TIME: Almanac 1993/TIME Almanac 1993.iso/time/050691/0506130.000

Text File | 1992-08-28 | 5.9 KB | 133 lines

                                                                                HEALTH, Page 58

Death in the Time of Cholera


As many as 6 million people, most of them very poor, may fall
ill and 40,000 of them could die because an easily treatable
disease is raging out of control in Latin America

By CHRISTINE GORMAN -- Reported by John Maier Jr./Rio de Janeiro


    Many doctors think of cholera as a kind of Lazarus
syndrome. Victims are brought to a clinic or hospital with no
apparent blood pressure or pulse, taking only shallow breaths.
"But if there is any life left in them at all, we can bring them
back," says Dr. David Sack, associate professor of international
health at the Johns Hopkins School of Public Health. Sadly,
thousands of people in Latin America will not be revived in time
and will die of the disease, which robs the body of fluids
through severe diarrhea and vomiting. Last week the first
epidemic of cholera on the South American continent in this
century was raging in several countries. The epidemic, which
started in Peru and is spread through contaminated food and
water, has surged into several neighboring countries,
overwhelming medical resources in many areas and striking mostly
the very poor in shantytowns, mountain villages and remote
jungle settlements.

    Already 165,000 have developed the affliction, and more
than 1,200 have died. By one estimate, as many as 6 million
people may fall ill over the next three years, with the death
toll reaching 40,000. Two weeks ago, Brazil reported its first
cases, in the Amazonian jungle on the border with Peru. In the
U.S., health officials revealed last week that four people in
the New York City area became ill after eating improperly
cooked crabmeat that had been illegally brought into the country
from Ecuador. (Excellent public sanitation should, however,
prevent a U.S. outbreak.) "We just can't hold the epidemic
within the present limits," says Carlyle Guerra de Macedo,
director of the Pan American Health Organization. "Most likely
we are going to have cholera in all of Latin America."

    Health officials from nine different Latin American
nations met in Sucre, Bolivia, last week to coordinate their
efforts and issue an urgent call for international help. The
World Health Organization (WHO) in Geneva announced the
formation of a special cholera task force. In addition, France
and the U.S. are sending supplies and medical staff to set up
emergency clinics.

    Scientists do not know exactly why cholera periodically
explodes into epidemics. The bacteria that cause it are part of
the aquatic ecosystem, helping to break down dead shellfish.
Cholera germs travel up the food chain by attaching themselves
to plankton, which are eaten by fish and then by people. Studies
by Rita Colwell, professor of microbiology at the University of
Maryland, suggest that a plankton bloom, a rapid growth like the
one reported off the coast of Peru earlier this year, may help
trigger epidemics.

    Quick treatment can easily save lives. Large amounts of a
simple solution of sodium and potassium salts and sugar can
rapidly replace the body's fluids. If patients are strong
enough, they can drink the lifesaving mixture instead of
receiving it intravenously. Antibiotics speed up the recovery
time. Unfortunately, in Latin America, distributing medicines
can be difficult, especially in remote areas.

    Even so, the epidemic may not be as devastating in other
countries as it has been in Peru. "The country where cholera
strikes first is always hit the hardest," claims Dr. Baldur
Schubert, head of Brazil's National Commission for the
Prevention of Cholera. "We've had time to prepare for the
disease." The Brazilian government has distributed 450,000
illustrated pamphlets on the Amazon border to teach people how
to combat cholera by boiling drinking water and washing one's
hands after defecating. Authorities have also allocated $6
million to build public toilets in the area. In Colombia the
folk troupe Los Natales is performing a modified version of
traditional dances to teach sanitary habits.

    If the efforts fail, however, the disease could continue
its eastward march and strike such major coastal cities as Sao
Paulo and Rio de Janeiro, which are teeming with favelas, or
slums. "That would be disastrous," says Afonso Infurna Jr., vice
president of the Brazilian commission. "Health and hygiene
conditions are already poor, and the disease could spread
rapidly." Although Infurna and other commission officials
predict they will contain the infection, they admit that the
cost of treating a full-scale epidemic would be high -- on the
order of $600 million.

    Relief efforts in Peru have been hampered by a strike
among health-care workers. When Bolivia tried to send doctors
to the Andean village of Puno, where an outbreak was beginning,
the medical team was asked to stay home. Finally the strikers
allowed a limited number of Bolivian technicians to disinfect
Puno's sewage pipes with chlorine.

    Even with the staunchest efforts, cholera's march through
Latin America could mean trouble for years to come. Before the
massive outbreak that spread from Asia in the 1960s, cholera was
rarely seen on the African continent. Now, however, it reappears
there every year and claims hundreds of lives. The only
effective solution is good public sanitation. "We know that
these diseases are basically problems of drinking water and
sewage," says Health Minister Camilo Gonzalez Posso of Colombia.
"Until we attack those fundamental needs, we will always be
vulnerable to tropical diseases turned plague." But according
to the WHO, providing safe water and sewage treatment in Latin
America could cost $50 billion over the next decade -- a
staggering sum for countries that are already deeply in debt and
struggling with the problems of crushing poverty.