Mexico Officials Minimize Cholera Epidemic’s Import

Carmen Ruiz’s father was one of six people who died suddenly of “the illness” just before officials canceled the annual patron saint festival for the first time in memory.

Dozens of Ruiz’s relatives and neighbors were stricken with the vomiting and diarrhea that claimed her father’s life two weeks ago and brought a swarm of health workers to douse the walls of their adobe huts with lime.

But even as brigades dug latrines, chlorinated wells and trucked drinking water down dirt roads, local officials denied they had a health problem in Santiago Miahuatlan. And no one ever explained to Ruiz or the other uneducated families what the illness is.

“Some people say ‘Cholera, cholera,’ ” said a confused Ruiz. “I don’t know. Other people say maybe they got sick from the eclipse.”

The case of Santiago Miahuatlan, about 150 miles southeast of Mexico City, illustrates the contradictory way in which the Mexican government is confronting the cholera epidemic that has made its way here from South America: They are vigorously attacking outbreaks totaling several hundred cases while downplaying their importance.

Unlike Peru, where almost 2,400 people have died and another 240,000 have been infected, Mexico has the resources and infrastructure to combat the disease, and the government has been doing so since the first cases appeared in June. Although health experts anticipate further outbreaks of cholera in Mexico, most doubt the epidemic will reach anywhere near the proportions that it has in Peru.

Yet, for Mexico, cholera is more than a public health problem. Outbreaks of the so-called “disease of the poor” are occurring at a time when the government is negotiating a free-trade agreement with the United States and Canada and is trying to emphasize Mexico’s modernizing economy. Instead, cholera is drawing attention to the most backward areas of the country and to the more than 40 million Mexicans who are classified as impoverished.

Officials are concerned that the cholera outbreaks may provoke a backlash in the United States against Mexican immigrants and imports, especially produce. As a result, some political observers and health workers believe, the government is underreporting the number of cases here.

Secretary of Health Jesus Kumate denies he is “hiding information.” He has confirmed 402 cases of cholera nationwide, with five deaths--two in the state of Hidalgo, one in Miahuatlan in Puebla state, and two more in villages near Miahuatlan.

But a visit to Miahuatlan suggests the official reports are low. Carmen Ruiz, her neighbors and a local health official provided the names of six people in the Santa Clara barrio who had died of violent vomiting and diarrhea, all within about a week.

A week ago, the government said there were 17 cases of cholera in Miahuatlan, but residents told reporters that dozens of people had fallen ill in the same way during the third and fourth weeks of July. On Friday, the government’s figure jumped to 41 cases, and officials acknowledged two deaths, one each in the villages of San Diego Chalma and San Gabriel Chilac.

At the same time, however, Dr. Jaime Sepulveda Amor, director general of epidemiology for the federal Health Department, declared the outbreak “under control.”

A local health official said there have been three deaths in the villages, but his report could not be confirmed.

Cholera is a highly contagious bacterial infection that attacks the intestines and provokes vomiting, diarrhea, cramps and chills. It is easily treated with antibiotics and rehydration solution but must be dealt with immediately.

The disease flourishes in poor, rural areas like Miahuatlan, where farmers and factory workers lack sufficient sewage facilities and potable drinking water. In the Santa Clara neighborhood, few houses have latrines or running water; the people live in close proximity to their cows, sheep and pigs.

According to some health officials, the residents relieve themselves “in the open,” and during this year’s heavy rains, the raw sewage washed into wells from which the villagers draw their water. Those who contracted cholera are believed to have done so through drinking contaminated well water.

A local health official, who spoke on the condition that he not be identified, said state officials have ordered him and other town leaders not to discuss the cholera outbreak with the media.

“Our analysis for why they prohibited us from talking is that it is not good for it to be known that what happened in Peru is starting in Mexico. That would affect the free-trade agreement,” the official said.

