Hello friends,
Recent tropical rains here in Colombia flooded the city we are in; roads became rivers and Ryan and I needed to hold hands to support each other when crossing the streets in order to fight the currents and standing waves. We wondered at the parasites and tropical diseases we could have picked up while wading through the thigh-high waters in this tropical, developing city. And yet I knew that this was nothing compared to what it would look like if we were in Haiti. Only an hour's flight away yet worlds apart.
Of course my mind came back to cholera. Spread through the water, this bacteria sneaks its way into your food, your bathing, your water. And creates mayhem. No cholera here in Colombia, and if there was it would be well-treated and controlled. People have access to clean water everywhere, even in the thick dense jungle.
But in Haiti it is different; the cholera treatment centers are struggling still with staffing levels, supplies, and rising numbers of patients. Reports keep coming in from various isolated communities in the north of patients dying en route, being turned away by hospitals ill-equipped to deal with cholera, or having not enough money to pay for the five cent fare to make it to any centers. Even the centers staffed by our own teams are fighting to stay abreast of the chaos; exhausted from working too much and frustrated by constant deaths and not enough resources, the medical staff are tiring, and people continue to die. It is thankless work, let me tell you, but they still need your help.
Cholera has reached port-au-prince and is quickly grasping hold of the worst slums. For some reason I thought the numbers wouldn't be bad in the capital; I was wrong. The numbers are climbing daily, and the statistics point to a constant increase. Many more will die, and more still will be infected. Estimates say 200,000 deaths will result from this outbreak, and we are only at 1300 at present. It is so sad, and so brutal, because this disease is so treatable. IF you get to the hospital in time. IF the hospital will take you in. And IF the hospital that takes you in then has access to the right resources and staffing levels. Resources are not much; all you really need is a constant supply of IV fluids, IV supplies, and diapers. Yet somehow it has been a challenge to supply most of the CTC with these items.
Please take the time to read this graphic but honest blog on cholera in Haiti's capital:
http://goatpath.wordpress.com/2010/11/22/cholera-reaches-port-au-prince-as-victims-are-left-in-mass-graves/
And please, in this holiday season, consider making a donation to Partners in Health, towards cholera treatment. They run many of the CTCs in the north, and have been present in Haiti for decades. They know the country, its people, and how to fight this battle. You can donate here:
https://donate.pih.org/page/contribute/donate
If you haven't already done so, please take the time to read my recent post "Love in the time of cholera". You will get a good idea of what it is like to work in a CTC.
Thank you all for your continued love and support; this means so much to me, and it pains me to see all the suffering in my cherished Ayti. Much much love from me.
Friday, November 26, 2010
Wednesday, November 17, 2010
Life in the time of cholera
Mirebalais Cholera Treatment Center; November 14
Shift 6 at the CTC (Cholera Treatment Center); my team has covered 1600-0800 in two eight hour shifts here at the PIH CTC here in Mirebalais. Set amidst the rolling greenery of the Haitian countryside, this treatment center is hydrating and treating upwards of 150 patients a day, one by one by one.
Cholera spreads through the water, and recent heavy rains from Hurricane Tomas exacerbated the spread of the bacteria. People bathe and drink the water from the river, and campaigns to drink and bathe in "dlo pwop" -clean water- have accelerated across the country. Unknown in Haiti for the past 50 years, cholera is thought to have been brought in by the Nepalese UN contingent, and recently UN forces have been subject to violent riots due to this epidemic. Cholera is already beginning to be stigmatized; we watched the Haitian nurses don masks and caps before entering the cholera tents, and although you cannot catch cholera through the air (or your hair), the lack of education and familiarity with the illness results in this fear.
We show up to work after we bleach our arms and shoes, are given our disposable scrubs (or biohazard suits when we run out of scrubs), booties to cover our shoes, then bleached again, and corralled into the "cholera tent". Our team, 5 nurses and 1 nurse practitioner from Vancouver, 1 logistician, and 2 translators, has worked in this tent nightly for the past 5 nights, treating patients of all ages, from the very young to the very old. The treatment is simple, basic, easy. Almost to the point of being mindless and boring. But the results are immeasurable.
Patients come in close to death, dehydrated beyond belief, limp figures on stretchers or in their parents' arms, having lost all fluid in their body through vomit and diarrhea. We often struggle to find veins, poking them many times before getting a decent line in. The more severe cases we ask the doctors to insert an IV straight into the jugular. And then many liters of fluid later, we discharge them home; alert, eyes open, and looking so much better.
