HEALTH

A silent killer

Cholera strikes Peru on an epidemic scale

D’ARCY JENISH February 25 1991
HEALTH

A silent killer

Cholera strikes Peru on an epidemic scale

D’ARCY JENISH February 25 1991

A silent killer

Cholera strikes Peru on an epidemic scale

HEALTH

Brazil donated medicine, France sent a team of doctors, and at least half a dozen other countries, including Canada, promised to contribute aid to Peru, an impoverished South American nation that is locked in battle with a deadly epidemic. Since late January, more than 12,600 Peruvians have contracted cholera and, by late last week, an estimated 100 had died. It was the first major outbreak of cholera to strike the Western Hemisphere in this century. Cholera, a bacterial infection that causes severe diarrhea, vomiting and dehydration, and which is fatal if untreated, is transmitted through contaminated drinking water and food. Medical authorities said that because of Peru’s primitive sanitation and sewage systems, the disease would be difficult to control and was likely to spread to neighboring nations. Said Dr. David BrandlingBennett, co-ordinator of the health situation and trend assessment program at the Washington-based Pan American Health Organization: “We have to be prepared for it to last a number of weeks.”

Despite the influx of doctors and medical supplies, the disease spread rapidly through Peru last week, with up to 2,500 new cases reported daily in the nation of 22 million. Genevabased World Health Organization officials said that the number of people affected there is already more than one-quarter of the 48,000 cases registered worldwide in 1989. Although most of the victims were in Lima, the capital, and in the Pacific port city of Chimbóte, there were reports of cholera deaths in other parts of the country. Several neighboring countries, including Bolivia, Ecuador and Chile, banned imports of Peruvian food in an attempt to prevent the spread of the disease. The newsmagazine Caretas (Masks) reported: “Terrifyingly, health conditions in 19th-century London were similar to those of Lima today.” During a 17-year period in the middle of the 19th century, an estimated 30,000 Londoners died of cholera.

In an effort to control the disease, the Peruvian health ministry used radio and television announcements to advise people to boil drinking water for at least 10 minutes and to avoid eating raw seafood, particularly a popular fish

dish known as cebiche. Officials credited those measures with reducing the mortality rate of those struck by the disease to less than one per cent from an initial 30 per cent. Still, the urban poor living in the country’s teeming shantytowns were resorting to folk cures that included eating hot yellow peppers and raw onions.

Others tried using smoke to rid their homes of the disease. Said Manuela Valdez, a shantytown resident in Lima: “They say you should fumigate the house with burning eucalyptus leaves to kill the cholera.”

Medical authorities said that after reaching Peru, the bacteria spread swiftly and contaminated drinking water. An estimated four million of Lima’s seven million residents live in

shantytowns that often have no sewage disposal or water treatment facilities. According to a study commissioned by Mayor Ricardo Belmont of Lima, 40 per cent of the city’s water supply is contaminated by fecal matter. Said Dr. Uriel Garcia, a former Peruvian health minister: “Cholera is a disease of the poor, and that makes all of Latin America vulnerable.” Cholera can be treated with antibiotics that kill the bacteria, or with rehydration liquids, which replace body fluids lost because of diarrhea and vomiting. Those liquids, made up of water, sugar and salt, are the most common form of treatment. There are no completely effective vaccinations against cholera. According to Brandling-Bennett, the World Health Organization no longer recommends cholera vaccines for travellers because they are effective for only 40 to 50 per cent of the people vaccinated, and then only for about three months.

Victims who do not get medical help quickly can face a painful death over a period of two to seven days. The first symptom is usually profuse diarrhea, which lasts several days. A cholera victim can lose up to four gallons of body fluids in 24 hours. The next stage of the disease is usually marked by vomiting. The victim’s skin becomes cold and withered, his pulse becomes faint and he can experience severe muscle cramps and thirst as he becomes more dehydrated.

Although outbreaks of cholera are still fairly common in the less developed countries of Asia and Africa, water and sewage treatment has almost eliminated the disease in the industrialized nations. The first major medical breakthrough linking cholera with contaminated water occurred in England in 1854. A doctor named John Snow interviewed cholera victims during the outbreak in London and found that all of them had taken water from the same pump in the city’s Broad Street, in the northern part of central London. Shortly after the city closed the pump, the epidemic ended. Before Snow’s discovery, cholera was a devastating disease. An 1831 epidemic killed thousands of people in Europe, and the following year the disease killed more than 6,000 people in Canada within four months.

According to some medical authorities, the current epidemic in Peru is

part of an outbreak that began 30 years ago in Indonesia and that has

since spread throughout the Pacific

region. The disease spreads when

someone carrying the bacteria travels to another place and contaminates the water supply. As a result, health authorities in South America’s populous nations were taking every precaution to prevent Peru’s cholera epidemic from spreading.

D’ARCY JENISH

NORA UNDERWOOD