It was October 2010 when reports first emerged of a mysterious disease spreading through Haiti.
In a hospital in Saint Marc, about an hour north of the country's capital Port-au-Prince, 400 cases of adults with watery diarrhoea had been reported in a single day.
On a regular day, there might be four people show up at the hospital with these symptoms.
"So literally, they had gone from a normal day to this kind of explosive number of cases," says Louise Ivers, an associate professor of global health and medicine at Harvard University.
For the doctors at the hospital, diarrhoea and vomiting pointed to one disease — cholera.
Left untreated, cholera can kill within hours. It causes acute diarrhea and leaves people severely dehydrated.
It's a bacterial infection, mostly spread through contaminated food and drinking water. So in areas with poor access to clean water and sanitation, it can spiral out of control very quickly.
But there hadn't been a documented case of cholera in Haiti for more than 100 years.
Within days, those first cases became a full-blown outbreak, with hundreds more cases pouring into hospitals across Haiti.
At the time, Dr Ivers had been working in Haiti for seven years as an infectious diseases physician.
"The clinical care was just overwhelming. We had patients in the hallways, we had patients on the floor, we had patients in the courtyard. It was very, very challenging for us," Dr Ivers says.
About 800,000 people would eventually get cholera in Haiti, and almost 10,000 would die. And 10 years later, people are still catching cholera there.
How did cholera come to Haiti?
As Dr Ivers battled the outbreak, journalist Jonathan Katz was investigating how it began. People were shocked when the disease suddenly emerged from nowhere.
He'd been working in Haiti for three years with the Associated Press.
As he travelled around Haiti for work, Katz began to hear various rumours about how the outbreak had begun.
"They all seemed a little bit far-fetched and they all had a variety of characters," he says.
"Some of the stories were about United Nations helicopters dropping a black powder in the river. Other people swore that their mom's cousin's lawyer's friend had seen a UN soldier taking a dump in the river."
The contents varied wildly, but two key themes continued to crop up — the United Nations, and a river.
There had been a UN presence in Haiti for six years at this point, with peacekeeper troops entering the country after a coup against the country's then-president.
And a new contingent of UN troops had arrived from Nepal earlier in October, just before the outbreak started.
'The smell was mind-blowing'
Most of the rumours seemed to centre on a particular UN base outside the town of Mirebalais, which sits near to Haiti's longest and most important river — the Artibonite River.
When Katz visited to investigate, locals guided him to the back of the base, where he found foul-smelling water disgorging from pipes towards the river.
He also found UN peacekeepers, collecting samples of the water for testing — this despite the fact that the UN had denied the possibility that human waste, dumped by the UN, could be behind the outbreak of cholera.
"The UN had been saying, 'There's no possible way that these rumours could be true.' And yet here were clear UN peacekeepers, obviously taking samples to take to a lab somewhere," Katz says.
Chasing justice
Through the end of 2010, Katz published a series of stories that brought attention to the situation at the UN base.
Within a few months, scientific research and the UN's own analysis identified the poor sanitation at the base as the likely source of the cholera outbreak in Haiti. It's believed one or a number of the UN troops, arriving from Nepal where cholera commonly circulates, brought the bacteria with them.
But it would take another six years before the UN apologised for their role in the cholera outbreak.
"The Haitians got somewhat of an apology. But they never got any real justice in the form of a remedy for the harm that was caused," says Dr Ivers.
She says that despite pledges at the time for new programs to support Haitians and improve development in the country, little has changed 10 years on.
"I think the consequences of having almost a million people fall ill in your country and at least 10,000 of them dying, most of them in the beginning of it and many of them uncounted — it's almost immeasurable," she says.
"They don't really have the luxury of too much reflection on what's happened in the past, to be perfectly honest with you. But that doesn't mean that they don't believe they deserve justice."
Cholera is now endemic to Haiti, meaning it continues to circulate in the community a decade after the initial outbreak.
"I think probably the biggest lesson, which we could have learnt before, but maybe the cholera outbreak amplified was that you really should be thinking of first do no harm," says Dr Ivers.
"And not just assuming that when you're going to participate in a work around international development that you're just automatically doing good by your very presence."
Patient Zero tells the story of Haiti's cholera outbreak and how scientists traced the spread back to its source. Listen now on the ABC Listen app, Apple Podcasts or on the RN website.
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2020-09-02 20:02:00Z
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