ST.-MARC, Haiti — Inside the courtyard of St. Nicholas Hospital, beyond the gate with the handwritten sign stating "Diarrhea Emergency Only," lies a grim but unusually orderly scene at the epicenter of this country's unexpected cholera epidemic.
Scores of children and adults are doubled over or stretched out on every available surface, racked by convulsive stomach disorder or limp with dehydration. Buckets sit by their sides, intravenous solutions drip into their arms. Life hangs in the balance, yet there is a sober, almost eerie calm.
That is why Martila Joseph stood out. On Monday, tears cascaded down her cheeks as she rocked her pink-smocked daughter, who lay all too still in her arms. "I don't know if my kid will survive," she wailed while another patient's wife shushed her.
"You made it to the hospital," the patient's wife said. "That means you have saved her."
Indeed, treatment is rescuing more than 90 percent of those who get to a clinic, and that is why health officials concentrated Monday on bolstering local hospitals and erecting cholera centers throughout the Artibonite region. This is, for the moment, the area of high infection where the bacteria must be aggressively attacked before it spreads.
"It's virulent, and it can travel," said Nigel Fisher, humanitarian coordinator for the United Nations, standing outside a tented cholera ward at the community hospital in L'Estère. "But at least here, we have been able, case by case, to somewhat stabilize the situation."
International health officials stressed that the pattern of the outbreak was almost impossible to predict. But Monday was a relatively good day: only six cholera deaths were registered in a 24-hour period. More than 200 died of the acute bacterial infection in the epidemic's first few days. The known death toll stands at 259, with more than 3,000 cases, all but 450 or so in the Artibonite area.
Despite its central role in this epidemic, despite the new banner at the town's entrance that says "Wash your hands!" St.-Marc is not a ghost town, with residents shuttered in their homes.
Girls in school uniforms, their hair in bows, skip through the streets, and vendors hawk their wares as boisterously as always. At the entrance to St. Nicholas Hospital, an anti-cholera message, set to a festive compas beat — "There's no life without health and no health without hygiene" — blares discordantly from a loudspeaker.
A gutter with fetid standing water greets visitors to the hospital, who now step on a chlorine-soaked foam pad and rinse their hands to enter. About 600 patients with intense diarrhea and vomiting are being seen at St. Nicholas daily, with Doctors Without Borders Spain helping to manage the caseload at the hospital, jointly run by the Haitian government and Partners in Health, based in Massachusetts.
In every corner of the courtyard and surrounding wards, the patients lie on benches, cots and floors as orderlies squirt chlorinated solutions around their patch of hospital turf. Relatives — one per patient — swat away flies, wipe brows and coax pouches of rehydrating solution into gaping mouths.
Gerda Pierre, fingering a necklace of costume pearls, spoke without affect as she described how her son, Gasner, 4, started retching just after midnight. Gasner sat on a hardwood bench with a wet towel over his head. He smiled wanly.
"Many people in our neighborhood have died of the diarrhea and vomiting," Ms. Pierre said, glancing briefly to the side as a man stumbled into the courtyard and collapsed. "But I'm not worried. I sped him here as fast as I could."
Medical professionals and supplies are arriving from around the world to support the Haitian government, still reeling from the January earthquake. About 20 rocky miles north of St.- Marc, a Cuban medical brigade, long stationed at the community hospital in L'Estère, has been expanded to 28 doctors and nurses, and Bolivian troops are building a 100-bed cholera clinic next door.
"Here is an example of a good operation," said Mr. Fisher of the United Nations. "They've seen 400 patients, and there have been 10 deaths."
Imogen Wall, a spokeswoman accompanying him, said she was rattled to be in a zone relatively untouched by the Jan. 12 earthquake and yet witness suffering "completely unconnected to that disaster. "Can't this country get a break?" Ms. Wall said.
On a bare metal gurney under a tent, Herese Vanel, 63, lay primly with her purse on her chest and an intravenous line in her bony arm. Her niece, Rosemene Vanel, said her aunt had probably been infected by drinking from the Artibonite River, which is the water supply for their community and is now believed to be contaminated by cholera.
"We stopped doing that as soon as people started dying," Ms. Vanel said.
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