BOIS CARRE, Haiti — The SUV slowly churns up the green mountainside, rocking from side-to-side as it struggles for traction on rocky terrain.
Any wrong turn and the packed vehicle could easily fall 300 feet. But to save lives in deeply remote rural areas, Fabienne Lorcerie and her team of cholera response experts must risk theirs.
"All the other medical missions I've been on, I could plan a little bit better,'' says Lorcerie, a nurse, whose voice barely hid her frustration. "Everything is so far away here, and that makes it hard to anticipate.''
The cholera epidemic that has claimed thousands of lives in Haiti has fallen from its peak. But the disease, which has infected more than 400,000 Haitians since its initial outbreak a year ago, is continuing to have a major impact on far flung villages surrounding communities like this one in the lower Aribonite Valley. Its main water supply, the 199-mile Artibonite River, was the initial source for spreading the epidemic.
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"It's a big headache,'' Romain Gitenet, head of mission for the French humanitarian aid group Doctors Without Borders who supervises the mobile cholera response team, which registered 10,000 new cholera cases in the valley over 10 weeks earlier this summer. "Cholera has no limits.''
More than half of Haiti's 10 million citizens live in remote rural communities, many of them accessible only by foot and mules. And at least 40 percent have no access to a doctor or nurse, much less sanitation or potable water. With even cell service lacking, alerts aren't often heard until too late.
The trip to Bois Carre, a mountaintop village in the lower Artibonite Valley, was sparked by an alert from a frightened farmer. After showing up at the Doctors Without Borders office in Gonaives, he told an alarming story: some 25 people were dead from cholera and another 58 had the waterborne disease in the nearby town of Ossé.
Panic ensued. The mobile reactive team had just returned from a cholera outbreak in the villages of Chenot and Perodin. In Chenot, the team took eight days to set up a 30-bed treatment unit and train medical staff after the community logged 15 cases a day. In Perodin, the mortality rate from the disease was at 11 percent.
With no way to confirm the farmer's information by telephone, the team took to the road. Bois Carre was the furthest point they could go by car before having to make the rest of the journey on foot.
"I am asking myself about the amount of time it will take to get there,'' Lorcerie said, standing in a dirt yard in Bois Carre, worried that the forming storm clouds could produce rain and make crossing the river at the foot of the mountain impossible. "The hardest part is knowing there is an emergency and not being able to do anything today, and you have to come back another day.''
Bois Carre has had its own bout with cholera, say villagers. Located hundreds of feet in the mountain, the village is desolate and rugged. The nearest hospital and cholera treatment facility are five hours by foot.
"The situation is very difficult for us,'' said Fredo, 49, a villager. "There are times the river is impassable and you are carrying a victim to get help. You have to put the person down and wait for the river to go down. By the time you reach, the person has already died in your hands.''
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