Deadly River: Cholera and Cover-Up in Post-earthquake Haiti by Ralph R. Frerichs (review)

Ralph Frerichs's Deadly River: Cholera and Cover-Up in Post-earthquake Haiti is a somber tale of how epidemiology and scientific detective work intersected in the wake of a cholera outbreak in Haiti. Its most unambiguous contribution is to chronicle how epidemiologists and public health officials underestimated and then failed to prevent a deadly epidemic. Additionally, Frerichs's book uncovers a narrative of an obscure potential cover-up attempt marshaled by the United Nations (UN) and World Health Organization (WHO) officials who refused to take accountability for the source of the outbreak: notably, a group of UN peacekeepers from Nepal who were stationed on the island.

As Frerichs argues, the UN's continual denial of culpability was partially due to officials' inability to view Haitian people as more than a monolithic racist stereotype of "dirty" and often diseased. This form of Haitian exceptionalism began with the Center for Disease Control's (CDC) 1982 AIDS/HIV transmission report naming Haitian people as "high-risk," and it continues today. To make matters worse, it was the UN's own negligent protocol on cleanliness that jeopardized an entire country and its people. The international community exacerbated this by diminishing the calls for action made by Haitian people and backing the UN. Consequently, the relationship between the Haitian people and the UN remains fractured.

Deadly River also highlights the valiant work of Renaud Piarroux, an epidemiologist, cholera expert, head of the parasitology and mycology department at the Pitiè-Salpêtrière hospital in Paris, and professor at the Sorbonne University Faculty of Medicine, who was tapped by the Haitian state in October 2010 to investigate Haiti's cholera outbreak along the Artibonite River. His objective was to pinpoint the source of the outbreak and propose strategies to contain it and eventually eradicate it from the country. The epidemic had come as a complete surprise since Haiti had never experienced a cholera outbreak before. Within days of the first confirmed case, cholera had spread to thousands and taken the lives of many Haitian people. It was not until January 2020, following a nearly decade-long outbreak that killed upward of ten thousand, that Haiti finally achieved a year free of new cases. However, back in 2010, Piarroux was intent on discovering the source of the outbreak; as any good epidemiologist would agree, such pinpointing of the causes was vital on the heels of the tragic earthquake at the start of the year. His investigation and surprising revelations are at the core of Deadly River. The book's staging of what is undoubtedly a contentious debate over the source of the outbreak, as well as the vexed question of accountability (or lack thereof), imparts the dramatization. The principal antagonists are those who promoted source conspiracies that countered Piarroux's findings.

For example, some environmentalists posited that the bacteria might have remained dormant in Haitian estuaries until the January earthquake unwittingly triggered its release some nine months later. "Most hypotheses put forward for how Vibrio cholerae had arrived in t he country were in one of two categories: environmental or human activity—long points of contention among the world's cholera investigators" (58). Others proposed that conceivably a watercraft transporting relief goods had disposed of pollution off the Haitian coast and, consequently, introduced cholera to the island's water supply. Piarroux rejected these assertions, claiming instead that the origin was evidently a substantial release of contaminated human excretions into the Artibonite River from the barracks of the Nepalese peacekeepers. The trajectory of the cholera, and its source, could be tracked in the maps of the outbreak's progression.

From the beginning, and as changes arose, Piarroux created screen grabs of the maps, which remained in his possession throughout his field study. Such documenting enabled the Haitian Ministry of Public Health and Population to report findings very early on: "On the day after cholera was officially...