cholera update

Good news: the cholera situation appears to be getting better. As Ted (Medical Teams International) put it last night, “no one is claiming victory yet”, but we were able to shut down two of the mobile/satellite clinics and our team of providers in St. Marc is seeing a drop in new admissions, and a drop in the severity of cases.

Bad news: Cholera is now in Haiti, and won’t be gone any time soon. Additionally, often times with such a highly infectious disease, there is a surge of cases, a lull (or calm before the storm), then a BIG outbreak. Especially with something like Cholera, that can take a week to show symptoms.

So we’re praying for the best, and celebrating the victories, while planning for the worst-case scenario – an outbreak in a tent city.

It must seem so foreign to the outside world - us being almost giddy with excitement about a cholera outbreak – but we all were. After the earthquake, there were so many injured. So many people that we could do nothing to help, other than to ease their pain (and in the beginning, we didn’t even have the supplies to do that.) But cholera – now that’s a whole different story. THIS is something we can fix. Cholera, if caught in time and properly treated, is totally curable. I like to jokingly say “there’s a drug for that”, and in this case, there IS a drug for that, but 80% of the time you don’t even have to give a drug. Rehydration with ORS and/or IV Hartmann’s solution (LR) will cure most cases of cholera, and proper education will prevent it from spreading. And education is really the key - and talking to people on a level that they understand, and will listen to.

For example, I live in a shipping container with a bunch of construction workers from Alabama. One of them asked me the other day “What is Cholera, and how would I get it?” And my response, after 10 hours of talking to medical people was “Cholera is a bacterial infection that is spread through the oral-fecal route.” Before it could set in that I was talking in “medical-ease” to a non-medical person, he asked “what does that mean?” to which I responded “it means don’t lick assholes.” We laughed, and then I went on with a more appropriate answer…

Cholera, the Cliffs Notes version…

Cholera is a deadly, but treatable, infection caused by eating or drinking something that contains v. cholerae bacteria. It could be from contaminated food, unsafe water, dirty hands, or coming into contact with the vomit or poop of infected people. If you have cholera, you will throw up a lot, have stomach cramps, and have very bad watery diarrhea, that looks like watery “rice-water”. There’s no fever, and they say there’s no rectal pain, but I suspect having up to 10 liters of watery diarrhea come out your butt might cause a little discomfort. It can take up to a week for symptoms to show up, and even after the symptoms go away, there are bacteria in your poop for up to 2 weeks.

As I said, cholera is very deadly – the dehydration can kill you in a matter of hours – but also very treatable. The keys to surviving are community education / prevention, and early treatment. If caught early, most cases can be cured with oral rehydration. More serious cases need IV hydration with electrolytes, and very severe cases need IV hydration and antibiotics.

Many groups have been getting the word out to the communities – through radio broadcast, skits, songs, and pastors. In the Arbonite area, we have utilized local pastors, who called their congregation together to dispel the myths and teach about prevention and early detection. And we have worked at coming up with “sustainable solutions”. For example, it is not always possible for people in tent cities to drink bottled or purified water. But they have a pot, and they have fire. They can boil water, and if there is dirt in it, let the sediment settle and only drink the clear water from the top. We are teaching people to do the best they can with what they have, and it is paying off.

At least, for the moment it is… The reality is, that cholera will be around for quite some time, and if and when it ever hits a tent city, the impact will be devastating. The CCRT is still in full operational mode, and has begun planning and preparing for what may come in the next 7 days.