Cholera’s Divisive Reappearance

May 10, 2011 • Frontiers, Theme • Views: 1093

by Deirdre Dlugoleski

‘The relationship between Haiti and the Dominican Republic is a complicated, very strange relationship,” reflected Robert Lamothe. A teacher of Creole, Lamothe left Haiti for the United States with his family at age 13 but remembers the widespread discrimination well. “I have to tell you that I was shocked that the Dominicans had sent helicopters, first aid, and rescuers to Haiti,” he added, frowning and folding his hands.

Despite this complicated relationship, the Dominican response to the devastating earthquake that hit Haiti last January was decidedly straightforward. Haiti’s neighbor sent food, water, mobile clinics, and teams of rescue workers across the border, providing one of the earliest and largest aid contributions to Haiti. Dominican hospitals took in Haitian victims and provided emergency care, and the Dominican government announced that it would halt deportations of illegal immigrants in the aftermath of the disaster. From a small country with a high poverty rate, the aid was a strong sign of solidarity with Haiti. This generosity is even more remarkable in light of traditional Dominican relations with its neighbor, which have never been smooth. The window for improved relations, however, may be closing with the appearance of cholera on Hispaniola, the island the two countries share, nine months after the disaster.

Since the 19th century, Dominicans have developed an explicitly anti-Haitian national identity. The Dominican Republic celebrates its 1844 independence from Haiti rather than Spain, its other colonial occupier. The worst manifestation of tensions came in dictator Rafael Trujillo’s 1937 massacres of Haitians along the border, considered by many as an act of genocide. Subsequent political leaders have used the “Haitian problem” to draw attention away from domestic issues. In the Dominican Republic today, the dark skin associated with Haitians is often a stigma, and Haitians still hold mostly low wage jobs. Given the island’s social history, Lamothe was certainly not alone in his astonishment at the Dominican outreach after the quake.

The appearance of cholera in central Haiti’s Artibonite Valley last October was the country’s first outbreak in over a century. It has since claimed over 4,600 lives. Upon hearing of a few cases of cholera in the Dominican Republic in November, many Dominicans feared a similar outbreak. “In reality, it is a very contagious disease,” observed Francisco Franjul, a taxi driver and former bank manager in the Dominican Republic. “In some cases, it can’t be avoided despite taking the appropriate measures.”

Though access to health centers is not a problem, adequate treatment is not guaranteed. “In all the provinces there are hospitals, and for almost every six kilometers there is a center for primary health,” said Jorge Amarante, a doctor in the Dominican Republic. “The problem is in the quality of the medical services given.” While almost every town has a clinic, few are equipped to handle an outbreak of the disease on the scale Haiti has seen. The Dominican Ministry of Health has undertaken an immense public education campaign in Spanish and Creole, including posters and mass text messages reading “¿Qué es el cólera?” and “Kisa kolera li ye?”—“What is cholera?”

But Dominicans face relatively little chance of death by cholera. Treatment is easy, often requiring only oral re-hydration for a recovery within three to four days. Cholera also does not move easily from human to human. “Cholera is essentially a water-borne disease; somebody has to get it from water and then pass it on to other people,” explained Ian Rawson, Director of Hopital Albert Schweizer, the first hospital in Haiti to receive cholera patients. “The reality is that the vast majority of people who got sick and who are getting sick got sick from the water that they drank.” But even water is easily treated. “A couple of grains of chlorine in a bucket of water will pretty much take care of it,” said Rawson.

Though cholera poses little danger to ordinary Dominicans, the same cannot be said for the country’s tourists. In January, over 100 guests, mostly wealthy Venezuelan businessmen, contracted cholera at a high-profile wedding in Casa del Campo, a Dominican resort. But the Dominican government only admitted to the presence of cholera on the island after Venezuelan President Hugo Chavez publicly spoke of the event.

