Overview n n n n Definitions Cholera clinical

Overview n n n n Definitions Cholera: clinical, epidemiology History and pandemics Peru: diary of Cholera’s epidemic Environmental factors Cholera today Conclusion

“The spread of cholera and other infectious diseases is the calling card of an economy in trouble” n Head of Ukrainian Parliament, when cholera reached Ukraine in 1994 (quoted in Lee & Dodgson)

Day 0: cases of diarrhoea!

Day 2: confirmed… its cholera

Day 5: fish eats excrement from foreign ships

Day 6: strike, death, dirtiness

Has God abandoned us? n February 8, 1991, extract from the editorial column, quoting a women on the streets: n “…God is getting tired of us, and today he pull off his hands from us. ”

Day 7: Shinning Path’s leader captured

Day 9: violence, death

Day 10: ceviche, Minister of Health public speech

Day 12: international reaction

God abandoned us, but not only that… n n Peruvians returned from Madrid… no vaccination card Mexico burns 600 kg of food from Peru Chile stops train to Peru Ecuador closes its borders with Peru

WHO: Cholera Fact Sheet n ". . . Indeed, although individual cases and clusters of cases have been reported, WHO has not documented a significant outbreak of cholera resulting from commercially imported food. "

WHO: Cholera Fact Sheet n In 1973 the WHO World Health Assembly deleted from the International Health Regulations the requirement for presentation of a cholera vaccination certificate. Today, no country requires proof of cholera vaccination as a condition for entry, and the International Certificate of Vaccination no longer provides a specific space for recording cholera vaccinations

Day 13 n n Resignation of Peruvian Prime Minister (who also acted as Minister of Economy) Starts veda: fishing is not allowed for 45 days 8 peasants died from cholera A doctor infected

Day 21: sea isn’t contaminated, rural deaths

Day 23: stop veda!, no drugs

Day 30: Fujimori stops veda

Day 38: aid cheques can’t be cashed (100 billions intis)

Day 49: it wasn’t the fish, it was the water

Behind the scenes… n n n WB/IMF to apply strict macroeconomic adjustment and to promote an export-oriented model Priority to covering up to protect tourism and fish exports Minister of health is forced to resign in March 1991

Peru in 1991 n n n Economic deterioration increased between 1986 and 1990 Endemic poverty, income concentration, deteriorated social structure Structural adjustment in 1990 n n Jobs lost Informal sector 2/3 of labor force

Peru in 1991 n Pueblos jóvenes are little more than rows of cardboard shacks, with no roofs, dirt floors and no electricity or running water. Children play in the streets alongside garbage… In these areas cholera is striking with the greatest force (The New York Times, February 17, 1991)

Peru in 1991 n n Poverty in [Peru’s] poorest areas is also linked to deficiencies in education, health, and the lack of basic services. Social indicators in the poorest rural departments are depressing (Inter. American Development Bank, 1992) ¼ urban popltn access to clean water

WHO on Global Epidemics - Cholera n In addition to human suffering, cholera outbreaks cause panic, disrupt the social and economic structure and can impede development in the affected communities. . . The cholera outbreak in Peru in 1991 cost the country US$ 770 million due to food trade embargoes and adverse effects on tourism.