January 12th , 2011 marked the one year anniversary of the 7.0 magnitude earthquake that rocked Haiti and left death and destruction in its wake. By late October 2010, the ravaged country began to face another crisis – a cholera outbreak that started in rural regions around the Artibonite River spread rapidly to every region of Haiti, including Port au Prince. The combination of unhygienic living conditions coupled with lack of access to clean water has made it difficult to contain the outbreak, causing nearly 200,000 cholera cases and nearly 4,000 deaths in just two months.
Cholera, a bacterial infection that can cause severe dehydration and diarrhea, is spread via contaminated food or drinking water. Without treatment, death can occur within hours. But if people are given adequate fluids–either orally or through an IV– they can make a full recovery. In recent years the World Health Organization has developed an oral rehydration solution of sugar and salt that is now being used internationally.
Over the Christmas holiday, Karis Cho, a One Medical physician based in New York, decided to travel to Haiti, to help treat and care for those infected with cholera. We asked her to share her experience from the field.
What made you decide to give up your Christmas holiday and travel to Haiti?
In mid-November, I received word of the cholera epidemic and the urgent need for medical volunteers at the Samaritan’s Purse Cholera Treatment Centers. I could think of no better way to spend Christmas than to give in this small way. It was the most meaningful Christmas I have ever had.
You did five all-night shifts taking care of cholera patients while you were there. What was that like?
In the United States, the people we treated would have been in the Intensive Care Unit. It was not uncommon for an adult patient to get 40-60 bags of IV fluids. The diarrhea from cholera is so watery that the sounds are indistinguishable from a gush of water. Patients lay on cholera beds, which are wooden platforms with a hole cut in the center and buckets underneath to catch the diarrhea. All too often, the buckets overflow. It truly is an undignifying disease to have. It’s like nothing I have ever, ever seen before.
Is there any other treatment aside from the oral rehydration solution or IV fluids?
While the primary treatment for cholera is rehydration of some form, our patients also received one dose of an antibiotic, usually Doxycycline. In addition, they received Zinc supplements to try to decrease the frequency and duration of diarrhea, as well as high doses of potassium supplements to replenish the large amounts that are lost in the stool. Low levels of potassium would cause patients to get intensely
painful leg cramps.
Does there seem to be any end in sight?
The Haitian government is so underresourced. Only five to 10% of the earthquake rubble from last year has been touched. The presidential palace looks exactly like it did a year ago. At first cholera started in the rural areas and now it’s hit every single area of Haiti, including Port au Prince. To stop it, you have to have the hydration solution, plus access to clean water. In October, the World Health Organization predicted there would be about 200,000 cases before the outbreak was over. But there have already been an estimated 180,000 outbreaks in less than three months. The World Health Organization is now predicting more than half a million cases in the next six months.
Was it an emotional experience for you to do this work?
It was emotional to see how ravaged the human body can get, and to have a real person in front of me rather than just seeing the cholera statistics. At the same time it was a rewarding experience because, unlike chronic diseases where you can’t do much without resources, cholera is so treatable. As awful as it was, it was also very life-affirming to be able to save lives. The mortality rate from cholera at most treatment centers is less than one percent. In that sense, our work didn’t feel hopeless.