LA PAZ, Bolivia -- Cholera has taken root in South America because governments have for decades failed to modernize the region's medieval water and sewage systems, health officials say. Now, there are no cheap solutions and the epidemic is forcing Latin American leaders to make excruciating choices.
Colombian Health Minister Camilo Gonzalez proposed during an anti-cholera summit in Sucre, Bolivia, that regional governments battle the contagion, which breeds in dirty water and sewage, with an emergency campaign to provide running water and basic sanitation to all Latin Americans -- in two years.
"The epidemic we face is not only the result of a bacteria, but also of poverty and the negligence of many governments," said Gonzalez, who represents the revolutionary M-19 former guerrilla movement in Colombia's coalition government.
Solutions are expensive, however.
Experts estimate the cost of piping in clean water to all Latin Americans at $11 billion, and say universal sewage treatment could cost an equal amount. With Latin nations already burdened by a $434 billion foreign debt and most governments committed to austerity programs, the question health experts ask about every anti-cholera strategy is: Who will pay?
Betraying a certain resignation to these political realities, the other health ministers at the cholera summit discarded Gonzalez's proposal for a two-year emergency sanitation program, instead calling for increases in public health spending and for international solidarity.
Carlyle Guerra de Macedo, director of the Pan-American Health Organization (PaHO), told the ministers that cholera offers an opportunity to correct Latin America's health inequities because it has "shocked the psycho-social conscience of our peoples."
About 89 million poor Latin Americans have no access to clean water, and 144 million persons lack toilet facilities, according to PaHO figures. Both groups are extremely vulnerable to cholera, according to German Perdomo, PaHO's representative in Bolivia.
The cost of bringing potable water systems to communities that have none averages about $120 per person, Perdomo said. Laying sewer lines is cheaper, but also represents an enormous investment for a continent in which less than 10 percent of all sewage gets any treatment, he said.
Health experts are pessimistic that regional governments can invest the billions of dollars necessary for modernization.
"They don't have the money, and no one is going to lend or donate it to them either," said Jose Fiusa, a Brazilian Health Ministry official studying the crisis.
Ironically, the continent enjoys the world's most abundant water resources, and before the Spanish Conquest the Incas built extensive aqueducts to channel fresh water throughout their empire. But progress failed to keep pace with population growth during colonial times, and during the 20th century Latin American governments have preferred flashier investments.
"Latin politicians haven't favored water lines and sewage plants because voters can't see them. They'd rather build public plazas, football stadiums and highways," Fiusa said.
During the 1960s, U.S. Peace Corps volunteers built hundreds of local water systems in Latin America, but they often used cheap materials and many systems have crumbled into disrepair, according to Jose Antonio Zuleta, a water specialist with the United Nations Children's Fund (UNICEF).
In 1980, Latin governments made their most sweeping commitment to basic sanitation when they declared the 1980s the "Potable Water Decade," vowing to deliver clean water to all in just 10 years.
Events overwhelmed those intentions.
During the decade, Latin America's population surged from 353 million to 438 million, with most of the increase coming in urban slums. Meanwhile, pollution levels rose in most of the continent's rivers and lakes, making clean water harder to find and costlier to distribute, according to a 1990 PaHO report.