On February 5 we spent a day traveling to the mountains of Haiti’s Arcahaie region in the Quest Department to investigate mysterious deaths among villagers.
Internet chatter began in earnest on January 26 when foreign medical interests in Haiti reported sudden onsets of blindness, breathing difficulties, paralysis and death in the remote Haitian village of Fond Baptiste. Men, women, and babies were falling ill with no apparent epidemiologic reason. It was not cholera and it was not polio, as some initially suspected. As the mystery unfolded the common consensus was that villagers had fallen prey to murderous merchants in the local markets who were selling methyl alcohol, an industrial solvent, disguised as the popular local drink called “Clairin.” But in some cases NGOs were blaming the victims and accusing the villagers of making their own “moonshine” because they were depressed. “Villagers drink to drown depression,” became one theory.
Clairin is sold as a cheap alternative to rum. Dispensed by the shot or by the gallon in local markets, Clairin is distilled from molasses or sugar cane. Depending on how many times it is distilled, its potency can reach 190 proof. Villagers will use it to warm babies who don’t have enough shelter in the mountains, and Clairin is also used to put infants to sleep. The use of Clairin is deeply ingrained in the culture and it is what the poor, the “peasants”, use for celebration, mourning, or mixed with herbs as a medicinal drink. There is nothing unusual or sinister about the use of Clairin, although one could argue against its use for purely medical reasons. But, then we would be arguing from a position of white privilege and forcing behavior upon a culture that finds comfort in its traditional values.
We met a “medsin fey” (leaf doctor) in La Pointe who used generations of knowledge to mix certain herbs in gallon jugs of Clairin. Depending upon what ails you, she would recommend certain combinations of plants. This wise medicine woman and her mother wanted me to try a taste, and I was tempted, but I was also certain the alcoholic content was too much to handle, so I begged off. They found my reluctance quite humorous. My point in telling the anecdote is that Clairin is not anything more than a very strong alcoholic drink and sometimes holds traditional medicinal values.
Methanol, on the other hand, is highly toxic wood alcohol. You can find it in automotive windshield washer fluid, copy machine fluids and paint strippers.
Whoever sold methanol disguised as Clairin to unsuspecting villagers knew exactly what they were doing, and the problem has not ended with the first fifteen cases reported at the end of January. These merchants of death are doing it solely for profit.
Yesterday, Le Nouvelliste reported that a 54-year-old man died at Lafito, near the Cabaret area on the night of Febraury 16. Cabaret is one of the area authorties investigated when the poisonings began. The man was reported to be the seventh of the newest victims—victims who unknowingly purchased their own “la mort serait dans la bouteille” (deaths in a bottle) for “a handful of gourds.”
When we visited Fond Baptiste and other villages on February 6, there was concern that the deaths were not over, that the merchants had hidden the methanol disguised as Clairin, and that once the heat was off, sales of the poison would begin anew. Villagers were fearful and in some cases, angry. They felt that the Haitian government was not conducting a rigorous investigation. They may be right.
It a country the size of Maryland, it seemed odd that officials and the combined efforts of all of the medical NGOs in the area had not been able to track the source of the methanol sales. So, we set out to find out the where and whys of this story, while hoping that with some luck we would find the “who.”
It is not easy to get to Fond Baptiste. We took the main Highway 1 north along the coast from Port-au-Prince to Saint-Medard, where we turned towards the mountains on a narrow, boulder-strewn road. Even in a four-wheel drive, there were times when it seemed we might not be able to navigate roads that barely had room for burros and donkeys.
We passed many villages along the way and stopped to talk to people as we asked directions. Chalk-like paths forked from “the main road,” and it was difficult to tell a donkey trail from the road in many areas. People were aware of what had happened in Fond Baptiste, but the deaths were limited to that village.
People were also eager to talk. Many were hoping we had come to bring them water. They were out of Aquatabs, the trade name for water purification tablets used to prevent cholera contamination of their drinking and cooking water. We received many requests for the tablets.
In the village of Chinchion, people were doing the best they could to just survive the cholera epidemic. They told us it was a great distance to get water from the river. They had a collection tank at the river, but no way to get the water to the village. Leaders told us that French and Canadian NGOs erected the tank “three or four years ago,” but that the Japanese pump was no longer working. The Haitian Red Cross gave them purification tablets a month ago, but they were about to run out. 6,000 people depend on this water, and for now they have to try to travel to market to buy Clorox at the cost of 5 Gourdes for a “small bottle (12 cents).” With average daily income in Haiti of less than $2 per day, and even less so in remote areas, 12 cents to purify your drinking water, the basic staple of life, is difficult to bear.
This narrative may seem like a digression from the Clairin investigation, but it demonstrates how completely forgotten and expendable these people are—forgotten by their own government, by the Red Cross, and other organizations who come to put a band aid on water problems, garner publicity and then leave without addressing the core infrastructure issues. The deaths of 12 to 15 villagers by poisoning was not getting much serious attention by their government. Villagers knew methanol was being sold as Clairin and that the Haitian Red Cross had taken “Maybe 15 people” from Fond Baptiste to the hospital. But, no one seemed to be doing anything about it and they were as hungry for information as they were for Aquatabs.
We reached Fond Baptiste shortly after the village market closed, although there were a few stands in place selling fruit, rice and legumes. The residents viewed us almost with indifference until we explained that we were looking for anyone with knowledge of the villagers who had died. Was anyone still sick? We were also looking for discarded containers that may have held the Clairin. Naively, we assumed we would find distinctive containers, like discarded Coke or rum bottles. It was later we learned that villagers brought their own containers to purchase the brew from blue 55-gallon drums in the markets.
