Cholera Attacks South America

May 01, 1991

Cholera stayed out of South America 100 years, but it has returned to devastate. The El Tor strain, isolated in Indonesia in 1961, is rolling through the Andes, a malevolent wind felling hapless humans in its path. Cholera, an intestinal disease discovered in India in 1817, passes only through contact with human feces, in food or contaminated water.

Some of the suffering in hardest-hit Peru might have been avoided. The epidemic started in the fishing port of Chancay, Peru, when a migrant farm hand drank irrigation water. The disease spread rapidly. Soon 1,500 people a day contracted cholera, prompting Peruvian Health Minister Carlos Vidal to warn against eating seafood, especially popular raw-fish and shellfish dishes.

Fishing interests complained and President Albert Fujimori rebuked Mr. Vidal, holding a televised fish feast. Peru's upper classes eat deep-water fish, but poorer diners eat the harvest of coastal waters often contaminated by raw sewage. The cholera epidemic, which had appeared to stabilize, skyrocketed within days.

Peru's food exports have been shunned by its neighbors, causing losses expected to be as high as $100 million this year. Experts say cholera can't pass through food exports, for the El Tor strain cannot survive the average 10 days it takes for exported fish to reach ports of destination.

That has not stemmed the fear this outbreak has engendered. Meanwhile, the epidemic has spread, to an estimated 158,000 cases in Peru, hospitalizing 54,000 people and killing 1,140. Neighboring Ecuador has almost 3,500 cases, with more than 100 dead. Colombia has 112 confirmed cases, with three dead. Five suspected cases turned up in Brazil, and the disease has spread down the Pacific Coast to Santiago, Chile, where 22 cases have been confirmed.

Long-term solutions will be costly. Cholera occasionally invades the United States, but it can be treated and modern sanitation systems make it easy to control. But 40 percent of the 7 million people in Lima, Peru, have no access to clean, piped water. About 40 percent of Brazil's 150 million have no sewers. Health authorities say it will cost $320 million a year for 10 years to correct Peru's sanitation problems, but Peru is broke.

For now, South American doctors are doing a good job of saving lives, but they will need continuing help with medical supplies. Improving public health facilities and and upgrading Latin America's 19th-century sanitation facilities are the best ways to put an end to an outbreak many experts fear could become endemic.

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