One patient stands out to me. She was admitted at 5:30 in the morning, a lifeless girl of 9 years, skinny and malnourished, and completely limp. We poked and prodded so many times, trying desperately to find a decent vein, failing even her jugular. She lay there completely disinterested and unaware of the pain we were causing her. Eyes rolled back. Reddenned hair: kwashiorkor- sign of malnutrition. No family with her. One leg significantly thinner than the other- "polio?" our Nicaraguan doctor wondered. We are strictly a cholera treatment center, nothing else, a fact that frustrates us often due to the lack of any other resources. No diagnostic tools other than two blood pressure cuffs, the stethoscopes around our necks, and a handful of thermometers. No emergency equipment. The doctor motions for me to get the ambubag. I look at him, eyebrows raised- we have no resuscitation equipment; the last time someone was resuscitated he placed a mask on the 9 month old on and gave mouth to mouth through the vomit. The baby died; no one was able to get a line in. He runs over to the desk and pulls out his own asthma spacer and mask: "we can use this if she needs it". An improvisation. Then, as we continue to poke her, looking desperately for a vein: "Go get the epinephrine. But don't break it [the ampule] yet." Resources are scarce, and we only have a few precious vials of epi. Finally the other doctor gets a line in her jugular, and we all breathe a sigh of relief as we watch her twitch, coming back to life as fluid pours in to her bloodstream. Fifteen minutes later and the line has gone interstitial, which means we have to pull it and start all over. The scramble begins again, and we seem to be losing her again. Climbing over each other and her, we are all trying to find access to her veins. 10 minutes pass and we have another line. Its small- only 24 gauge- but its something.
We watch her closely and after about half an hour she is back with us. She opens her eyes. The Cuban doctor sees this and jumps on it. "Como ou ye?" he asks- How are you? She looks at him, trying to focus. "Huh? Como ou ye?" he repeats. We hold our breaths, wanting a response. She blinks. Then a tiny, almost imperceptable squeak of a voice responds. "Pa pi mal"- not too bad. We laugh and smile at her, and my heart fills with love. Moments from death, but not too bad. Another life saved.
Shift 6 at the CTC (Cholera Treatment Center); my team has covered 1600-0800 in two eight hour shifts here at the PIH CTC here in Mirebalais. Set amidst the rolling greenery of the Haitian countryside, this treatment center is hydrating and treating upwards of 150 patients a day, one by one by one.
Cholera spreads through the water, and recent heavy rains from Hurricane Tomas exacerbated the spread of the bacteria. People bathe and drink the water from the river, and campaigns to drink and bathe in "dlo pwop" -clean water- have accelerated across the country. Unknown in Haiti for the past 50 years, cholera is thought to have been brought in by the Nepalese UN contingent, and recently UN forces have been subject to violent riots due to this epidemic. Cholera is already beginning to be stigmatized; we watched the Haitian nurses don masks and caps before entering the cholera tents, and although you cannot catch cholera through the air (or your hair), the lack of education and familiarity with the illness results in this fear.
We show up to work after we bleach our arms and shoes, are given our disposable scrubs (or biohazard suits when we run out of scrubs), booties to cover our shoes, then bleached again, and corralled into the "cholera tent". Our team, 5 nurses and 1 nurse practitioner from Vancouver, 1 logistician, and 2 translators, has worked in this tent nightly for the past 5 nights, treating patients of all ages, from the very young to the very old. The treatment is simple, basic, easy. Almost to the point of being mindless and boring. But the results are immeasurable.
Patients come in close to death, dehydrated beyond belief, limp figures on stretchers or in their parents' arms, having lost all fluid in their body through vomit and diarrhea. We often struggle to find veins, poking them many times before getting a decent line in. The more severe cases we ask the doctors to insert an IV straight into the jugular. And then many liters of fluid later, we discharge them home; alert, eyes open, and looking so much better.
One patient stands out to me. She was admitted at 5:30 in the morning, a lifeless girl of 9 years, skinny and malnourished, and completely limp. We poked and prodded so many times, trying desperately to find a decent vein, failing even her jugular. She lay there completely disinterested and unaware of the pain we were causing her. Eyes rolled back. Reddenned hair: kwashiorkor- sign of malnutrition. No family with her. One leg significantly thinner than the other- "polio?" our Nicaraguan doctor wondered. We are strictly a cholera treatment center, nothing else, a fact that frustrates us often due to the lack of any other resources. No diagnostic tools other than two blood pressure cuffs, the stethoscopes around our necks, and a handful of thermometers. No emergency equipment. The doctor motions for me to get the ambubag. I look at him, eyebrows raised- we have no resuscitation equipment; the last time someone was resuscitated he placed a mask on the 9 month old on and gave mouth to mouth through the vomit. The baby died; no one was able to get a line in. He runs over to the desk and pulls out his own asthma spacer and mask: "we can use this if she needs it". An improvisation. Then, as we continue to poke her, looking desperately for a vein: "Go get the epinephrine. But don't break it [the ampule] yet." Resources are scarce, and we only have a few precious vials of epi. Finally the other doctor gets a line in her jugular, and we all breathe a sigh of relief as we watch her twitch, coming back to life as fluid pours in to her bloodstream. Fifteen minutes later and the line has gone interstitial, which means we have to pull it and start all over. The scramble begins again, and we seem to be losing her again. Climbing over each other and her, we are all trying to find access to her veins. 10 minutes pass and we have another line. Its small- only 24 gauge- but its something.
We watch her closely and after about half an hour she is back with us. She opens her eyes. The Cuban doctor sees this and jumps on it. "Como ou ye?" he asks- How are you? She looks at him, trying to focus. "Huh? Como ou ye?" he repeats. We hold our breaths, wanting a response. She blinks. Then a tiny, almost imperceptable squeak of a voice responds. "Pa pi mal"- not too bad. We laugh and smile at her, and my heart fills with love. Moments from death, but not too bad. Another life saved.
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