Cholera Stalks A Continent

As many as 40,000 may die in the next three years

In a slum near Peru's capital, Lima, Julio Mendoza helps his elderly parents hobble out of the only hospital serving a million people. Two days earlier Mendoza watched his wife collapse and die of cholera. Now a doctor tells him that there is no room for his infected parents; the hospital is reserving its 45 available beds for the critically ill, because health workers are on strike. Back in the Mendozas' shack, another child has fallen ill with cholera and lies curled up on a bed behind the old man. A trip back to the hospital is impossible. Julio is unemployed and has no money to pay for the four-mile ride.

It has been nearly a century since the last time cholera swept across South America. But in Peru today scenes reminiscent of 19th-century medical holocaust are being played out across the country. The deadly V. cholerae bacterium, brought over on a ship from Asia and spread by contaminated water, fish and vegetables, has infected at least 170,000 people in Peru, of whom more than 1,250 have died. And the disease is spreading. In Ecuador, 3,000 cases have been confirmed, with 100 deaths. Colombia, Chile and Brazil have all reported cases. At a summit of health ministers in Bolivia last week, Carlyle Guerra de Macedo, director of the Pan-American Health Organization (PAHO), said cholera could spread to the entire continent of South America and kill 40,000 people over the next three years. "I'm afraid the possibilities of controlling this epidemic are not very bright," he said.

The epidemic is the price of decades of neglect of basic public-health needs. During the 1960s and 1970s, South American governments of all political stripes invested heavily in prestige projects like nuclear power plants and office buildings. They went into foreign debt to pay for these unproductive investments-debts that their populations are now obliged to work off. "Latin American presidents have always disliked social investments," says Felipe Ortiz de Zevallos, a Lima economist. "They prefer things you can put a plaque on and have an inauguration ceremony."

Only about 40 percent of Peruvians have access to potable water. Lima, an oceanside megalopolis originally designed for 500,000 people, dumps 97 percent of its raw sewage into the Pacific. For the family of Rosario Espinosa, a cholera victim who lives in a slum outside Lima, "going to the bathroom" means walking to a garbage dump near a neighborhood playground. A single mother of three, Espinosa spends most of her time and her $11-per-week earnings trying to get clean water, When she does, her children wash their hands and plates in the same plastic bucket, even after returning from the dump. The family can afford toilet paper once a month.

The death rate in South America would be higher if not for the fact that cholera--once diagnosed--is relatively treatable. Not long after eating marinated raw fish called seviche, Espinosa doubled over with the intense nausea and diarrhea that are the telltale symptoms of the disease. Massive intravenous doses of saline fluids saved her life. In fact, epidemiologists believe Peru's government, with the help of emergency medical aid being flown in from the United States, Canada and Western Europe, has done a good job of treating the sick. "That is fundamental because cholera doesn't wait," says Horacio Lores, a PAHO epidemiologist. "It kills quickly."

Health officials across the region are launching prevention efforts to teach people to boil water and avoid unhygienic outdoor food stands. In Peru, the Health Ministry warned of the dangers of eating seviche, a popular snack sold by sidewalk vendors. These steps were undermined, however, when President Alberto Fujimori went on television to eat seviche as a misguided plug for the devastated Peruvian fishing industry. A cabinet minister who joined the president in eating seviche was later hospitalized--with what was officially called laryngitis.

A recent PAHO report said decent water and sewage for all 22 million Peruvians would cost $3.2 billion over the next decade--10 times what Peru spent over the last 10 years. Peru's payments on its foreign debt are more than $55 million per month. The recent shift by Peru and other South American countries toward market-oriented economics promises more sustainable economic growth. But the cholera epidemic is a reminder that prosperity itself depends on public health: Peru now stands to lose hundreds of millions in export earnings and tourist dollars because of the cholera scare. Meanwhile, thousands in Peru jammed the streets for tickets to see a Brazilian faith healer. His shows were free.