It was October 2010 when reports first emerged of a mysterious disease spreading through Haiti.

In a hospital in Saint Marc, about an hour north of the country’s capital Port-au-Prince, 400 cases of adults with watery diarrhoea had been reported in a single day.

On a regular day, there might be four people show up at the hospital with these symptoms.Listen to the podcastEven big diseases start small. RN Presents: Patient Zero — a new podcast about disease outbreaks, and how we found ourselves in the middle of one.Read more

“So literally, they had gone from a normal day to this kind of explosive number of cases,” says Louise Ivers, an associate professor of global health and medicine at Harvard University.

For the doctors at the hospital, diarrhoea and vomiting pointed to one disease — cholera.

Left untreated, cholera can kill within hours. It causes acute diarrhea and leaves people severely dehydrated. 

It’s a bacterial infection, mostly spread through contaminated food and drinking water. So in areas with poor access to clean water and sanitation, it can spiral out of control very quickly.

But there hadn’t been a documented case of cholera in Haiti for more than 100 years.

Within days, those first cases became a full-blown outbreak, with hundreds more cases pouring into hospitals across Haiti.

At the time, Dr Ivers had been working in Haiti for seven years as an infectious diseases physician.

“The clinical care was just overwhelming. We had patients in the hallways, we had patients on the floor, we had patients in the courtyard. It was very, very challenging for us,” Dr Ivers says.

About 800,000 people would eventually get cholera in Haiti, and almost 10,000 would die. And 10 years later, people are still catching cholera there.

How did cholera come to Haiti?

As Dr Ivers battled the outbreak, journalist Jonathan Katz was investigating how it began. People were shocked when the disease suddenly emerged from nowhere.

He’d been working in Haiti for three years with the Associated Press.

As he travelled around Haiti for work, Katz began to hear various rumours about how the outbreak had begun.

“They all seemed a little bit far-fetched and they all had a variety of characters,” he says.

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“Some of the stories were about United Nations helicopters dropping a black powder in the river. Other people swore that their mom’s cousin’s lawyer’s friend had seen a UN soldier taking a dump in the river.”

The contents varied wildly, but two key themes continued to crop up — the United Nations, and a river.

There had been a UN presence in Haiti for six years at this point, with peacekeeper troops entering the country after a coup against the country’s then-president.

And a new contingent of UN troops had arrived from Nepal earlier in October, just before the outbreak started.continue reading