"What is that?" I asked Pugliese.
"That … that could be anything."
A villager was swimming a few yards away.
"It -- it does not mean it is from the base," he said. "The people here, they swim in the river. They bathe in it." He pointed to the swimming man. "They -- you know how they are!"
That was the end of the tour. The U.N. team refused to go across the street with us to see the dump pits.
The next day, less than two weeks after the outbreak was first confirmed, the CDC put out the results of an analysis it had undertaken: The cholera in Haiti matched strains circulating in South Asia, including Nepal. It refused to investigate further.
The death toll passed 400.
Authorities defended their refusal to investigate the origin of the outbreak on grounds that pursuing the source would detract from fighting the epidemic. So on Nov. 3, I called one of the most prominent public health experts in Haiti, if not the world. Paul Farmer's medical NGO, Partners in Health, was taking a leading role in tackling cholera. I asked if there was a public health rationale not to investigate. "That sounds like politics to me, not science," Farmer replied.
Health officials look into the source of cholera outbreaks all the time. In fact, the modern practice of epidemiology was built on the disease in 1854, when a physician named John Snow set out to find the source of one of London's worst cholera outbreaks. Such investigation is still the practice. In a 2004 guide, the WHO recommended investigating each outbreak's origin "so that appropriate control measures can be taken."
Those seeking to protect the U.N. -- the WHO and CDC, sympathetic journalists, aid workers and diplomats who depended on the U.N. for protection on the ground -- kept coming back to a three-word phrase: "the blame game." The journal Science would later note that cholera experts' "passion for traditional shoe-leather epidemiology [had] been tempered by diplomatic and strategic concerns."
Most journalists, particularly those not based in Haiti, seemed to feel the same way. They stayed away from the story until there was too much evidence to ignore, and then did their best to beat it back. When the New York Times published a story about the U.N. defending its anti-investigation stance, three weeks after our visit to the Nepalese base, health reporter Donald G. McNeil, Jr. wrote a Week in Review piece titled "Cholera's Second Fever: An Urge to Blame." He gave past examples of cholera "blame games," including 19th-century New Yorkers accusing Canadians and the Irish. He warned of danger: "Scapegoating provokes violence."
The U.N. was not a threatened minority, but the most powerful military force in the nation, if not the region. In fact, as the dramatic events of November 2010 would soon show, it was stonewalling that would provoke the Haitian crowds. By refusing to take the concerns seriously, investigators would cede inquiry to the very agitators and xenophobes they feared.
In two years, more than 7,800 Haitians have died of cholera. One in five people in a nation of roughly 10 million has fallen seriously ill with the disease, while the unusually virulent strain has spread across the Caribbean, into South America, and the United States.
The United Nations has made grandiose, if seemingly empty, promises to fight and eradicate the disease, but refuses to consider its own accountability in starting the epidemic. Aid workers and donor governments have lost a critical opportunity -- to demonstrate that they took Haitian lives and welfare as seriously as their own.