Rage in the Time of Cholera* / Jeovany Jimenez Vega


Cholera – also referred to as Asian morbus because of repeated and deadly worldwide pandemics originating in India and China – is the result of colonization of the digestive tract by the Vibrio cholerae bacillus, “a bacteria of the Spirillaceae family, very sensitive to heat and acids, which quickly kill it.” It was discovered in 1893 by R. Kock, who also discovered the tuberculosis bacillus in 1882. It is treated as a very infectious contagious disease and is transmitted orally through drinking water, foodstuffs contaminated with fecal matter and vomit from an infected person or a carrier. On rare occasions it can be transmitted through urine, as well as through contact with objects such as glasses, dishes or tableware used by an infected person.

The illness has a very short incubation period “that can last between two to three hours, but which generally varies from ten hours to three days” during which time the infected individual shows no symptoms. One should always bear in mind that cholera can be asymptomatic (which is the case in the so-called asymptomatic carriers of the bacteria) as well as the fact that in a significant number of cases – the majority of cases according to some writers – one does not see the typically severe symptoms, but rather a common and easily diagnosed form of diarrhea. After the incubation period comes the stage during with the patient becomes truly ill. A patient can develop one of five different clinical forms of the disease.

It was just a matter of time before cholera reached Cuba. Large numbers of tourists, foreign students and personnel from Cuba’s Medical Mission and other areas of collaboration in countries affected by the epidemic have for years provided a potential gateway for infectious diseases to enter the country. On this occasion it began in Santiago de Cuba and in recent months has spread to the west of the country, including the capital, in the form of outbreaks that have been quickly treated with varying degrees of success, but which for now have not reached epidemic levels.

The epidemiological situation in the Cuban capital is not homogeneous. Some some urban areas are more affected more than others. But it would be extremely irresponsible to speculate here about figures about which I am not completely certain. Similarly, it would not be prudent or ethical to try to minimize the threat facing the country, even if we are not now facing an epidemiological explosive situation. I am certain, however, that health authorities are making great efforts to resolve the situation and do not doubt that the issue is being treated as high priority by governmental officials. Threatening these efforts are irregularities in drinking water supplies, the unfortunate condition of the distribution network, and the deterioration of drainage systems and sewer lines in many locations throughout the country, “whose repair depends on multi-million dollar investments over the medium and long-term.” Further complicating matters is the lack of awareness among certain segments of the population of the risks posed by a disease that has been unknown in Cuba since the end of the 19th century.

This is a problem that must be assessed appropriately, one that should not be underestimated “since we are facing a potentially lethal disease that throughout history has amply demonstrated its toll in lives lost.” We should not, however, overestimate it either. I have every confidence in the competence of my colleagues to adequately treat each case. Cuban society should make use of its full organizational capabilities to eradicate this scourge and thus avoid its becoming a full-blown epidemic. The Cuban public health system is prepared to achieve this aim. Without being gratuitously over-confident, I am convinced that within a few months the situation will be under control.

Cuban doctors are quite sensitive to this danger and are trained to deal with it. The fact that our government is in debt to us, that it pays us a “salary” that is laughable, forcing us to live in an absurd state of insolvency, that it still pays scant attention to the medical sector, that the old anger over my pending vindication still persists – all this is, as we say, wheat from another sack. This is not the post that I intended to write, but in spite of everything it seems rage is still my most conspicuous vocation.

By Jeovany Jimenez Vega

*Translator’s note: The title – a reference to the novel Love in the Time of Cholera by Colombian author Gabriel Garcia Marquez – is both a joke and a pun. Also, in Spanish the word cólera can refer either to cholera, or can mean rage or anger, as the word choler does in English.

February 15 2013