The pictures should make us all quite queasy—the little children swimming in the flood waters immediately after a hurricane or similar water-related catastrophe. The adults in developing countries might not have been educated at any time as to the dangers involved in exposing their children to this liquid breeding ground for disease. Or, it could be that they are simply too distressed and distracted by a hundred other things demanding their attention after a disaster. They might catch the children out of the corner of a worried eye, maybe registering the natural sight of kids and water as something almost soothing midst the chaos and turmoil. Inexperience can be terribly costly.

Just days after Hurricane Matthew, insult is being added to the injury, with lives that made it through the blowing wind and churning water now being claimed by cholera. Casualties increase by the day as the standing putrid pools recede ever so slowly, leaving behind the once inundated towns and villages as remnants of the places already compromised before the deluge. The endemic disease now following reveals troubling possibilities.

The bacterium responsible for cholera lives and transmits itself through the bodily fluids of patients already infected. When a storm hits, sources where the bacteria might otherwise have been contained are compromised by invading waters, allowing cholera to infect new victims as they ingest either food or water that has been contaminated. Without treatment, the mortality rate is astonishingly high. A victim can exhibit first symptoms in the morning and be dead by late afternoon. However, with a very straightforward rehydration regimen (sometimes accompanied by antibiotics), most can recover in a matter of days.

When the bacterium has successfully invaded the human body, it releases a toxin that causes the lower intestine to secrete copious amounts of water, taking along vital electrolytes with it. The result is the characteristic fluid loss in patients, through diarrhea and vomiting. A rapid onset of severe dehydration is the predictable and tragic outcome.

Of course cholera isn’t the only frightening illness that comes in a water wrapper. There are many others, besides, most of them spreading via microbial agents, parasites, bacteria, viruses, and algae. They latch on to each new victim as a result of that person bathing in, washing their clothes in, drinking or cooking in the innocent-looking water that may actually be dripping with these unseen pathogens.

Most of those affected by such illnesses live in developing countries without adequate access to clean water. Poor sanitation and substandard hygiene are also major contributors. In the 21st century, it is astonishing to discover that millions are infected with the cholera bacillus every year, with well over 100,000 victims, many of them children, succumbing to its ravages as a result.

In the aftermath of the 2010 earthquake that devastated Haiti, cholera came visiting then, too, never fully going away until the present time. Even just shortly before Matthew struck, people in parts of Haiti were still dying of cholera. In a country among the poorest in the western world, this can’t possibly be unexpected. The rebuilding of Haiti six years on was still rife with political acrimony, corruption, and bureaucracy. Included in this mix of missteps and miscalculations are over 10,000 cholera-related deaths since 2010.

Cholera is a tough one to wipe out. Many parts of Africa, India, and other parts of the world have suffered, or are still suffering, outbreaks, as well. The common denominators seem easy enough to derive: poverty, lack of education, lack of sanitation, lack of water and infrastructure. With the basic necessities of life in short supply across the planet, it is unlikely that cholera will ever be eradicated entirely. The devil hides in the most unexpected places.

Cholera follows when chaos arrives. Cholera lives where poverty thrives. With Haitians living near an earthquake fault line and also directly in the path of many hurricanes, we can safely assume that cholera is not quite done with the island nation yet.

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