Poor sanitation spurs cholera in Peru Fearful countries ban food imports


LIMA, Peru -- Agustin Marioni, 24, could not remember arriving at the hospital. "I made it to the door and I collapsed," he said, recalling the nightmare of his acute dehydration four days earlier.

A street vendor who sells Popsicles in the shanty slum of Villa Maria del Triunfo, Mr. Marioni had eaten several of his own Popsicles, made with unboiled water and fruit juice. Violent diarrhea and later, vomiting, had gripped him. Hours later, he arrived at the Maria Auxiliadora Hospital on the verge of death.

Along with some 22,500 other Peruvians, Mr. Marioni had fallen victim to the cholera epidemic sweeping this impoverished country. Like most of the victims, Mr. Marioni survived.

Noting his sunken eyes and fluttering pulse, doctors immediately began giving him an intravenous salt solution. In one hour, they pumped about a gallon of liquid into him. His pulse returned to normal, and he woke up, to begin the regimen of oral rehydration solutions and antibiotics that would help him recover.

With its rapid response, widespread publicity and free medical care, the Peruvian Ministry of Health has kept the cholera epidemic from becoming devastating. Only 115 cholera patients have died, a mortality rate of 0.5 percent, and the number of new cases is declining.

But though the worst of the epidemic may be over, Peru, already plagued with economic collapse and two violent insurgencies, may have to live with cholera and its effects, economic as well as medical, for years to come.

According to the Ministry of Health, the epidemic began in the fishing cities north of the capital before spreading down the coast into Lima.

How cholera, which is new to Peru, arrived here is a mystery. The Centers for Disease Control in Atlanta sent a team of cholera experts to Peru but was unable to pinpoint the cause of the outbreak.

The disease's proliferation, however, is easier to explain. Public sanitation in Peru has declined catastrophically in recent decades. In the last 30 years, as Peru industrialized, millions of highland peasants crowded into the coastal cities.

Once a refined middle-class city, Lima is now a filthy, sprawling metropolis of more than 7 million. Along with the dramatic social changes of the past decades came deepening economic difficulties.

Last year inflation topped 10,000 percent. Battered by the economic crisis and plagued by bad management, the Peruvian government has done little to update sanitary systems to cope with the urban population boom.

"Forty percent of the people in Lima don't have potable water, and in provincial cities the numbers are even worse," said Dr. Uriel Garcia, a former health minister. "But even if you have potable water, you can't guarantee it's not contaminated. The sewage and water lines leak, and their contents mix."

Dr. Garcia also noted that Lima's sewage plants treat only 10 percent of the city's waste. The remaining 90 percent is discharged, untreated, into the ocean, where it contaminates beaches and fisheries.

Health Minister Carlos Vidal believes the cholera is now under control. Peruvians responded quickly to his ministry's intensive publicity, boiling water, relinquishing weekend trips to Lima's contaminated beaches and giving up their cherished ceviche, or raw fish steeped in lemon juice.

The minister promised immediate action to limit the dumping of untreated sewage into the ocean and said that Peru was seeking a loan to build sewage treatment plants outside Lima.

But the loan has been delayed, he added, until Peru completes its "reinsertion" -- the painful effort to return to the good graces of the international financial community. That effort, which depends on boosting exports to pay off debt arrears, may be set back by the epidemic's economic side effects.

Several countries have now banned Peruvian imports. Neighboring Bolivia destroyed 200 tons of canned fish and prohibited importation of Peruvian foodstuffs. Colombia did likewise, and France has halted imports of Peruvian fruits and frozen seafood.

There are reports that the U.S. Food and Drug Administration will demand that all fresh and frozen seafood, as well as fresh or frozen fruits and vegetables that have been washed in Peruvian water, be tested for cholera before entering the United States.

Health Minister Vidal denied that these products represented a threat, citing a CDC report which said that only "seafood which is to be consumed raw" represented a potential hazard.

Mr. Vidal added that the bacteria die if subjected to temperatures below 25 degrees Fahrenheit or above 212 degrees, so frozen, canned, or cooked food is safe.

Foreign restrictions have panicked Peruvian exporters. According to Hernan Lanzara, general manager of the Exporters' Association (ADEX), the restrictions may affect 5 percent of Peru's exports. The bans could, he said, upset Peru's economic stabilization effort.

ADEX and the Foreign Ministry are planning an intensive international campaign to combat the negative publicity the cholera epidemic has brought Peru and its exports.

Meanwhile, outside the hospital where Mr. Marioni lay recovering, a woman hawked Popsicles. She didn't know, she said, if the water used in making them had been boiled.

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