In the teeming city of Port-au-Prince, Haiti, millions of people have no reliable water supply.
Many of the underground pipes that did exist were ruptured by the 2010 earthquake. Many public water kiosks are dry.
So life for most people is a constant struggle for water. And now that cholera has invaded Haiti, safe drinking water has become Haiti's most urgent public health problem. Contaminated water is the main cause of cholera, which has sickened 530,000 Haitians since late 2010 and killed more than 7,000.
In Port-au-Prince, street vendors sell water in plastic baggies for a few pennies. Much of the city's water supply is trucked in by commercial vendors or a dwindling number of nongovernmental organizations that took on the task after the quake.
On one busy street corner, just outside one of the city's biggest slums, people with plastic buckets jostle to get to a length of garden hose that snakes out of a hole in the pavement — a source of free water.
A young woman named Marlene Lucien controls the hose. A self-appointed keeper of the peace, she tries to prevent fights from breaking out.
Is it safe water? "We are used to it," someone replies. "It's the water we use every day." But another person waiting in line says she does worry about cholera. "We are scared of it because it can kill you within hours," she says. But she has no choice; she has to drink whatever water she can get.
Haiti has never had the kind of water systems that developed nations take for granted. Chalk it up to decades of dysfunctional governments and unreliable international aid. Whatever the reasons, it's never happened.
In the countryside, clean water is even harder to come by.
In the tiny rice-growing village of Ballange, 50 miles north of Port-au-Prince, people have taken their water from the Artibonite River for generations. "They spent many years drinking it and they had never been sick," says Absolue Culberte, a community leader.
Then, 18 months ago, things changed. "Suddenly, [people] started being sick," Culburte says. "They were scared because they didn't know what was going on."
Cholera had entered the Artibonite River, Haiti's longest, 60 miles upstream — most likely from a leaky latrine at a United Nations camp for peacekeeping troops, who carried it from Nepal.
Many people in Ballange got sick, and some died.
Now, cholera is entrenched in the environment. With the coming of the spring rains, cholera cases are beginning to climb again in the Artibonite Valley.
But this spring, there's reason to hope it will skip over Ballange. That's because the village has a brand-new water treatment system. A U.S.-based charity called Water Missions International installed it, along with systems in a couple of dozen other villages.
Two big tanks provide plenty of clean water for about 3,000 people. The system cost about $25,000.
Ballange is a bright spot in Haiti's quest for clean water. But a few miles upriver, in a village called Ote Dibison, there's a grimmer reality.
Another international aid group put in a similar water purifier in 2009. But it broke down just before the cholera outbreak.
Silencier Bonhomme, a member of the local water committee, says all it would take to fix the system is a couple of new batteries and a new pipe. But when villagers tried to reach the aid group, they didn't get a response.
"We don't have anyone who can fix it," Bonhomme says. "People now are using water from the river, and they get sick. We're getting close to two years since it broke down."
Other villages have the same problem. Water purifiers were put in, but they broke down, and villagers weren't able to fix them.
A hundred miles southwest there's an even bigger failure, in a seaside area called Petite Riviere des Nippes on Haiti's long, westward-pointing peninsula.
Nine years ago, the Haitian government built an elaborate water system there. It was designed to pump water from a pristine, protected stream to a hilltop reservoir and distribute it through pipes to the area. It was a big project, costing several hundred thousand dollars. A red government sign called it "a public treasure."
But it hasn't functioned in more than two years. The pump failed. A truck reportedly drove over a pipe and crushed it. Local authorities couldn't scrape up the money to get it repaired. And it's unclear when the national government plans to fix it.
"It's a tragedy," says Kenny Rae of OxfamAmerica, "particularly in the middle of a cholera outbreak, when people have to now use water they take from the river. We've tested it. It's very, very contaminated."
So Oxfam is trying a simple, low-tech solution to provide clean water. The NGO is installing what they call "chlorine boxes" — green metal poles with dispensers on top. With a quick tap, it squirts just the right amount of chlorine to disinfect a 5-gallon bucket of water.
