on his lower lip. Now Percy, as well as his eight- month-old brother, has come down with the tell-tale signs of cholera: vomiting, diarrhoea and cramps.
It's no surprise that the Ripas family, as well as thousands of other poor families in the shanty towns sprawled across the hills around Lima, are victims of Peru's cholera epidemic. Nearly 1,500 people have died and around 200,000 have been stricken with cholera since the epidemic began. The bacteria - spread mainly via contaminated water - strikes and flourishes in areas that lack running water and proper sanitation services. It will be years before the Ripas family has either.
The Ripases set up their straw shack along with 600 other families one night last year, squatting on an empty lot earmarked for an open-air market in the middle of an older shanty town. The dirt lanes between the shacks - reeking of urine and excrement - and a smouldering garbage dump only metres from the houses, serve as the settlement's only toilets.
They beg for bucketsful of water from their longer-established neighbors across the road, most of whom have scraped together enough money to replace their straw huts with brick houses. Some of these buy water from trucks and store it in outdoor cement tanks. Others, like Maria Ripas' aunt, Domitila Panuera, have running water. But even then the taps are often dry for weeks at a time.
The cholera outbreak, the first to strike Latin America in over 100 years, was detected in late January in the port town of Chimote, 400 kilometres north of Lima. Epidemiologists say that it most likely was brought to Peru on a ship from Asia.
The epidemic swept quickly to other coastal cities and within weeks had spread to the most remote areas of the Andes and the Peruvian Amazon. At the end of March, when the epidemic peaked, around 1,000 people a day were falling victim to cholera.
'It's a reflection of poverty,' said Dr Hugo Contreras at the Ciudad de Dios health centre, one of four medical posts that serve several million shanty-town dwellers to Lima's south. 'Cholera patients almost always come from shanty towns.'
It is not only the lack of running water and sewage facilities that makes the poor a target for cholera. Many barely have enough money for kerosene to cook every day, much less to buy the extra fuel to boil drinking water for ten minutes, as the Ministry of Health recommends. And in the Ripas household, the one-burner kerosene stove is nearly ready for the junkyard. 'The kids have to get up at dawn every day to fire it,' Maria said. 'It's hard to keep the water boiling for so long.
Now health officials say that the epidemic, in Lima at least, is under control. But doctors caution that the slump in the number of cases does not necessarily mean that cholera has been beaten. The bacteria tend to lie dormant with the drop in temperatures during winter, which in the southern hemisphere begins in early May.
Meanwhile the epidemic is still raging in the jungle, where the year-round heat is providing ideal conditions for the epidemic to spread. In the jungle, as well as in the Andes, many people live two or three days' journey by boat or by foot from health posts where they can be treated with life-saving rehydrating salts. In four jungle provinces the number of cases quadrupled within a matter of days in mid-May.
The Peruvian Government's frontline attack on the cholera epidemic with economic aid, supplies for medical posts and massive distribution of health rules, has helped keep the mortality rate of the epidemic so far to 0.7 per cent of those with the illness - one of the lowest rates in the history of worldwide cholera epidemics.
The Government is footing the bill for all cholera patients. Peru has received millions of dollars in medical aid from over 60 countries since the epidemic began and most hospitals have had enough supplies to treat all cholera patients. 'The problem at most hospitals wasn't having enough medicine but enough beds for the number of patients,' Dr Contreras said. 'I was at a very remote village in the highlands that is six hours from the nearest town, and even the smallest medical post there had medicines for cholera,' he said.
But doctors at the same time severely criticize the Government for refusing to clear the streets of street vendors who prepare everything from hand-squeezed orange juice to cebiche, a dish of raw fish marinated in onion and lime juice. Many cholera patients say they came down with cholera after eating food from the street.
To make matters worse, President Alberto Fujimori and the Minister of Fisheries, Felix Canal, in mid-March launched what the local press called 'the cebiche war' against Health Minister Carlos Vidal. Both Fujimori and Canal refused to heed warnings by the Health Ministry to avoid eating raw fish. They appeared on national television several times eating cebiche. Vidal resigned - and the number of cholera victims increased by over 30 per cent in just two weeks.
Health Ministry officials, as well as the World Health Organization, say dishes prepared with raw, shore-hugging fish and shellfish are cholera carriers. Raw sewage is dumped in the ocean throughout Peru, and health officials say that fish, although they do not die from cholera, pass the bacteria on to humans if they are not cooked.
But cebiche prepared by street vendors is one of the cheapest meals available. 'Cebiche sold right outside this centre costs the same as a bus fare,' said Dr Contreras. 'No-one can make a lunch at home for that little.'
The World Health Organization (WHO), which says cholera is already endemic in Peru, is concerned that the bacteria will be around in Latin America for many years to come. Outbreaks have been detected in Ecuador, Colombia, Chile and Brazil, and authorities in Venezuela are gearing up to battle the disease when it crosses their borders, which they say is 'inevitable'.
The Panamerican Health Organization says that 40,000 people in all of Latin America are in danger of dying from cholera and six million are likely to fall ill by 1995.
'It will always be people without water and sewage facilities who will be affected with cholera,' a WHO spokesperson in Lima said. The WHO estimates that in Latin America and the Caribbean only 40 per cent of the population has clean water and 30 per cent has effective sanitation.
In Peru, health specialists and social workers agree that improving living conditions for the poor majority is the only way to beat cholera for good. 'The educational part (of the anti-cholera campaign) is good, but the Government still hasn't done anything about san- itation. What it needs to do is give water and sewage facilities to those that don't have any,' said Fanny Cotos, a social worker with the Anglican Church who is helping out the Ripas family.
WHO officials also say that only longer-term solutions will work. They say that Peru must spend $300 million a year over the next 10 years to provide clean water and sewage services to 80 per cent of the 28 million people who will live in Peru by the year 2000.
But it won't be easy. The country is facing one of the worst economic crises in its history. It is only now making headway in its attempt to win fresh foreign loans after five years of clashes following former President Alan Garcia's refusal to pay back the $20-billion debt. And while aid has been prompt in arriving to combat the immediate cholera danger, there is little sign that the international community has the will to help Peru tackle its water and sanitation problem.
As just one example of how slowly things are likely to move, a $12-million project to increase the capacity of Lima's water-treatment plant has been on hold for nearly a year despite having been declared a 'priority project'.
In other words, Peru's poor are likely to be fighting off cholera for a long time to come.
Suzanne Timmons hails from Tulsa, Oklahoma but lives and writes in Lima.