PERU 390 78 Cholera reappears in Latin America THE latcher snidemic in Dory was more than a THE last cholera epidemic in peru was more than a hundred years ago. The first cases of the new outbreak were diagnosed at the end of January 1991. By the start of February there were 500 people affected, but a week later the responsible bodies indicated that the figure had already gone over 8,000. By the beginning of March there BOLIVIA were 34,000 cases with 134 deaths (El Pais, March 1,
1991). The Peruvian health minister, Carlos Vidal, has declared that there are probably 300,000 carriers of the disease and that he expected there to be around 10,000 fatalities (Le Monde, February 12, 1991). The following article first appeared in the March 8, 1991 issue of the Swiss revolutionary Marxist biweekly, la Brèche.
Of the 22 million Peruvians, 15.4 million live crammed into slum neighbourhoods without drains; 40% of urban districts are not connected to running water. In the capital Lima, four to seven million inhabitants live in shanty towns, in huts of mud, branches, boxes and in the pueblos jovenes (self-built neighbourhoods, some of which have a certain amount of infrastructure). There is no way of getting rid of refuse and in the coastal district, where most of the population live, it rarely rains. How can people be expected to wash their hands when there is only one tap for 1,000 people? The cholera bacteria are killed by boiling the water, but most inhabitants of the shanty towns are too poor to pay for the fuel. On September 30, 1990, at the time of the United Nations conference on childhood, the Spanish daily El Pais published a dossier on Peruvian children. In Latin America there are some 20 million homeless children, perhaps many more. In Lima the police estimated that there were 2,500 such children in 1987, UNICEF on the other hand gave a figure of 120,000. Each year 85,000 Peruvian children die before they reach 5 years old. UNICEF estimates that 35% of Peruvian children are suffering from malnutrition. From crisis to disintegration
Peru is a very poor country which has gone beyond economic crisis to economic disintegration. There is a foreign debt of $20bn. Only one Peruvian in five has a steady job. Inflation reached 1770% in 1989 and 7000% in 1990. On August 8, 1990, Alan Garcia, who resisted IMF demands and halted debt repayment (in
ROBERT LOCHHEAD fact it was already not being paid), was succeeded by Alberto Fujimori. Elected because he rejected the dellationist shock therapy proposed by the right wing conservative candidate Mario Vargas Llosa, President Fujimori lost no time in embarking on just such a policy. At a stroke he abolished all price support. Fuel prices rose by 3000%, water, telephone and electricity by 1000%, bread by 800% and milk by 319%.
The promised programme of social compensation for the poor was only put into effect after a delay and in a whittled down version. Certainly the currency depreciation has stopped, but the price has been a murderous recession.
The purchasing power of the middle classes has fallen by a half, and thousands of enterprises have closed their doors. Hundreds of thousands of small independent traders have been ruined and have joined the ranks of the paupers. Hundreds of thousands of workers have lost their jobs.
Peasants flee counter terror
Meanwhile hundreds of thousands of peasants from the Altiplano, swept off the land by the failure of the agrarian reform, the recession and by the counter-terror which the army justifies as a response to the terrorism of the Sendero Luminoso guerillas, are coming down to swell the numbers in the shanty towns around the big coastal cities. Before the "Fujishock" the UN considered there were seven and a half million Peruvians in dire need. Now there are five million more - bringing the total up to a half of the population. 11
The poor are twice struck by cholera. It April 15, 1991 • #204 International Viewpoint
PERU c of the boor _ makes them ill and it deprives them of their already meagre means of existence — many of them are pedestrian food sellers. The Lima city authorities have prohibited this type of business to prevent infection through food.
The government has also exhorted the population to boil drinking water, to avoid Lima's beaches, to wash fruit and vegetables and not eat raw fish. All this is for the rich. The poor have no choice in these matters, and one of the staple meals of the people of a country which is one of the world's biggest exporters of fish is precisely raw fish marinated in lemon juice.
The government has distributed chlorine tablets to disinfect water and organized the treatment of emergency cases. The simple and tested treatment - antibiotics, medication and rehydration solutions - of one patient costs $200. In a country where medical care has to be paid for in cash, this sum is beyond the reach of the majority. At the start of the epidemic many victims did not seek help and simply died in silence.
To get through to the shanty town population, which does not read the newspapers or listen to the radio, the government has sent loudspeaker cars through the Shanty towns, to warn people and offer practical advice.
According to Le Monde of February 27, 1991: "the appearance of cholera is just another scorpion on the backs of the poor of the many that already exist....The weekly Caretas has entitled one of its articles 'the seven wounds' emphasizing: *cholera is only one of the epidemics that we are experiencing.'
New series of epidemics in
Peru
"The list is long: bubonic plague, malaria, rabies, dengue-fever, yellow fever, tuberculosis, and others continue to cut their swathe....
