PORT-AU-PRINCE, Haiti — Ysabelle Marcellins went about the morning like she did most Saturdays, cooking and cleaning house in this city of rubble and recovery.
Hours later, she was doubled over in pain vomiting.
“We didn’t know what was happening. One minute, she cooking lunch and then she was in so much pain,” said her brother, Louis Marcellins, as he paced in front of a cholera clinic at Port-au-Prince’s General Hospital. “It was all so sudden.”
The speed at which cholera overtakes patients like Marcellins worries health officials and aid organizations as much as it surprises Haitians who received ample warning of the disease’s strength.
It ravaged the countryside near the suspected source of the outbreak — the Artibonite River — and now it is sweeping across the capital. The death toll is quickly approaching 1,000 and health workers worry that its impact on earthquake-torn Port-au-Prince will be grave. The United Nations estimates that as many as 200,000 people could be sickened within six to 12 months.
Anger over the cholera outbreak led to violent demonstrations on Monday as protesters set fire to a police station and clashed with U.N. forces in Cap-Haitien, a city on the north coast. One protester was killed. Many Haitians blame a Nepalese U.N. contingent for causing the outbreak when sewage from their camp leaked into the Artibonite.
In Port-au-Prince, aid organizations restricted personnel from working in downtown areas out of fear of demonstrations there.
Since cholera reached the city on Nov. 9 — when health workers confirmed the bacteria in a 3-year-old girl — it has spread rapidly. Within three days, more than 600 people were hospitalized and 27 were dead.
“We’re getting patients from all over, from the camps, from the communities, from different parts of Port-au-Prince,” said Dr. Yves Lambert, an infectious disease specialist who runs the downtown clinic. “What we don’t know is how quickly it’s going to increase from here.”
If the scene at Lambert’s clinic was an indication, the disease was spreading quickly.
As relatives of patients quietly paced outside, new patients arrived. A Haitian police truck arrived with a man in a straw hat in the back. They had found him lying on the street and assumed he had cholera, they said.
Afraid to touch him, they called over hospital workers. Latex gloves stretched tightly over their hands, mouths and noses covered with tan masks, they carried him into the clinic. His listless body disappeared through the blue tarp that separated the ward.
Moments later, a man with a grimacing woman slung over his shoulder shouted, “The clinic? Where’s the clinic?” Her sandals dragged through the crumbling concrete as he lugged her toward the entrance. “She’s sick. She’s throwing up,” he told them.
Orderlies lifted an old woman, too weak to walk, from her son’s car and dropped her into a wheelchair. Her white-haired head fell to her shoulder as they rolled her inside.
Inside, a team of doctors and nurses who were working in shifts around the clock, treated 50 patients, even though they had only 30 beds — 10 of which were for children.
“The moderate cases sit in a chair and take oral solution” of water, sugar and salt, Lambert said. “We try to keep the beds for the severe cases, the people who need antibiotics. But if we start getting more cases, we’re going to have to expand the clinic and get more personnel.”
The clinic had treated 350 patients, nine of whom died, Lambert said. “Two of them died before we could get them inside,” he said.
Cholera can kill quickly, but it’s also preventable and treatable. The spread of the bacteria, through food or water contaminated with fecal matter, can be prevented through hand washing and by drinking purified water.
Posters warned residents of the camps — where an estimated 1.3 million are living — not to drink untreated water. Warnings only go so far.
A boy filled a plastic water bottle from a spigot at a camp not far from the hospital and took a swig. Asked if the water was treated, he shook his head, paused and then spit the water to the ground, as if he’d just remembered the warning. “No, that’s why I just rinse my mouth with it.”
Other kids took short breaks from the soccer match they played with a deflated ball on a patch of dirt to drink freely.
“Everyone here is afraid of cholera,” said Marie France Sanon, who ran a small restaurant not far from where the children played. Sanon moved to the camp after the January earthquake toppled her business and killed her husband. “They warn you enough. You hear it everywhere.”
Radio stations and television channels flooded airwaves with prevention and treatment spots, including song-and-dance reminders about hand washing. Mobile phone companies sent text message updates.
“We all knew it was coming. I got a text message. We knew that you had to wash your hands and drink clean water, but we did all that,” said Josef Luckenson, whose brother and 2-year-old nephew were being treated at the clinic. “And they still got it.”