AT the outskirts of South America's largest city, Valdei Nascimento slowly cranks a bucket of water to the top of a well on a trash-strewn hillside. She pours the bucket into a basin full of her daughter's diapers and the soap begins to form bubbles. But Ms. Nascimento's source of water is just yards above Sao Paulo's polluted Billings Reservoir.
"I buy mineral water for the baby, but I drink the well water," she says, adding that she does not stop to boil it first.
Nascimento's neighborhood was created by people who came here four years ago to escape high inner-city rents. But if Brazil's water and sanitation authorities are correct, such settlements are exposed to contamination and could be affected by cholera if it surfaces in Brazil, as health authorities have predicted. The disease has spread beyond Peru, where it appeared in January, to Ecuador and Colombia.
"Areas like these are most vulnerable to the dissemination of the illness," which travels in water, says Wagner da Costa, technical director of the Sao Paulo state disease control center.
Sewage in the street
Like many of Latin America's poor, Nascimento and her husband moved onto the land where they now live, a former dump, without buying it. Some residents ran hoses up to the city water pipe. Some dug wells. For waste disposal, a few have septic tanks; many others send sewage down the middle of the street.
This sanitation situation is not unlike parts of Peru. There, decrepit infrastructure in the form of decaying sewage treatment systems, broken water pipelines, and other old systems has permitted the cholera bacteria into the water supply and ultimately into the food supply. Peruvians also eat ceviche, a raw-fish dish associated with the bacteria, which can be eliminated when food is cooked or water boiled.
In Peru, 170,000 cases of cholera have been reported. Approximately 1,250 Peruvian deaths have been associated with the illness, which has spread from Peru's Pacific coastline through the Andes mountains to the Amazon meeting point of the Peruvian, Colombian, and Brazilian borders.
The World Health Organization Tuesday reported more than 1,000 cholera cases in Ecuador. In Colombia, the WHO says there have been 189 cases, and five deaths. In Chile and in Brazil, a handful cases have appeared.
Health authorities say they expect cholera to become widespread in South America, largely because of poor sanitation. The Pan-American Health Organization (PAHO) says, based on Peru's experience, that the disease could affect 6 million of Latin America's 450 million people. The organization also predicts thousands more deaths. So far, however, the death rate has been low because of rapid treatment, authorities say.
And there are other costs. Peru, for example, has lost more than $1 billion in tourism and in exports - mostly of canned fish - to Europe and the United States.
"Peru has spent more than $1 billion to fight cholera, and it has put the Peruvian economy in check, as it depends on fish exports," says Baldur Schubert, Brazil's secretary for disease control. "If you analyze all this, you will see it has an impact not only on health, but on the life of the community, a political, administrative, and cultural impact."
Debt and decaying pipes
Some authorities say cholera's spread may be part of a region-wide trend in which several diseases have spread amid decaying sanitation infrastructure and struggling economies.
"Problems with external debt and inflation have had an impact on the health sector," says David Brandling-Bennett, coordinator for the epidemiology program at PAHO in Washington, D. C.
"Before the last decade, there was investment [in health], but unfortunately, with the economic crisis, the system couldn't be maintained.... What is happening in terms of cholera may be the effect of the economic crisis."
A report on the World Health Organization's "Water and Sanitation Decade," which ended in 1990, found that Latin America needs an additional $80 billion to bring its water and sanitation systems to up to the level needed to prevent cholera and other water-born diseases.
Meanwhile, sanitation and health experts are doing what they can. Latin American officials in charge of stopping cholera are meeting this week in Washington to coordinate efforts. And PAHO, a regional department of the WHO, has been working in Peru to gather funds, equipment, and personnel to improve water quality and treat the ill.
Brazil has spent about $10 million so far in to prevent the spread of cholera and has set aside about $5 million more. Technicians have been flying in and out of the Amazon basin, training local health officials, testing river water, building latrines, and chlorinating water supplies.
The government has also set up detection systems at all water ports and airports and is airing an educational TV ad campaign. It is also organizing state and municipal officials to spot the disease.
A side effect of Latin America's mobilization has been the attention it has focused on deficiencies in hygiene and sanitation.
Mr. Schubert describes the international attention as "an opportunity to invest in the very important and sensible process of development."