Sex, Drugs, and Public Health

November 13, 2010

HAITI IN THE TIME OF CHOLERA

Filed under: Uncategorized — cbmosher @ 6:32 pm


The set-up was there.  In April, when I was in Haiti with a medical team, this is what I saw: people living in tents pitched on the rubble, in city parks throughout the capital, even on sidewalks; Streams of foul smelling waste water flowing through the streets, right past people, tents and food stands; Kids in clean uniforms walking to school, crossing these polluted flows.

There are dozens of tent camps, with hundreds of tents all crammed next to each other, both in the capital and along the road leading north, to St. Marc.  I saw very few portable toilets among the tents.

In Saint Marc, the city north of the capital where we conducted clinics, the major river was a thick brown color.  The irrigation canal, which serves that area, roiled with brown foam and floating garbage.  I watched children swim naked in the canal, and women scoop water from it.

The bacterium that causes cholera is very unique.  It can live in both sea water and fresh water.  The disease is endemic in the waters of India, but had not been seen in the Americas for decades until it exploded as an outbreak in Lima, Peru in the early 1990’s.  My family and I were in Bolivia at that time, and Public Health officials were working feverishly to prevent its spread to the tropics.  The fear was that people migrating from the mountains near Peru, down to the tropics, would bring the disease with them (they did).

In addition to building protected water systems and closing lakes to bathing, the local hospitals built special beds in a separate “cholera ward”.  These beds were merely cots, with plastic covered mattresses that had a hole in the center.  A patient with cholera is placed, naked, on the mattresses with his buttocks over the hole.  A bucket is slid under the cot to catch the diarrhea.  A cholera patient may lose up to ten quarts of water a day.

The hospital’s storeroom was stocked with bags of IV fluid.  Cholera patients die of dehydration, not infection. So the goal was to replace the volume of lost diarrhea fluid with an equal amount of IV fluid, and prevent dehydration.

In Haiti, the people know their water resources are polluted.  So, when they can afford it, they purchase water.  It comes in small, sealed plastic bags the size of your palm.  But on the plane bound for Haiti, an elderly Haitian woman in a flamboyant dress told me:   “doze bags of water, don’t you drink dem.  Bad.”

When people carrying the cholera bacterium within their intestines, come from St. Marc to Port-a-Prince to visit relatives in refugee tents, it’s gonna be a catastrophe.

As before, for any of you who want to help, I’d advise you contribute to Partners in Health.  They are a competent medical organization that has been in Haiti for over twenty years.  They will help the ill.

That will have to suffice until Haiti’s Public Health Ministry can, someday, separate the water from the sewage.

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