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Up in the hills of Port-au-Prince, I accompany a team from one of UNICEF’s partner organizations, Croix-Rouge française (CRF). The capital spreads from these high hills down to the blue ocean, down to Cité Soleil, Haiti’s famous slum. Here in the hills is where cholera resurged, in the slum of Martissant, one of the poorest and most gang-infested areas of the city. CRF delivers emergency responses to outbreaks. If someone arrives at a CTC or clinic and is thought to have cholera, a team is dispatched—ideally within 48 hours—to set up a “cordon sanitaire,” or sanitary barrier. Speed is an important weapon, both in the spread of cholera and in the fight against it. UNICEF and other agencies are excited about a new Google Drive system that enables them to get real-time updates on cholera cases all over the country, something that didn’t exist before. If they know cholera’s routes, they can block them more effectively.

Today’s team wears red vests and baseball caps. They resemble the men on Port-au-Prince street corners who are selling mobile-phone minutes, but they carry chlorine sprays, not phone cards. Our target is a narrow street. We reach it through other narrow streets, where women are selling raw meat and cooked food. None of it is covered. The flies are landing freely, their feet likely contaminated with feces.

In the National Plan to Eliminate Cholera, the country’s sanitation is described as “practically non-existent.” Port-au-Prince has only one operational waste treatment center for a city of 2 to 3 million people. People who do have latrines have them emptied manually by an underclass of bayakou (men who jump, often naked, into the pits and shovel out their contents). Hardly any of that waste is disposed of at the treatment plant; instead, it ends up anywhere the bayakou can put it. It’s the same “anywhere” where the majority of Haitians without latrines go to do their open defecation. It’s the anywhere where cholera thrives.

We park, finally, and the team gets ready. One man is the disinfector. He puts on a mask, apron, and gloves and gets his spray can. There are three stages of disinfection and three strengths of chlorine solution: Today will be A-strength (four spoonfuls of chlorine solution in 20 liters of water) and the whole house will be sprayed, along with the neighbors’ houses. Another team member has a clipboard and pen. To combat the speed of contamination, questions are as important as chlorine. How did you get cholera? Where have you traveled? Who have you met? Cholera is easily transmitted in food and water, but also at funerals and carnivals and street markets.

The questions are being asked of Gaelle, just discharged from a CTC after three days. She leans against the dingy curtain in the dingy concrete house as if it is holding her up. I ask her how she got cholera: “I don’t know. We treat our water.” She and her sister Lourdes say they buy Aquatabs, water-disinfection tablets that are widely available for sale but seen as expensive, unless they are dispensed freely by NGOs. (Most people add chlorine to their water, though usually too much.) I ask Gaelle how cholera is transmitted: “With dirty hands or when the environment is dirty.” Finally, in my most patronizing mode, I ask what she thinks cholera is. A small animal, a virus? “No,” she says with some pity for my stupidity. “It’s a microbe.”

Parkin Parkin / Mosaic

When I interview Haitian officials, they talk about outreach and messaging. They mean hygiene posters and pamphlets and megaphones that instruct Haitians to wash their hands, treat their water, keep themselves clean. I don’t think this kind of top-down didactic approach works ordinarily: No one responds well to hectoring. It’s even less successful when the messages are so well known, says one NGO worker, “that if you start [a sentence about hygiene], it’s them who finish the sentence.” As cholera retreated, lassitude grew. “They know what to do,” says Olivier Lamothe, who works on emergency responses for UNICEF. “They say, ‘but I’ve always done that and there was no cholera.’ There’s a reticence. We have to figure out how to adjust the message.”