Audio Transcript:

Marco Werman: I'm Marco Werman. This is The World, a co-production of the BBC World Service, PRI and WGBH Boston. It's been two years this week since a powerful earthquake hit Haiti. The Haitian government has put the death toll from the quake at well over 300,000 people. Another potent aftershock was the spread of Cholera which has killed some 7,000 Haitians and sickened about a half million more. UN Peacekeepers are thought to have brought Cholera to the island inadvertently. Now scientists think they may have identified the first Haitian who caught Cholera and then spread the disease to others. The details are in a new study co-authored by Dr. Louise Ivers of Boston's Brigham & Women's Hospital.

Dr. Louise Ivers: The Cholera epidemic started when the bacteria was introduced into the river in a small town in central Haiti called Mirebalais, and once the bacteria was in the environment, the way that people have to live in kind of intimate relationship with the water and the river by bathing in it, drinking from it, gathering their water to wash and other things, they were exposed to the bacteria and then became sick because of it.

Werman: So who is this 28 year old now from central Haiti that you think might have set the epidemic in motion? Tell us his story.

Ivers: He is a young man who had serious mental health problems. He had a psychiatric issue and had hallucinations and had very bizarre behavior. In fact, he was a person in the community that they stigmatized and treated as a ââ?¬Å?crazy person.ââ?¬  He had never been able to really get any treatment for his mental health problems and even though his family actually had access to water that was drinkable, he would bathe in the river and drink water from the river, and we found that he had been in the river and drinking water from the river and became sick very shortly thereafter, did not go to the hospital to seek any advice, and passed away very quickly, and then members of his family who had participated in preparing his body for a wake, became ill themselves a few days later.

Werman: Umm. How do you actually go about trying to find the person, the Patient Zero who might have triggered the outbreak? I mean is it like simple, medical detective work?

Ivers: We were able to really trace the oral history of the community back in to find out who was the first person who was sick. The actual, the first documented cases of Cholera in the facilities and the healthcare facilities in the area were a few days later than this particular one. We met with local community leaders and tried to find out from them who they knew was the first person to have become ill with what's a very notable disease. It's not subtle to have Cholera, so we were able to trace that back through our networks with the community, really through oral history taking.

Werman: How confident are you, Dr. Ivers, that you did identify Patient Zero in this Cholera epidemic in Haiti?

Ivers: I think we're fairly confident. It's certainly possible that there were others and we don't have scientific evidence because, of course, the person passed away and we don't have the microbiology to prove that this was Cholera, but certainly everything that we know about the disease and everything we know about this community would lead us to believe that this was the first patient.

Werman: If it hadn't been this 28 year old man, would it have been someone else with the disease that would have spread it?

Ivers: Yes. I think the answer is, it's most likely that is the case. This is one young person who was exposed to the bacteria that's in the river water, but there are many people who live in Haiti and in this area who are obliged to gather their water from the river, so because this disease is not spread necessarily from person to person, but it's spread because of contaminated water source, it's most likely that the epidemic still would have occurred even if it wasn't for this young man, but we wanted to try to learn as many lessons as we could from his case.

Werman: So for you, what are the big lessons for Haiti and anyone concerned about community health?

Ivers: First of all, the importance of mental health. You can't have health without mental health. The second important point I think is the issue of globalization. Cholera was a disease that had never been recorded in Haiti before and was introduced to Haiti from the (inaudible) from a different country, and similarly, very quickly, within the space of a couple of weeks, a disease that was happening in Haiti began to be introduced back into other countries, so we had cases in the U.S. There were cases in Boston and Miami and in the Dominican Republic that came from Haiti, from what otherwise is a very isolated, rural town in the center of the country that most people never would have heard about before. So the issue of globalization going in both directions, we don't just have to think about how could diseases that have been eliminated from rich countries where we live, how could they come back from poor places like Haiti. We also have to think about how does our activity and does what we do affect people who live in rural Haiti where we can introduce diseases there that hadn't existed in the first place.

Werman: Dr. Louise Ivers has co-authored, along with David Walton, a new article in the American Journal of Tropical Medicine & Hygiene. It's called The First Case of Cholera in Haiti, Lessons for Global Health. Dr. Ivers works with the A Group Partners in health. Thank you very much indeed.

Ivers: Thank you.

Werman: There's more in-depth coverage from Haiti at theworld.org including a new blog post from Producer, Deb Sharp, recalling her experience in Haiti on the quake's first anniversary.