From cradle to tomb
Isn’t that long a stay.
Life is a Cabaret, old chum,
Only a Cabaret, old chum,
And I love a Cabaret!
“What’s a cholera bed?” you probably just asked. It’s a bed made of wood which sits about eight inches off the ground. It has a thin padded area on the upper half and a triangular hole cut out near the middle. The “bed” is covered in a thick waterproof plastic. There is a small bucket situated underneath the hole.
“What’s the hole for?” you probably just asked. It’s for “twalet”. Twalet is a kreyol word for poop.
Cholera is a disease process like nothing I’ve experienced before. It’s caused by a bacteria which, when ingested, causes severe…SEVERE…watery diarrhea and for some, vomiting, or “vomi”.
When cholera first struck in Haiti, it caused many deaths. Because cholera was previously unknown (traced to a Nepalese relief worker) in Haiti, people didn’t have any idea what was happening to them. Death was due to rapid dehydration. The fluid losses through diarrhea and vomiting can be massive, depending on how much of the bacteria was ingested. Timely treatment is imperative if the fluid losses are to be addressed before vascular collapse and death occurs. The goal of treatment is to rehydrate however possible. Some are able to keep up with the losses by taking in an oral rehydration solution. The solution is made of purified water, salt, sugar, and when available, lime juice and flavoring. It doesn’t taste good, and if there is enough vomiting and diarrhea, it’s not adequate to maintain hydration. Then IV fluids are indicated. Lots and lots of IV fluids….40, 50, 60, 70 or more litres over the course of a few days.
Samaritan’s Purse has been doing, and continues to do, a fantastic job in dealing with the ongoing problem. At this time, it is no longer the problem of crisis proportions that it was when in struck, but there are still hundreds of people seeking medical care for it every week. SP has two Cholera Treatment Centers (CTCs) which primarily treat those with cholera symptoms. The CTC where I was assigned was in an area called “Cabaret”.
Some of the people who sought treatment here have other illnesses which also need treatment. Like malaria and upper respiratory infections. But in order to stay here, you must have cholera. Samaritan’s Purse has an excellent reputation for treating cholera, and for their relief efforts in general. SP has also focused on community education and clean water distribution. So they’ve been attacking the problem on all fronts.
Before each cholera patient is discharged, they receive education about the disease, a large bucket for water treatment, tablets to treat water, bags of salt and sugar to make oral rehydration solution, and strict instructions on when/if they need to return.
As part of the community treatment program, fresh water is made available to those who need it. These large containers are filled twice daily. People (or their buckets) are almost always there waiting for the water to come. There’s a franticness to the process that’s a little bit unsettling. Like people are just “this far” away from panic. It’s understandable. Even though it seems like there is a huge amount, the people drain the containers almost as soon as they are filled. Some bring huge barrels. I think they’re worried in case the water doesn’t come the next day.
From all appearances, cholera seems to be losing its footing in this battle. Patients who would have died months ago had they become ill now know what they have and quickly obtain help. In the two weeks I was at this CTC, we, thankfully, had no deaths. A number of the patients were incredibly close to death on their arrival despite rapidly seeking help. Like Lazarus.
His name really wasn’t Lazarus, but that’s what I called him. Lazarus was brought in by his family. He was carried in by his family and was pretty unresponsive. He’d been sick for just a few hours. He was so dehydrated that when pinched, his skin would stay in the pinched up position. Pinch the skin on the back of your hand. It doesn’t take long for it to return to its normal position. His just stayed up…tented like that. Because Lazarus wasn’t able to alert us to when he needed to go to the bathroom, he was put into diapers. He was in his early fifties, but he looked 80. Before he was brought into the men’s tent, he received half a dozen or so liters of IV fluids in the pre-admission area through two large bore IVs. Despite it being blisteringly hot, Lazarus was shivering as all those IV fluids made him hypothermic. I kinda liked that he was shivering. An excellent sign of life. As I was still pretty new to this whole cholera treatment thing, I didn’t really know what to expect when someone was feeling better. I was told that when a patient sat up (sometimes after just lying there for the longest time) that this was a “positive sitting up sign” and indicated vast improvement in condition. So I waited for Lazarus to sit up. It was later in the day, and after about a dozen liters of IV fluid that it happened. He didn’t just sit up. He sat up, then he stood up, then he took his IV bag from its hook, draped the tubing over his arm, and took off for the bathroom, with his too-loose diaper drooping down to his mid-thighs. I don’t even know how he knew where he was let alone knew where the bathroom was!
Watching this happen was like watching a miracle…and that’s why I call him Lazarus. (READ) Lazarus was with us for a few days before he could keep up with his fluid losses with oral rehydration fluid, pee adequately, and before his episodes of diarrhea abated enough to go home. The better he got, the younger he looked. When he left, he looked his age and looked like a respectable Haitian gentleman.
Stay with us “here” a bit longer, Lazarus. And welcome back.
Score one for the good guys.