Ralph R. Frerichs, Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti. Ithaca NY: ILR Press, 2016. xi + 301 pp. (Cloth US$ 29.95)
Rarely do we have the opportunity to follow a genuine detective story about a timely and urgent topic written intelligently by a scientist who does not talk down to us. Ralph Frerichs offers such a text.
The cholera epidemic in Haiti has killed almost 10,000 people since its outbreak in 2010. That has never been in question. However French epidemiologist Renaud Piarroux has been challenged for asserting that it was caused by infected U.N. troops from Nepal—an endemic country that had a recent outbreak—who were neither tested nor treated. In 2011, René Hendriksen, Lance B. Price, and James M. Shupp backed up the epidemiological evidence for his assertion in “Population Genetics of Vibrio cholerae from Nepal in 2010: Evidence on the Origin of the Haitian Outbreak” (in the journal ImBIO). Deadly River follows the work of Piarroux from October 2010 until late 2014, recounting a real-life, all-too-deadly detective story, as much about Piarroux and his methods as about epidemiological research and the outbreak in Haiti itself.
The book also chronicles a systematic cover-up by the United Nations, which first cast doubt on the source of the outbreak, then argued that the source was not important, and then spun confusion about multiple factors, including academic careerist hubris on the part of a U.S. researcher who was willing to sacrifice the truth and thousands of Haitian lives in an effort to prove her “environmental” thesis as the cause of the outbreak. Eventually, truth won out, but at the expense of thousands of lives and the loss of a sense of urgency. After Hurricane Matthew (2016), the United Nations finally acknowledged responsibility and led a fundraising campaign for eradication of the disease. But the coverup and lack of urgency have cost dearly: funds have been too little, too late.
The story is eminently accessible to readers not familiar with technical medical/epidemiological terms and argumentation. Frerichs, a retired epidemiologist, joined Piarroux’s efforts, and has a wealth of personal information to share. He does not attempt to present a “balanced” account; he does not, for example, include interviews with official U.N. sources. As such it adds to a corpus about people working in Haiti, notably Tracy Kidder’s heroic account of Paul Farmer, Mountains Beyond Mountains (2004).
Frerichs’s focus on the personal story, inviting to many nonspecialists, might be off-putting to Haitian scholars and activists who have seen their country serve as a platform for many a well-intentioned foreigner. His account of Piarroux serves as an introduction to the United Nation’s systematic coverup and has the added benefit of solving an urgent and present mystery. Warming up to the story, he includes several long passages that heroize Piarroux, such as his recounting of a fable from his childhood, while other experts such as Haitian individuals working in public health, water, and sanitation, are only noted in passing.
Readers familiar with the region might also wish for more context. The single page dedicated to the twenty-year-long democratic transition that led to the 2004 ouster of President Aristide and, hence, the U.N. mission takes a decidedly partisan pro-Aristide position, and statements such as “political turmoil has been a hallmark of Haitian history since U.S. troops left in 1934” (p. 125) are left without explanation, leading some readers to conclude that U.S. imperialism might have been good for Haiti when in fact the opposite occurred. Chapter 14, dedicated to Haitian Vodou, discusses the history of scapegoating, noting parallels with other outbreaks, but it could have pressed further to discuss the specific circuits of aid from evangelical groups within an explicitly right-wing, anti-Vodou agenda that fueled the violence against oungan following the October 2010 outbreak.
Piarroux and several Haitian professionals have underscored the importance of the truth about the source of the epidemic, suggesting racism in the U.N. efforts to minimize it. Frerichs also argues forcefully for the importance of admitting responsibility early on to avoid suspicion and scapegoating, and being able to enlist the population in combating the disease, not giving in to fatalism.
The book’s lasting contribution will not only be how the truth finally won but how exactly the United Nations roadblocked efforts to assume responsibility. Interestingly noted in the text are “back channel” diplomatic signals and efforts by the French Embassy to privately empower Piarroux while publicly distancing themselves from him. An “unknown source” within the Haitian government reveals critical information. These are unsolved mysteries that open the door for readers’ questions about how large-scale bureaucracies and diplomatic circles function. Deadly River is a must read for the tens of thousands of us foreigners who went to Haiti trying to “do good”—and everyone in the U.N. system, from Secretary General to front-line workers. Hopefully this lesson will be finally learned. And more importantly, applied.