Combating Cholera in Haiti
At St. Louis du Nord, we were lucky to have ample supplies of intravenous fluids provided by MTI and delivered by the United Nations Humanitarian Services. We also had a good supply of clean water. Space was limited, and patients were put on cots and even on the floor. The floor and the cots were constantly being washed with bleach. Patients were provided with basins to use as toilets for their diarrhea, since cholera cots were in short supply and constantly soiled.
What was the setup at the hospital where you worked?
From Dr. Lai’s blog: The cholera treatment area was divided into three areas: the so-called ICU, which held the sickest patients, all of whom were on IVs and encouraged to take ORS; the step-down unit (where patients were taking ORS and had been discharged from the ICU, but who still had diarrhea and some vomiting); and the ready-to-discharge unit (patients on ORS who were ready to be discharged).
In the units with the less severe cases, patients and their relatives slept on mats on the floor. After the first few days, we were told that the patient count had decreased by half. There were 20 or so patients in this area. In the ICU there were about 25 patients lying on cots, some of which were diarrheal cots, with holes in the center. The ward was surprisingly free from strong stench. Many of the patients had the classic glazed look, with sunken and listless eyes, and were either restless or motionless.
What were some of the specific cases that you managed?
From Dr. Lai’s blog: One day, two men carried a sick woman in on a bed-frame. She had been sick for 5 days with vomiting and diarrhea, and it was rumored that they had to travel for 2 hours to come to the mission. The woman was not able to answer questions; her eyes were glazed and she was dehydrated. I examined her and felt her belly and asked if she was pregnant. She turned out to be 7 months pregnant. I told my interpreter that we would need to put two IVs in her. She asked me why. I replied that she was very dry, having been sick for 5 days and that she was pregnant. My interpreter looked at me and said, "Is the second IV for the baby?" Her face brightened up at the idea. The woman improved within 2 hours, after initially only being able to whisper to us.
Another case was a baby being breast-fed by her mother. One of the doctors placed an intraosseous line in the tibia, but it wasn’t working, so we used a nasogastric tube. After 100 to 200 cc of fluids were pushed into her, she became quite feisty. IVs and ORS made a huge difference for so many of these patients.
Interview by Heidi Splete. Blog excerpts are from haiticholeraoutbreakkwankew.blogspot.com.
Think globally. Practice locally.
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