The economics of cholera (water)

From Haiti:

Recently, just behind the base’s barbed-wire periphery, Dieula Sénéchal squatted with her skirt hiked up, scrubbing exuberantly colored clothes while a naked 6-year-old girl, Magalie Louis, defecated by the bank, gnawed on a stalk of sugarcane and then splashed into the water to brush her teeth.

Approaching with a machete on his way to hack some cane, her gap-toothed father, Légénord Louis, said Magalie had contracted cholera late last year but after four days of “special IVs” was restored to health. He knew the river water was probably not safe, he said, but, while they brushed their teeth in it, they did not swallow.

For drinking water, Mr. Louis said, his family relies on a local well. But he lives from hand to mouth and cannot afford water purification tablets; the free supply he got in 2010 ran out long ago. So he gambles.

“If you make it to the hospital,” he said, “you survive the cholera.”

The NYT feature article is interesting throughout.


At the risk of sounding old-fashioned and judgemental, this is an example of ignorance, not poverty.

Adhering to all the little rules one must follow in order to stay alive while poor is itself exhausting, costly and tends to leave one poor.

Yeah, but not taking a dump in the same water you brush your teeth in seems like a no-brainer to me.

As the Ween song goes, don't sh*t where you eat, my friend.

Brings to mind the Jewish restrictions on clean water, or mikva'ot, of course in medieval europe this was taken as proof that Jews were spreading plague.

You know it is actually not that hard to create proper sanitation, you just have to "know" that it is important. This is a pretty perennial problem for armies. Some armies have officers and NCOs who have both the understanding and discipline to force their men to actually not shit in their water supply, others don't. The ones that don't have insane amounts of non combat casualties. Of course it helps a little if the soldiers actually come from a culture that has internalized this sort of precaution.

As to the father saying that cholera is not a problem if you get to the kid to the hospital, might I suggest that this is also relatively true with gunshot wounds... Not to sound cruel here, but then he clearly is cruel enough to his children to disregard their suffering from recovering from a bout of cholera, but it sounds like he doesn't have to pay for that treatment, talk about dependency breeding terrible behaviour.

Weren't Haitians blaming the Gorkha peacekeepers or some such for bringing in the cholera pestilence?

No, I'm serious. It's not ignorance, as the quote points out - the parent knows the cholera is survivable and the risks, to the parent, don't outweigh the costs of doing things required to acquire clean water. So they don't. It really is that simple. Observe that the quote even shows how they mitigate what risk they can by not swallowing the water. Why stop assuming rationality just because they do things hard to imagine for you? Does the supremacy of local knowledge stop at the water's edge?

It seems unbelievable because you take it for granted that you'd obviously go boil some water but for you in the first world boiling is cheap for you and furthermore it's only one thing, not one thing amongst hundreds of things like figuring out how to acquire, store, and cook food cleanly without clean water, electricity, or gas. And guarding what possessions you have from theft, and keeping an eye on your children, and... - all without the aid of the failed state or the unaffordable market.

I wouldn't say she had to boil the water, but I'd certainly say she shouldn't defecate that close to her drinking water. Does poverty cause people to become ignorant of basic common sense re: sanitation? If so, the species would have died out eons ago.

The parents' analysis is warped by high time-preference and free medical care. (I am assuming a family that shits in their drinking water and can't afford to boil it is not paying for antibiotics and IV's).

Billions of dollars in aid, thousands of good-intended busybodies, and nobody stops to think maybe the first thing we should do is lay pipe for a sewer system.

Um, guys? Maybe it could be both? Having a rationally self-interested mode of behaving in the world does not mean you have perfect information about risks and consequences, and having gaps in your knowledge does not mean you are wholly irrational. They could be responding perfectly rationally to incentives by not boiling water and/or using purification tablets, and yet they could of course obviously benefit from a bit more knowledge about basic hygiene. Two important points: 1) as sort_of_knowledgeable points out below, there are major coordination/commons problems because its a public stream, and 2) what is "common sense re: sanitation" has been defined very recently on a historical scale and obviously it is not present everywhere yet.

It is a shame that, whenever poor people are involved, the debate gets boiled down to "they are doing everything right" (which is of course true of no one) versus "they are to blame for their own situation and arguing that they possess some degree of rationality is an attempt to guilt trip westerners" (?!???)

I wonder if Légénord Louis is one of those moderates who doesn't trust science institutions.

The child is clearly skeptical of banks.

Seems like Haiti is a place with lots of liberty and no government dictates telling people how to live, nor dictating absurd science ideology as if it were true. Haiti didn't have cholera before the world government infected Haitians with it, so the practices described are not the reason for Haitians getting sick - its a world government conspiracy.

I'll have some of what mulp is smoking!

Progressives are just happy to have another rejoinder to libertarians now that "Go live in Somalia" was getting threadbare.

Well what is the libertarian response to cholera in Haiti? Assign property rights to the water to members of the Duvalier family? As the comments above point out, it's an elementary cost-benefit analysis for any one individual to go ahead and sh*t near the water.

Tell the French they can have it back.

Good article, but at the beginning of the epidemic many people thought it would made much more victims given the sanitary conditions most people are living in. It's also worth noting that the epidemic mostly affected the rural areas while slums in Port-au-Prince and other cities (which look far less clean and sanitary than the countryside) reported relatively few cases. This may be an indication of a major "sanitation gap" between the countryside and extremely poor slums in many parts of the world.

Lack of social institutions. If people upstream are defecating in the river upstream you might as well do so if it is more convenient,. On the other hand if well water is available for drinking presumably it is available for brushing teeth.

Any thoughts on legal claims for Nepalese responsibility versus the Good Samaritan Laws that exist in a number of countries? Would doing so adversely impact future relief efforts?

Wasn't the Nepalese contingent acting under the UN umbrella? I suppose, if at all, the UN would take care of it. In any case that is what is practically happening anyways? Who pays for the cholera treatment?

I saw similar behavior in Nicaragua. I wanted to believe it was due to ignorance, but it wasn't. I saw people washing dishes in maggot-infested water, with a bottle of bleach in sight. I saw kids walking barefoot in the dump, their shoes cast aside. Knowing what to do and doing it are two different things.

Seems like money is urgently needed for an UN-administered educational program on not defecating into your water supply.

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