In the courtyard of the bright green Nicolas Armand hospital, jointly run by Cuba and Haiti, relatives waited anxiously for word of their kin, sitting under cover from the baking sun.

Worryingly for responders seeking to halt the cholera outbreak's spread, a number of the patients here drank treated water.

"I only drank treated water," protested an older patient, echoed by other men in the room.

The treated water, albeit taken from the infected Artibonite River, is the main source of "clean" water for most of the population here, and is contained in small blue plastic bags carted around town by the truckload and then distributed by hand.

Gabriel Thimote, director general of Haiti's health department, has said the water in the plastic bags -- which bear a label describing the contents as "purified" -- may not be safe to drink.

Rumors were swirling in Haiti Tuesday that cholera-carrying Nepalese troops with the UN peacekeeping mission in Haiti (MINUSTAH) were the origin of the outbreak, further north at Mirebalais on a tributary of the Artibonite, running from a border mountain range to Haiti's Caribbean coast.

The mission rushed to deny the claims, insisting that despite belief that "human refuse thrown into a river in Mirebalais by MINUSTAH would be at the origin of the cholera epidemic in Haiti... (the mission) uses seven septic tanks" situated far away from the river.

Jacklin Anore, a strongly built man, was lying prostrate on his bed, rendered powerless less than 24 hours after he suddenly felt sick.

The 24-year-old could barely raise his head, a metal pan full of bile on the floor nearby testifying to his ailment. A nurse gently poured water on his head, to which he feebly whispered thanks.

Yet cholera cases are dropping off dramatically, doctors reported in this coastal town south of the outbreak's ground zero in Saint-Marc and 48 kilometers (29 miles) from Port-au-Prince.

Less serious cholera patients were strung out on benches in the courtyard with dogs sleeping nearby, as sweat-drenched laborers wearing sanitary masks continued building a new wing to the facility.

Some 250 people sought medical treatment in Arcahaie on October 19, but by Tuesday the daily influx had declined to 10-15 people, medical officials said.

Three people, including two young boys on Monday, have died here.

Nationwide, the death toll climbed to 284 on Tuesday -- 25 more than the previous day -- prompting aid agencies to step up efforts to keep the outbreak from reaching the capital's teeming tent cities that sprung after a catastrophic earthquake in January.

"The situation remains very serious, people are still coming in," a Cuban aid worker said as she did her rounds.

earlier related report
Haiti urges caution as cholera death toll climbs
Arcahaie, Haiti (AFP) Oct 26, 2010 - Haiti reported 25 more cholera deaths on Tuesday as officials warned the epidemic was not yet over, and aid groups fought to keep the disease out of the capital's teeming refugee camps.

With 284 known deaths and 3,612 infections, the first cholera outbreak in quake-hit Haiti in more than a century has stabilized in recent days but the situation is still grave.

In Arcahaie, a small coastal town south of the outbreak's epicenter in the central Artibonite River region, 24-year-old Jacklin Anore lay on a bed in a darkened room of the Nicolas Armand hospital with a bucket by his side.

Barely able to raise his head, hooked up on a rehydration drip, he intermittently spat into a rusted bed pan and whispered thanks to the nurse who poured water over his head.

Patients have died here, but as in the case in Saint-Marc further north where most of the ill have flocked, doctors say the number of new cases is easing.

Signs urging residents in Port-au-Prince to clean their hands and take care with drinking water appeared in recent days, as the government seeks to keep the epidemic from reaching crowded urban areas, and the tent camps that have housed hundreds of thousands of people since the disastrous January earthquake.

Doctors Without Borders (MSF), which has eight facilities open to cholera infections in Artibonite and around the capital, said that despite the fewer deaths the need for vigilance remains.

Around 450 patients were treated on each of the last two days for oral or intravenous rehydration at the MSF-supported Saint Nicholas Hospital in Saint-Marc.

An isolation unit has been established there for the most severe cases, but the aid group said fewer and fewer patients were arriving in such dire condition as before.

"The fact that we are seeing fewer severe cases is positive," said Federica Nogarotto, the MSF field coordinator in Saint-Marc.

"It suggests that people are taking precautions and that there is a greater understanding in the community of the need to maintain strict hygiene and to seek medical assistance at the first sign of symptoms."

So far, the Americas' poorest country has managed to avoid the nightmare scenario of the epidemic taking hold in the unsanitary tent cities that cling to the hilly slopes of Port-au-Prince.

They sprung up after large parts of the capital and other nearby towns were flattened by the 7.0-magnitude quake that killed a quarter of a million people and displaced 1.3 million.

As the cholera toll climbed, Haiti's more prosperous neighbor, the Dominican Republic -- with which it shares the Caribbean island of Hispaniola -- tightened up border security to keep the disease at bay.

Officials in Santo Domingo said entry into the country from Haiti would be severely restricted, and border security increased. Later Tuesday officials in the neighboring country reopened markets on the border after establishing "sanitary controls" in the region.

In Geneva, World Health Organization spokeswoman Fadela Chaib said more cholera cases would be found but urged the Dominican Republic to keep the border open.

"There is no need to close the borders or restrict travel or trade because a neighboring country has cholera. This is what we say for all cholera outbreaks worldwide."

Aid agencies meanwhile stepped up efforts to educate Haitians about the risks and treatment of the disease, using local radio stations and text-messages about hygiene precautions.

Haitian officials said Monday they believed the outbreak had been contained and was limited to central areas near its believed source on the Artibonite River.

But a UN statement quickly tempered any optimism by warning that a nationwide outbreak infecting tens of thousands of people was still a distinct possibility.

"We are particularly concerned about Port-au-Prince and those in the slum areas as well as in the camps, but we are also preparing for outbreaks in the rest of the country," said Nigel Fisher, UN Humanitarian Coordinator in Haiti.

Living conditions in the camps, where pools of human waste lie in areas where people bathe, do laundry and share meals, are ideal for cholera to thrive.

The disease, which is primarily transmitted through contaminated food and water, can fatally dehydrate a victim in just hours.

Five cholera cases were confirmed at the weekend in the capital, but UN officials said those people traveled in from outside and were quickly diagnosed and isolated.

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