A young woman who was chewing on a stalk of sugar cane offered to take us another half hour or so up the road to the home of a man who had fallen ill from the poison, had gone blind, but was still alive. She was almost nonchalant as she explained that her mother died from methanol and that her infant had been killed during the earthquake when a wall collapsed on the baby.
Such is life in Haiti’s remote areas. Life and death are so closely intertwined that death does not seem to be a surprise. It is always just around the next corner, is not shocking, and is accepted with a stoicism that both inspires and repels first world sensibilities. This is unacceptable to the American mindset, which demands entitlement. Haitians and others of the world’s dispossessed do not experience the basic human right of clean water. Life and death is game of winner take all, and death takes all with no impunity.
Incongruously, we also encountered a wedding along the way. Life does go on.
Without extending this narrative, here is a video we made of an interview with the blind survivor we found in Fond Baptiste.
Villagers explained that the first victim was a 45-year-old woman who went to market down the mountain—they were not sure which market—and purchased what she thought was Clairin. She immediately fell ill with great pain, blindness and a swift death. Not making the connection, the villagers prepared a funeral and did what they always do, which is to celebrate or ease their pain, it was not clear which, by drinking what they assumed was Clairin at the funeral.
More deaths followed, and still the connection was not made. Somewhere along the way the tainted brew was also given to an infant. As little as a couple of tablespoons (about 14-28 ml) of methanol causes methanol poisoning in children. In adults, two ounces (56 ml) is all it takes. One thing was very clear. The man in our interview purchased what he thought was Clairin at the market in Montrouis for his father’s funeral, drank it, and shared it with others who all died. It turned out that his father had also died from methanol poisoning.
The 34-year-old man we interviewed may or may not be alive today, but his testimony was strong and unwavering. Listen to it to get the full picture. He seems to have been lucky, if you can consider permanent blindness “luck.” His testimony indicates that he initially got to a hospital where “they gave me an IV and pills.” He did not fully understand what was happening, but an IV drip of ethanol is standard treatment for methanol poisoning. Or it may be that the Haitian Red Cross took blood samples that proved methanol poisoning. Patient advocacy is non-existent here, and it was clear the man was confused, frightened, and had no idea what was happening to him. A Cuban doctor had given him a prescription for Vitamin B, but Vitamin B is not the standard treatment for methanol poisoning.
When we stopped at the Cuban field hospital on Highway 1 several days later, the doctors there explained that when the poisoning first presented in the form of blindness, they did not know what they were dealing with. As they put it, if a patient with sudden blindness comes in and is walking, talking and all other vital signs are normal, more specialized testing is needed. Methanol poisoning was not in the constellation of possibilities at that time.
Imagine drinking anti-freeze or Sterno. Methanol is the same, and poisoning occurs over a number of hours. It is only mildly intoxicating, but it is metabolized into formalin. Think of the lab specimens you had in biology class–preserved in formaldehyde. Treatment must be swift and it is complicated.
Treatment for methanol poisoning is fairly intensive. Many patients have a nasal-gastric tube inserted with activated charcoal, which helps “pump the stomach.” Patients are observed for sharp declines in blood pressure, seizures, or stopping breathing. It is quite common for people to need dialysis, and most people are also given an antidote to methanol in the form of ethanol. As symptoms develop, other medications, like anticonvulsants may be needed. Many people require breathing support like a respirator.
Now imagine trying to get this kind of an intervention in an emergency room in the United States, let alone in a remote region of Haiti, where there is no infrastructure for water and sanitation, and doctors initially had no idea what they were dealing with.
Our visit to Fond Baptiste produced some understanding, frustration, and an idea where we could investigate a known source of the methanol. It was Saturday when we started down the mountain, but we would not make it to the market in Montrouis until Monday morning.
The Montrouis market, located along the well-traveled Highway 1, south of St. Marc, is not as welcoming to “blancs” as the mountain villages are. We got the feeling that as far as younger men were concerned, we represented easy prey for money and abuse. I could not blame them, really.
After all, the usual foreign visitors were well-heeled NGO employees on their way to pay over $100 per night plus the cost of a boat trip to the island of la Gonave. La Gonave had been our own agenda in order to investigate a proposed industrial and theme park, but NGOs had booked all of the hotel rooms and driven up the prices in the process. What they were doing on la Gonave is anyone’s guess, but the inns were full.
Nervousness aside, when I found myself alone and surrounded by a group of men screaming in my face and demanding money in Kreyòl, I could understand their fury. It did not take long for several sympathetic women to form a protective circle around me and pretend to be teaching me Kreyòl: “Tomat, Kreyòl; Papay, Kreyòl; Glas. Kreyòl.” Tomato, Papaya, Ice. It was like a chant that kept me safe.
I was very happy to pay them for the timely language lesson and to learn once again that Haitian women are the “Poteau Mitan” or central pillars of society.
Meanwhile, our guide and translator was able to locate the local Clairin “distributor” deep in the alleyways and narrow passages of the market. The 55-gallon drums were well hidden and you had to know where to find the proprietor.
The owner of the Clairin stand was eager to demonstrate that his brew was safe and consisted of Clairin—not methanol–by drinking several shots and offering me the same. Of course he was aware of the poisoning and had no idea who had sold it, he said. We certainly were not expecting a confession, and there was really no reason to suspect him, especially after he readily offered that he was the only dealer in the market when we informed him that villagers in Fond Baptiste had obtained methanol in Montrouis.