Soon there will be 90 chlorine boxes scattered around the surrounding villages, which get their water from sometimes-contaminated streams. "The cost of chlorine is very low," Rae says. "A $100 tub will cover all dispensers for six months."
When NPR visited, the hillside hamlet of Font de Liane was buzzing with excitement as a group of men dug holes and mixed cement to install two chlorine boxes.
"We were thirsty for something like this," says Jacob Labote, a schoolteacher who is chairman of the local water committee. "I believe that everybody will be using it."
This story was produced for broadcast by NPR's Jane Greenhalgh.
Note: After myriad delays, vaccinations against cholera finally began today. The program plans to vaccinate some 100,000 Haitians against the disease.
STEVE INSKEEP, HOST:
Health workers in Haiti today begin vaccinating people against cholera. The project will reach only one percent of the population, but its organizers hope vaccination will eventually protect millions. Since cholera hit Haiti in 2010, more than a half million people became ill, and 7,000 have died. A vaccine may help as people wait for the real solution: safe drinking water. NPR's Richard Knox reports.
RICHARD KNOX, BYLINE: In the teeming city of Port-au-Prince, millions of people have no reliable water supply. So life for most people is a constant struggle for water.
(SOUNDBITE OF BUCKETS AND WATER)
KNOX: On one busy street corner, just outside one of the city's biggest slums, people with plastic buckets jostle to get to a length of garden hose.
The young woman holding the hose is Marlene Lucien.
JEAN MAGLOIRE: Marlene, Marlene (unintelligible)...
KNOX: That's Jean Magloire, our translator. The hose comes from a crack in the pavement. It's attached to a broken water pipe, a source of free water. Marlene controls it.
MAGLOIRE: Yeah, she's in charge just to avoid people fighting for the water.
KNOX: Is it good water?
MAGLOIRE: That's the water we use every day.
KNOX: But it's of doubtful purity. And even though they drink it, people worry that the water contains cholera.
MAGLOIRE: We are scared of it because it can kill you within hours.
KNOX: Haiti's current cholera epidemic is the largest in modern history. It makes clean drinking water more important than ever. Trouble is, Haiti has never had the kind of water systems that developed countries take for granted. It's had decades of dysfunctional governments. And international aid has been unreliable. So it's never happened. And in the countryside, safe water is even harder to come by.
(SOUNDBITE OF POUNDING)
KNOX: Women in the tiny village of Ballenger pound rice into flour. We're on the banks of Haiti's biggest river, the Artibonite. Other villagers are putting their rice crop through a threshing machine. Absolue Culberte is a leader of the community. For generations, he says, people here have taken their water from the river.
ABSOLUE CULBERTE: (Through translator) They spent many years drinking it. They have never been sick.
KNOX: Then 18 months ago, things changed.
CULBERTE: (Through translator) Suddenly they start being sick. They were scared because they didn't know what was going on.
KNOX: Cholera entered the Artibonite River 60 miles upstream. Scientists say it came from a leaky latrine at a United Nations camp for peacekeeping troops, who carried it from Nepal. Many people in Ballenger got sick, and some died.
CULBERTE: (Through translator) After people have been to the doctor, they have been told that this disease was caused by drinking bad water, water that was not safe.
KNOX: With the coming of the spring rains, cholera is beginning to surge again in the Artibonite Valley. But this spring there's reason to hope it will skip over Ballenger.
(SOUNDBITE OF WATER FLOWING INTO A BUCKET)
KNOX: This village has a brand-new water treatment system. A U.S.-based charity called Water Missions International installed it here and in a couple dozen other villages.
Danielle Lacosole fills a big bucket from the spigot and balances it on her head for the trek home.
DANIELLE LACOSOLE: (Foreign language spoken)
KNOX: How far do you have to take water?
LACOSOLE: (Through translator) In a place called Mireille, that way, 30 minutes.
KNOX: It looks very heavy.
LACOSOLE: (Through translator) Yes, it's heavy.