During an interview at the government health clinic in Miahuatlan, Dr. Varuch Garcia Balderas denied there were any deaths in the town or any knowledge of a cholera outbreak. The mayor’s assistant, Victor Fermin Serapio, accused a doctor in the nearby city of Tehuacan of spreading “false rumors” of a cholera outbreak.

The physician who spread the “rumor” was Dr. Conrado Tapia Cardoso, a Tehuacan city councilman in charge of health affairs who on July 21 and 22 treated seven Miahuatlan patients who appeared to be suffering from cholera.

Tapia said he went on the radio the next day to warn citizens of the outbreak and advise them to take precautions, but only after the mayor of Tehuacan had been told that the lab tests for cholera were positive.

State officials sent word to Tapia that he had no business making the public statement, and a local radio announcer denounced him on the air. Tapia said that he has never received the lab results for his patients and that laboratories in Tehuacan have been ordered to give all test results for cholera directly to state health officials.

“We don’t have access to the analyses,” Tapia said. “There is an official order not to alarm people. They want to cover the sun with one finger to protect the water industries around here and agriculture enterprises.”

Most of Mexico’s bottled drinking water comes from springs in the Tehuacan area, but there are no reports that any of that water is contaminated.

Sepulveda, of the federal Health Ministry, said that what may appear to be foot-dragging in the release of cholera statistics is, in fact, caution. He said that more than 9,000 cases of diarrhea are reported every day in Mexico, with 60 to 70 deaths. Each of those must be examined, but relatively few are cholera, he said.

“An epidemic is out of control. That is not the case here. We have isolated outbreaks that so far have been controlled,” Sepulveda said.

The reason the government has been able to contain the spread of cholera, he said, is that officials acted quickly. Soon after the epidemic became known in Peru, the Mexican government formed a national committee for the prevention of cholera, began training epidemiologists and opening laboratories in each state.

The first outbreak occurred in San Miguel Totolmaloya, a farming village in the mountains about 75 miles southwest of Mexico City. Because the area is highly inaccessible, officials theorized that South American drug traffickers had brought the disease to clandestine landing strips near the village.

The other outbreaks also have occurred in poor, rural areas--Valle de Tula, Hidalgo; the Huasteca mountain area on the border of Hidalgo and Veracruz, and Ciudad Hidalgo, Chiapas, on the border with Guatemala. Officials surmise that the outbreaks either were spread by residents of San Miguel Totolmaloya, or by tourists or illegal immigrants coming from Central and South America.

Each time an outbreak is reported, the Health Department sends out brigades of doctors and health workers to take fecal samples, distribute antibiotics, treat water and deliver drinking water. In some cases, they dig latrines and build dams around infected waters.

Critics say officials should be taking more aggressive preventive measures rather than awaiting outbreaks. According to the World Health Organization, 44 million Mexicans do not have potable water and 25 million do not have adequate sewage facilities. Some health officials fear the disease could spread into the squalid slums that ring Mexico City with several million migrants from the countryside.

“There will not be any outbreaks of cholera in the federal district,” Sepulveda told reporters on Friday.

Health officials are advising people to boil drinking water and wash raw fruits and vegetables with disinfectant. Since May, the government also has prohibited the common practice of irrigating crops with sewage.

While the large farms that produce food for export can be regulated, health workers worry that the government cannot control all of the country’s mom-and-pop farmers who grow crops for themselves and local markets. Such operations are irrigated with river water that often is contaminated.

Mexico exports about $1.6 billion worth of produce to the United States each year. Most of the produce comes from large farms in the north of the country.

The U.S. Food and Drug Administration has begun testing Mexican crops and seafood for the cholera bacteria at its Los Angeles and Dallas offices, according to Emil Corwin, an FDA spokesman in Washington.

“We’re watching it very carefully, and, so far, there are no cases of contaminated fruits and vegetables or seafood from Mexico,” Corwin said. The FDA is not warning Americans against eating imported Mexican fruits and vegetables.

U.S. WARNING: Doctors will be asked to watch for U.S. cholera cases. A8