In the early days of the earthquake search and rescue phase, Haitian officials and aid organizations braced themselves for an outbreak of cholera and other communicable diseases that follows huge natural disasters that disrupt regular water supply.

Three months later, however, there was a general sense that the country had escaped such misery and other emergencies, such as what to do with a million homeless and hungry people, took precedent. So in October when a cholera outbreak began in the Artibonite Valley region hit, Haitians and foreigners were not ready to properly deal with a disease that last set foot on Haitian soil more than a century ago.

“They were totally unprepared,” said Dr. Jean Claude Compas, a Brooklyn physician, who has followed the situation in Haiti closely. “Many hospitals didn’t have the necessary medicines and doctors were not properly trained on how to cure cholera.”

To be sure, this oversight has been taken care of, thanks in part to about $42 million disbursed by the United States Agency for International Development, not counting money and resources from other international donors. Since the first cases were diagnosed a massive education and treatment program has slowed down the spread of cholera, particularly the number of death related from the disease.

In addition to educating people about how to treat and to avoid cholera, international officials have brought in tons of chlorine water treatment bottles, oral re-hydration solution, soap, IV sets and solution and cholera test kits. In addition more than 10,000 community health workers have been hired or trained to combat the disease.

Still, public health and crisis management officials said that during the early stages everyone- from Haitian health officials to the aid workers to the average Haitian — failed to grasp the severity of this strain of cholera, which has claimed more than 3,000 lives so far and has sickened hundreds of thousands.

“Our frustration is that in the beginning people had trouble taking the message seriously,” said Marc Ward, acting director of US Foreign Disaster Assistance at USAID. “It just wasn’t getting through.”

Ward said that what is important now is that the message has resonated. He said people who are not necessarily stricken with cholera are coming in for treatment at the hundreds of cholera clinics opened across the country.

Cholera is caused by a bacteria, Vibrio cholerae, which causes an infection of the intestine and produces a toxin that triggers watery diarrhea that can lead to dehydration and death. The disease has disappeared in countries that have access to clean drinking water. But it can spread rapidly in areas where people drink tainted water. An infected human can produce the bacteria in his feces for up to two weeks, even if they don’t show signs of illness.

According to a report from the Centers for Disease Control a median of 41 people died in Haiti every day.

“Because cholera can lead to death rapidly, ideally all persons at risk for cholera should be within one hour of a location where they can receive [oral rehydration solution] and should have access to more advanced care,” the report said.

Curing cholera, a disease that develops when water supply is affected with feces, is relatively simple. It is a question of re-hydrating a patient quickly enough with saline solution. But cholera can be deadly if let untreated in a matter of a couple of hours.
While officials said they didn’t focus on combating cholera, steps taken during the days following the earthquake made it more manageable to handle the disease when it reared itself, Ward said.

“Cholera could have been much worse had we not made quite an effort to make sure that people had potable water and sanitary environment,” Ward said. “When it hit we were better prepared to deal with it.”

The Haiti cholera epidemic has been mired in a sort of political controversy. French health experts have said that they have strong scientific evidence that the strain of cholera that is ravaging Haiti came from Nepalese United Nations soldiers stationed in the area, about an two hours north of Port-au-Prince, the capital.

UN officials have vehemently denied its soldiers are the source. But last week, UN Secretary General Ban Ki Moon appointed a 4-member panel to investigate the source of the cholera outbreak in Haiti. Ban said that determining the source of the disease has become important for the UN, which has enjoyed a tense relation with the Haitian population. The UN has a force of 7,000 soldiers and 1,000 police officers occupying Haiti. That force, which is known by its French acronym, MINUSTAH, has not been well received since it began more than five years ago in an effort to stabilize the country’s fragile social and economic ecosystem. To many Haitians, the cholera is yet another disruptive contribution of the UN forces.

While the number of cholera cases has increased to 176,000 people, health officials estimate that by the time the disease is completely eradicated, more than 400,000 patients will be affected.