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Filth, Poverty Make Cholera Endemic in Peru

April 5, 1993

LIMA, Peru (AP) _ Health experts murmured admiringly, praising the stainless steel portable kitchen as a breakthrough in the fight against cholera. Unfortunately, no street vendor could afford one.

The Health Ministry said the gleaming, easy-to-clean kitchen was an ideal replacement for the thousands of dirty wooden food stands, a main source of cholera.

Then the price was announced: $1,800 each, about five times what a successful street stand clears in a month. The kitchen was a museum piece even before the unveiling ceremony ended.

Abysmal hygiene, deteriorating sewer systems and widespread poverty have spread an epidemic of cholera from Peru to other parts of South and Central America in the past two years.

Tourists from the United States have been infected with the disease, which had been nearly eradicated in much of the world in the 1950s.

Even oyster beds in Alabama have been contaminated with the South American strain, most likely by ships from Latin America that dumped tainted water, according to the U.S. Centers for Disease Control and Prevention.

On the day the steel kitchen was displayed, reality could be seen in the street behind the Health Ministry. A vendor urinated on a tree near his filthy stall, then waved off the flies and began making roast beef sandwiches.

″The problem in this country is that nobody cares,″ said Teofilo Salazar, a 75-year-old vendor who has served sandwiches from the same Lima corner for 40 years. ″They throw the waste water near their stands. They let their dogs get into the food.″

Cholera causes vomiting and diarrhea so severe it can kill from dehydration in hours. Peru suffered an outbreak this year for the third consecutive summer - January, February and March in the Southern Hemisphere. Nearly 39,000 cases had been reported by early March, and 149 people had died.

Cholera caught Peru by surprise in 1991, when an epidemic infected 323,000 people and killed nearly 3,000. Last year, cholera infected almost 200,000 people and killed nearly 700.

The disease spread to other parts of the hemisphere, but Peru was hit hardest. All of Latin America had 391,750 cases and 4,002 deaths in 1991 and 352,070 cases, with 2,909 deaths, last year. The Centers for Disease Control said 102 Americans contracted cholera last year, the most in 30 years, and one of them died.

Cholera has slackened in Peru in 1993, but experts say squalor and poverty make it endemic.

″My patients are all poor and they all live in miserable filth,″ said Dr. Nora Nunez, director of cholera treatment at May 2 Hospital in Lima.

One patient, Ricardina Mendoza, 45, said she got cholera because the $1.50 she must pay each week for two garbage cans full of water - almost 15 times the price paid by residents with running water - does not leave enough money for fuel to boil it and kill the bacteria. Nor can she afford the water needed to wash her hands regularly.

″I can’t change the way I live,″ she whispered between spasms of cramps.

Dr. Nunez said personal experience and government education campaigns have promoted awareness.

″Many patients know the treatment so well they walk in and simply say, ’Rehydrate me,‴ she said.

The government spends nearly $2 million a month on awareness and treatment programs.

Since the 1992 outbreak, doctors have trained more than 7,000 slum dwellers nationwide to deal with cholera in their neighborhoods. The Health Ministry gives them rehydration salts to treat minor cases.

Posters of people urinating and defecating near kitchens and wash areas show what not to do. The government also has put awareness messages on television and radio.

″This has saved a lot of lives,″ said Dr. Juan Aguilar, a cholera expert with the U.N. Childrens Fund. ″People will continue to catch cholera, but at least we’re managing to keep the mortality rate down.″

The ministry says Peru’s mortality rate of less than one-half of 1 percent of cholera patients is one of the lowest in the world, but that the government needs $2 billion to improve drainage and the water supply.

Dr. Carlos Moreno, director of the anti-cholera campaign, said the related infrastructure in Peru, which is fighting leftist rebels and struggling with a faltering economy ″is behind most other countries by 40 years.″

Less than 10 percent of Lima’s sewage is treated. The remainder is poured into the Rimac River or the Pacific Ocean.

Half the households in the city of 7.5 million have no electricity, sewers or running water. Less than half of the garbage goes to proper dumps.

Lima is on Peru’s desert coast, where rainfall is rare. Garbage rots in the streets. The pavement near street vendors, often covered with waste water and dog excrement, never receives a cleansing rain.

″This brown stain you see on all the buildings is the filth of more than 20 years,″ said Enrique Bedos, an ecologist.

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