A sign in front of a public health building on the Haitian side of the border. (Dr. Robert Chase)

Since that public relations debacle, the Dominican government has taken extraordinary measures to publicize their efforts against cholera. “They’ve been doing everything in their power to control the spread of the disease, but controlling the disease itself doesn’t prevent against the backlash of how potential tourists perceive the threat from abroad,” explained Gerald McElroy, a local program coordinator for the NGO Yspaniola who works mostly in the border region. The implementation of these measures, however, betrays the underlying issue behind the cholera panic: illegal immigration.

“The Dominican-Haitian border is very vulnerable to being crossed without control,” observed Amarante. An estimated 600,000 Haitians lived illegally in the Dominican Republic before the earthquake, a figure that has climbed to one million in its aftermath. Around 80 percent of agricultural workers in the Dominican Republic are Haitian or of Haitian descent.

“It’s becoming an uncontrollable situation,” Franjul said. “They don’t maintain a low profile in the country, causing more inconveniences than cholera, like robberies, homicides, and beggars in the streets, asking for money and using children for this business.” With no legal status, it is also impossible to monitor their health. “Illegal Haitian migration to our territory is worrisome,” explained Franjul, “They don’t apply a hygienic conduct to be able to control this disease that they bring to the country.”

The government seems to agree. Despite the rarity of human-to-human transmission, the Dominican Republic has undertaken anti-Haitian initiatives to prevent the spread of the disease. Mass deportations, suspended after the earthquake, have recently resumed. “Any individual with a Haitian-like appearance could be stopped and asked for papers,” said McElroy. “If they don’t have their documents on them, which oftentimes are expensive or difficult to obtain for Dominicans of Haitian descent, they will be sent to Haiti.”

Authorities have also segregated border markets, like the once-thriving Dajabón, where both Haitians and Dominicans would go to sell goods in a civil exchange. “They’ve built this completely separate complex far away from where the market used to take place,” said McElroy. “Now, there’s a check point. They’ve built a completely new border crossing, a new bridge, so now there’s two, and as you cross the second bridge you’re pushed into this fenced in area with this wooden building and all sorts of venders and stalls… They want to have all the Haitian vendors in one area separate from the Dominican vendors.”

Despite this active segregation in cities and border markets, the government has turned a blind eye to mixed communities on the border. High numbers of Haitian migrant workers live in crowded, makeshift villages called bateyes with little or no access to electricity, sanitation, health care, or running water. They are neither immobile nor sequestered from contact with Dominicans. They can commute between Haiti and the Dominican Republic, and some bateyes have a high proportion of Dominican residents. These communities are especially at risk for diseases like cholera, but government-ordered deportations, which traditionally have occurred around electoral campaign seasons, have thus far avoided the bateyes, focusing instead on the cities. With elections scheduled for May, this may change; bateyes have been subject to routine sweeps in the past.

Few medical specialists have concerned themselves with how the disease reappeared in the country. “I don’t think that the origin is relevant except in discourses that serve to provide a rationale for discrimination,” said Ana Lara, a second year Ph.D. student from the Dominican Republic. “For me,” McElroy said, “one of the really upsetting pieces of the past two months has been how the conservatives in the Dominican Republic have used the epidemic as a political tool. Illegal immigration has always been an issue here, so when you can empower these conservative politicians to have some sort of legitimate reason to start deporting Haitians, it’s a disaster.”

Ironically, the Dominican Republic may be stirring itself into a frenzy over a threat that has largely passed. After a successful public health campaign and aid from many NGOs, the disease has abated in Haiti and remains relatively under control. Most international medical organizations have already departed, though a handful remains to run cholera treatment centers. The Dominican Republic’s own prevention campaign has seen so much success that serious outbreaks of cholera have not even appeared in the bateyes.

For both Haitians and Dominicans, it seems that history has proven more intractable than the disease. It is the relationship between the two neighbors that needs treatment more urgently than the water supply.

Deirdre Dlugoleski ’13 is a History major in Ezra Stiles College. Contact her at deirdre.dlugoleski@yale.edu.

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