Week One of Cholera Epidemic

This is the one-week anniversary for the cholera epidemic at HAS; it was last week on Saturday that we first saw the few cases of severe diarrhea, and without recognizing it for the relatively obscure disease that it was, treated the patients successfully. Several more patients arrived on Sunday and by Monday we began to recognize that there was a serious trend which connected them all. At the same, we were hearing from our partner facilities in St. Marc, Petite Riviere, and Verettes that they were seeing similar cases. When I visited St Nicolas hospital in St. Marc on Wednesday, it was overrun with patients, and they had to ask the numerous family members to stay outside so the nurses could get to the patients.

By Wednesday evening HAS had also begin to see an influx of new patients, and these numbers continued to grow through yesterday (Friday). We reorganized the patient care units so that the 25-bed observation unit was set aside for acute-level patients (by that time the disease had been confirmed by the CDC as cholera), and we set up a transitional unit of about 25 beds for patients who were evaluated for discharge. By the middle of the day today a pattern had emerged in which it was possible to discharge about 15 patients, who were then replaced by patients from the observation unit, who were in turn replaced by new, acutely ill patients. Currently, most patients seem to recover well within 2-3 days, and are discharged with an additional supply of oral rehydration powder.

The halls around the observation unit are an overflow area, from which we try to
bring patients into the unit as soon as possible.

The transitional unit is located on the former horse courtyard, where, when we first opened the hospital, patients tied their horses when they came to the outpatient clinics.

On Friday, when we had a large number of patients who were scheduled for return appointments, it was with some difficulty that we were able to separate the cholera patients from the normal patient group. By Monday, we will have acquired a tent which will be placed outside, where the outpatients will wait unitl they can see a physician in small offices in a formerly unused office building.

More than 30 children have to HAS with acute cholera; we opened up two rooms which had been used by the rehabilitation technician training program, which is now in vacation. The patients were interested to see the skeleton being carried out of the storage closet as we cleaned the rooms.

During the day today, several international relief agencies arrived with very useful resupplies of gloves, oral rehydration packets, antibiotics and buckets. We accompanied them to the Ministry of Health facility in nearby Verettes,, which is receiving a large number of cases, and which had used up their meager supplies. They were restocked, with a promise of another shipment tomorrow.

We are awaiting the arrival of the CDC epidemiological team which will continue the research to identify the source of the pathogen.Most of the early patients had reported drinking from the Artibonite river, and they clustered in an area where the rice fields now require a large number of day laborers. More recently, however, the cases are from a wider region, especially the children, and the incidence pattern no longer has a clear focus. The major concern, of course, is the potential spread of the disease more broadly in our area, but of even greater impact, into the urban areas, where so many people live in tent cities with poor hygiene and limited water supplies.

Ian G. Rawson