Overview

1
Overview

• Definitions
• Cholera clinical, epidemiology
• History and pandemics
• Peru diary of Choleras epidemic
• Environmental factors
• Cholera today
• Conclusion

2
The spread of cholera and other infectious
diseases is the calling card of an economy in
trouble

• Head of Ukrainian Parliament, when cholera
  reached Ukraine in 1994 (quoted in Lee Dodgson)

3
Day 0 cases of diarrhoea!
4
Day 2 confirmed its cholera
5
Day 5 fish eats excrement from foreign ships
6
Day 6 strike, death, dirtiness
7
Has God abandoned us?

• February 8, 1991, extract from the editorial
  column, quoting a women on the streets
  
• God is getting tired of us, and today he pull
  off his hands from us.
  

8
Day 7 Shinning Paths leader captured
9
Day 9 violence, death
10
Day 10 ceviche, Minister of Health public speech
11
Day 12 international reaction
12
God abandoned us, but not only that

• Peruvians returned from Madrid no vaccination
  card
  
• Mexico burns 600kg of food from Peru
• Chile stops train to Peru
• Ecuador closes its borders with Peru

13
WHO Cholera Fact Sheet

• "...Indeed, although individual cases and
  clusters of cases have been reported, WHO has not
  documented a significant outbreak of cholera
  resulting from commercially imported food."

14
WHO Cholera Fact Sheet

• In 1973 the WHO World Health Assembly deleted
  from the International Health Regulations the
  requirement for presentation of a cholera
  vaccination certificate. Today, no country
  requires proof of cholera vaccination as a
  condition for entry, and the International
  Certificate of Vaccination no longer provides a
  specific space for recording cholera vaccinations

15
Day 13

• Resignation of Peruvian Prime Minister (who also
  acted as Minister of Economy)
  
• Starts veda fishing is not allowed for 45 days
• 8 peasants died from cholera
• A doctor infected

16
Day 21 sea isnt contaminated, rural deaths
17
Day 23 stop veda!, no drugs
18
Day 30 Fujimori stops veda
19
Day 38 aid cheques cant be cashed (100 billions
intis)
20
Day 49 it wasnt the fish, it was the water
21
Behind the scenes

• WB/IMF ? to apply strict macroeconomic adjustment
  and to promote an export-oriented model
  
• Priority to covering up to protect tourism and
  fish exports
  
• Minister of health is forced to resign in March
  1991

22
Peru in 1991

• Economic deterioration increased between 1986 and
  1990
  
• Endemic poverty, income concentration,
  deteriorated social structure
  
• Structural adjustment in 1990
• Jobs lost
• Informal sector ? 2/3 of labor force

23
Peru in 1991

• Pueblos jóvenes are little more than rows of
  cardboard shacks, with no roofs, dirt floors and
  no electricity or running water. Children play in
  the streets alongside garbage In these areas
  cholera is striking with the greatest force (The
  New York Times, February 17, 1991)

24
Peru in 1991

• Poverty in Perus poorest areas is also linked
  to deficiencies in education, health, and the
  lack of basic services. Social indicators in the
  poorest rural departments are depressing
  (Inter-American Development Bank, 1992)
• ¼ urban popltn access to clean water

25
WHO on Global Epidemics - Cholera

• In addition to human suffering, cholera outbreaks
  cause panic, disrupt the social and economic
  structure and can impede development in the
  affected communities... The cholera outbreak in
  Peru in 1991 cost the country US 770 million due
  to food trade embargoes and adverse effects on
  tourism.