KNOX: She's carrying seven-and-a-half gallons. It weighs 63 pounds. Ballenger is a bright spot in Haiti's quest for clean water. But a few miles upriver, in a village called Ote Dibison, we find a grimmer reality.
(SOUNDBITE OF CLANGING DOOR)
KNOX: Silencier Bonhomme unlocks the door of a similar water treatment system an international aid group put in a few years ago.
SILENCIER BONHOMME: (Through translator) This is a water system that's no longer working, and we don't have anyone that can fix it.
KNOX: It broke down just before the cholera outbreak. All it would take to fix it is a couple of new batteries and a new pipe. But when the villagers tried to reach the aid group, they didn't get an answer.
BONHOMME: (Through translator) People now were using the water from the river and they got sick.
KNOX: That's a bad time to break down.
BONHOMME: (Through translator) Yes, we're getting closer to two years since it broke down.
KNOX: Right next to the broken-down purifier, a steep path leads down to the muddy Artibonite.
(SOUNDBITE OF WATER SPLASHING)
KNOX: A stately older woman named Gladys Dorsay comes here twice a day to fetch her water.
GLADYS DORSAY: (Through translator) Now this is the way we get our water, from the river. The way you see me taking it, that's the way everybody does.
KNOX: And is this for drinking?
DORSAY: (Through translator) Yes, we drink it. We have no other source of water.
KNOX: Other villages have the same problem. Water purifiers were put in, but they broke down, and villagers weren't able to fix them. A hundred miles southwest, there's a bigger failure. It's in a seaside area called Petite Rivieres des Nippes.
(SOUNDBITE OF GOATS)
KNOX: Nine years ago, the Haitian government built an elaborate water system here.
KENNY RAE: The spring is underneath this concrete reservoir.
KNOX: That's Kenny Rae of Oxfam America.
RAE: It's clean, it's pristine. There are no people living above this spring that could potentially contaminate it. It' very clean.
KNOX: The system is supposed to pump this clean water to a reservoir on a nearby hill. It was a big project. A government sign calls it a public treasure. Problem is, it's not working.
RAE: This system hasn't functioned now for over two years.
KNOX: The pump failed. Local authorities couldn't scrape up enough money to get it repaired. It's unclear when the government plans to fix it.
RAE: It's a tragedy, particularly in the middle of a cholera outbreak when people have to now use water that they take from the river.
KNOX: And that water is unsafe, I assume?
RAE: We've tested it. I wouldn't want to swim in it. It's very, very contaminated.
KNOX: So Oxfam is trying a simple, low tech solution to provide clean water.
(SOUNDBITE OF DIGGING)
KNOX: Half a dozen men are digging holes and mixing cement in a tiny village called Font de Lian. It's one of the many remote villages scattered in the lush hills overlooking a turquoise sea.
JACOB LABOTE: My name is Jacob Labote.
KNOX: What's happening here?
LABOTE: (Through translator) We are putting on dispensers for people to get access to chlorine.
KNOX: They're installing a chlorine box. It's a green metal pole with a dispenser on top. With a quick tap, it squirts just the right amount of chlorine to disinfect a five-gallon bucket. Soon there will be 90 chlorine boxes scattered around these hills.
RAE: The cost of chlorine is very, very low. A $100 tub will cover all dispensers for six months.
KNOX: The village is buzzing with excitement. Women and children gather to watch as the men install two dispensers. Labote is chairman of the local water committee. He's been anxious to get the boxes installed before the rains bring another cholera outbreak. We were thirsty for something like this, he says.
LABOTE: (Through translator) I believe that everybody will be using it.
KNOX: These dispensers will work for small mountain villages like this one. But it's going to take a lot more time, money and commitment to bring safe water to most Haitians.
Richard Knox, NPR News.
(SOUNDBITE OF MUSIC)
INSKEEP: And our NPR crew documented Haiti's water trouble at a time of cholera in sound and pictures. You can see their slideshow at npr.org. Transcript provided by NPR, Copyright NPR.