As you walk into almost every healthcare facility in Saint-Marc, the western port city in Haiti that was the epicenter of the deadly 2010 cholera epidemic, you are reminded that cholera is still here. Posters, written in Haitian Creole and sponsored by the World Health Organization, the Center for Disease Control, and the Haitian Ministry of Public Health and Population( MSPP), admonish us to wash our hands—and most importantly, give a step-by-step demonstration on how to do it. After the epidemic there was an explosion of sanitation infrastructure-building and health education, starting with this focus on the hands.

On the heels of the 75th anniversary celebration of WHO’s regional office in Nigeria comes the organization’s annual World Hand Hygiene Day on May 5. This day is dedicated to promoting high quality and safe healthcare that encourages a culture of clean hands to “prevent” and “control” the spread of infectious diseases, as well as provide better care for patients. Last year’s theme was the “culture of safety and quality.” For WHO, culture is key to promoting a better attitude and appropriate behavior in the fight against infectious diseases.

But containing infectious diseases is about much more than culture. The 2010, cholera bacteria was brought into Haiti by United Nations peacekeeping forces that arrived as part of a UN stabilization mission that was ostensibly there to help with relief efforts, but also brought about the removal of the first democratically elected president, Bertrand Aristide, with the help of  the US, Canada, and France. By disposing of their feces on the shores of the Artibonite, a river widely utilized by many rural Haitians, the troops set off one of the biggest cholera plagues within a single country in modern times. The UN denied that its members were the source of cholera, until scientists mapped out the genome of the cholera strain, and proved it came from South Asia, where the peacekeepers had just been.

This epidemic killed thousands and triggered protests amongst the masses, creating even more distrust of the UN and Haiti’s army of militarized NGOs. The UN has taken responsibility, but now that cholera is endemic to Haiti let’s just wash our hands. Although considered a forgotten epidemic, the people of Saint-Marc still remember.

Yet, somehow, even with all the rigorous disease surveillance and containment done by the CDC, cholera is still here. In 2022, cholera outbreaks occurred in the poorest neighborhoods in areas around Port-au-Prince riddled by economic insecurity and gang violence. Haiti’s history around hygiene education is not just centered around cholera, but also includes the history of waste disposal imperialism by the US and interrupted, incomplete infrastructure-building caused by political insecurity.

The history that surrounds Haiti, cholera and sovereignty extends back even further. In the 1800s, when the greater Caribbean plantation milieu was bombarded by a cholera epidemic that killed many, Haiti was spared. Scientists linked the outbreak to the European colonial presence and militarized infrastructure. The colonial presence in Haiti, however, had been much diminished in the wake of its violent revolution that destroyed infrastructures and led to the establishment of the first black republic in the New World.

In 2017, it was reported that an NGO dumped gallons of raw sewage in Port-au-Prince, an incident similar to one that occurred decades previously when the US dumped trash that had been collected in Philadelphia, Pennsylvania, onto the beaches of the coastal Haitian city of Gonaives. The neoliberal policies of structural adjustment have destroyed local Haitian industries, created dependency and opened the Haitian market for even more outside intervention. The rural, agricultural capacities of Haiti have long been under assault, and Haiti has become the recipient of cheap food and other resources from the outside, with no place to dispose of the excess plastic, Styrofoam and other waste products that are introduced into the country through these imports.

The WHO has pointed to political unrest as placing limits on the provision of effective assistance in Haiti, yet addressing the roots of racism, political economic constraints, and the constant assault on Haitian sovereignty remains out of their reach. So “we”—those of us who are living in the garbage “dumps” of industrial nations—must ask: what do we do next, WHO? That is, after we wash our hands?