One in Every Two Cases of Cholera in the World Today Occurs in Haiti

You can look it up (Barzilay et al. 2013. “Cholera Surveillance during the Haiti Epidemic — The First 2 Years”. The New England Journal of Medicine 368:599-609 http://www.nejm.org/doi/full/10.1056/NEJMoa1204927). Today we went to Jacmel to visit the St. Michel Hospital. This hospital is one of the sites from which we obtain stool samples to test for the prevalence of different diarrheal diseases. There is a CTC, “Cholera Treatment Center”, at St. Michel. The CTC is a building separate from the hospital and the other buildings in the compound.

Monthly totals of cholera cases at CTC in Jacmel
The first column shows the month, the second column the total number of cases for the month

Marie-Maude, nurse at CTC-Jacmel

As we enter, Marie-Maude, the nurse greets us in Creole. There are three patients here today, hooked up to IV lines. They are lying on cholera cots. I have heard of cholera cots and showed slides of them when I taught cholera to the medial students. But I had never seen them in person. A cholera cot is a cot with a large hole cut in it. The patient lies on the cot with their butt over the hole. There is a large bucket under the cot under the hole. The treatment for cholera is simple: fluid and electrolyte replacement, and fast. If that can be done orally, using ORS, oral rehydration solution (similar to Pedialyte that you can buy in your local pharmacy), people do not need to be treated at the clinic. But cholera can rapidly dehydrate an individual. An adult with cholera can lose as much as 20 liters of fluid in a day. If a patient cannot be treated by ORS, they are brought to the CTC, placed on a cholera cot, and an IV line started.  As I said, the treatment is simple. Fluid out must be replaced by fluid in. The bucket under the cholera cot is calibrated to measure volume and it serves to measure what the patient is losing. It is a simple technique that has guided treatment for decades.

26 year old women on a cholera cot in CTC-Jacmel next to an empty cholera cot

Empty cholera cots in CTC-Jacmel

The scene in the CTC is impressive. But I tell myself that these patients are the fortunate ones. They are being treated and will likely recover and go home within a day or two. Meer tells me later that it was not unusual for the International Centre for Diarrhoeal Disease Research in Bangladesh, where Meer used to work, to treat 800-1000 cholera patients a day. The vast majority of those patients stayed 24 h or less and returned home completely rehydrated. 

Our driver, Makendy, collects the stool samples from Marie-Maude. We thank her ("mèsi") and say good-bye ("orévwa"), and head out the door. Marie-Maude reminds us to wash our hands. It is a cholera clinic after all. As another reminder, just outside the clinic door, there is a basin with a large piece of spongy foam soaked in bleach. We step into it, one foot at a time, to decontaminate our shoes. It is the time of cholera in Haiti.