Tuesday May 15th, 2012--Cholera (Guesly 1 of 2)

Guesly:
"Dokte! Mwen gen dyare pou twa jou ak paske se mwen tèlman fèb, mwen vle tonbe." Peering at me through sunken eyes, she is telling me she has had diarrhea for 3 days, and she is so weak that whenever she tries to walk or stand, she feels like she will pass out. I sit less then an arm's length away, looking at this frail woman as she struggles to climb onto the exam table. She is cachectic, wasted. Her face is a shriveled prune. Her skin has lost any semblance of its normal elasticity due to her severe dehydration. She is only forty-two, but I could have easily taken her for sixty. Haiti, with the punishing sun and heat of the physical climate and the punishing daily struggle for good food, clean water, and decent shelter of the economic climate, ages everybody before their time. Her dehydration from the diarrhea has magnified that effect. In contrast, I can tell by her clean, nicely pressed yellow dress that she must have put in much effort to look presentable. Regardless of how poor or sick people are in Haiti, they always wear their Sunday best to look clean when they see a doctor. 

Her eyes appear fixed on me as if reading my thoughts. She continues “I can barely leave  the twalet before I have to go back to it. It has taken tout enèji mwen, all my energy, to not just want to stay there.” I can't help realizing how close she is sitting to me as I think about cholera. Haiti has been battling cholera since it came in 2010 with a UN team after the January earthquake. Before that Haiti was cholera-free for more than 100 years. Haiti has its share of diseases, natural disasters, and civil unrest. Now Cholera is taking those wounds and rubbing salt into them. Cholera seems cruelly designed to take advantage of Haiti's weaknesses. It is caused by the bacterium Vibrio cholerae.  When someone drinks water contaminated by cholera, it thrives in the intestines where it makes a powerful toxin that causes the walls of the intestines to literally pump out water from the body. An untreated person can lose up to 20 liters of fluid in one day's time. Humans, on average, only have about 3 liters of fluid in their blood vessels, 15 liters of fluid outside their cells, and 40 liters in the entire body, so that kind of water loss is devastating and can be rapidly fatal, even in someone who was previously healthy and well-nourished. If any of the diarrhea makes it back into the water supply, the bacteria continue their spread. Haiti has very little of either sewage treatment or drinking water purification. It is not uncommon for one stream to find use as wash water, bath water, drinking water, and as a latrine. Haiti also has no shortage of weak, malnourished people. In some ways it is surprising Haiti stayed clear of it for so long. I look at my patient, it seems likely she is yet one more cholera victim.

I do not withdraw from her. She is looking to me for help.  I know that cholera is highly contagious, but I also know I must set aside any concern for my own health to minister to hers. Once my questioning is done I get up to examine her after taking necessary precautions. Everything I see confirms my suspicion.  This woman needs treatment and IV fluids.  Fortunately, Haiti has established centers for treating cholera victims, and we can send her there.  As I finish, I exit the room to ask one of the Haitian nurses for help in transferring this patient to the cholera camp.