"Doctor Felix Bruceno, an official for a Caritas aid programme states that: in the marginal and poor neighbourhoods, almost 60% of the population is underfed.' The cholera epidemic that is ravaging Peru shows the state of decomposition of a country whose population had not, only a short time before, reached such depths of poverty and vulnerability."
Cholera doubly strikes Peru. First it makes people ill and kills them, and overwhelms a health system that is already very inadequate for the poor. But it also sharply reduces fish exports; the main source of income for a country in a deep economic crisis. Ecuador, Chile and Brazil have blocked food imports from Peru. The fishing economy has thus collapsed. 1,000 tons of fish have been destroyed in 12 Lima market since they could not be sold. 60,000 fishers and fishmongers are not International Viewpoint #204 • April 15, 1991 enolera. a scourge or the poor
THE cholera bacterium only infects human beings. It is transmitted exclusively by the bowel motions of infected persons, whether they are healthy, sick or convalescent. The principal vector is drinking water contaminated by human excrement. Contagion is also passed on through raw fruits and vegetables washed with such water, by humid towels or by house flies. The bacterium can live outside the human body for 2 to 4 weeks. Elementary measures of hygiene are sutticient to eliminate the sickness; adequate sewage, a clean or sterilized water supply, bodily cleanliness. Cholera is thus strictly an indicator of poverty and the absence of means of hygiene.
But it is also an epidemic disease with a complex history; its origins lie in the Ganges Delta in Bengal. That is, in the kind of ecosystem that suits it best. A humid tropical country, with innumerable canals, rural and heavily populated, where the waters are chronically contaminated by human excrement. From Bengal it has periodically struck South East Asia and southern
China.
There have been seven great epidemics of cholera outside of this area.
After the sixth, which traversed Russia and Central Europe from 1899 to 1922, the disease seemed exhausted, until a seventh epidemic broke out in 1961, originating from the Celebes in Indonesia, where it had begun in 1936. This epidemic involved a new, more violent strain of the bacterium, called El
Tor.
In 1963, the disease spread outside Indonesia. In 1965, winter stopped its advance in Iran, whilst the Soviet health authorities blocked it at the Caspian through draconian health measures. However, a Soviet air flight to Conakry introduced the disease again into Atrica, which has been affected since then. This seventh epidemic today affects 100 countries. Now it has hit Peru via a boat from South East Asia. Experts fear it may now cross the Andes to hit the shantytowns of Colombia and the favelas of Brazil. Since the early years of this century, Europe has never been hit by cholera, save for a small outbreak of El Torin Naples in 1973 leading to a dozen deaths.
Cholera is affected by the weather, striking above all when the rains have failed. Such is the case in working (the World Health Organization has explained that tinned Peruvian fish are safe, since they will have been heated during canning.)
Tourism has also been hit, although the Tourism Office has not hesitated to spell out that there is no danger of contagion to tourists, since it is only the poor neighbourhoods that lack adequate sanitation.
Peru is now receiving more foreign aid for the struggle against cholera. Chile, Ecuador, Cuba, Brazil, the United States and Canada have offered money and drugs. Germany and the European Community (EC) have offered financial aid. UNICEF has sent 800,000 doses of rehydration solution. The Peruvian embassies in Europe are collecting antibiotics. The WHO and Red Cross underline that Peru has sufficient competent medical personnel and a relatively well organized hospital system, but lacks drugs. The Peruvian authorities state that they have the epidemic under control. The death rate of those who get the disease has fallen from 1.3% to 0.7%.
Government plays down gravity of situation
However, after appealing for aid, the Peruvian government is inclined to play down the situation given the impact on exports. Thus, the health minister has
Peru over the past year. * given a figure of 110 cases in the city of Huacho, while Caritas cites 626. Caritas' health director estimates that there are ten big centres of infection. The health minister has announced that the figures will only be given out twice a week (Le Monde, February 23, 1991).
The disease has reached the highlands of the Altiplano and beyond that the Amazon. Eleven people have been hospitalized in Juliaca, a town situated at an altitude of 3,800 metres. The WHO believes that cholera has already reached Ecuador and Chile. UNICEF experts reckon that there will be 200 to 300,000 cases in April. Dr. Branedli of the Swiss Institute of Tropical Medicine in Basel believes that cholera is now established in Peru and will now appear in periodic waves.
The only effective long term measure is an adequate supply of clean water, which means large infrastructural projects. More than a few million dollars in emergency aid is needed.
The health ministers of Bolivia, Brazil, Colombia, Chile, Ecuador, Venezuela and Peru met in Lima on Ebruary 27 to create a Latin American alliance against cholera (El Pais, March 1, 1991). They decided to lift the more disproportionate restrictions on Peruvian imports. The Brazilian health minister brought with him to Lima his own supplies of drinking water and food. *