Cholera

Well, I am adding to my job description "cholera nurse." I am not sure if you have heard about our epidemic over here, but it is starting to hit a bit close to home...

Yesterday afternoon, our two of our twin boys came to me and told me that their older brother (who is about 21 and lives on his own in town) had bad diarhea and was kind of sick. They didn't know if it was cholera or not, but they were concerned. Early this morning, one of their cousins came to the orphonage to tell them that he was in bad shape. Apparently he does have cholera. The boys went to check on him and found out that he was at a cholera clinic that UNICEF and Doctors without borders have set up down the road. They waited an hour or so to see him and saw 4 dead people carried off, so they promptly road their bicycles back to get me. I drove our van over and got in to see the brother. Had to drive through a river of raw sewage that his been running down the road in that place for a month (wonder why we have a cholera problem??)

Driving into the gate of that clinic was like driving into a nurse's worst nightmare. People were being wheeled in in wheelbarrows. There were crowds outside of the building waiting to be registered and seen. Actually entering the building was like entering a vomiting and diarhea hell on earth. There were long rows of IV bags hanging from bailing twine streched down the halls and in lines across the rooms. Underneath the bags were rows of people collapsed onto benches, draped across chairs, slumped directly on the concrete. Eyes sucken in, half open, but not seeing. Each person had a 20 liter bucket. Most were half full with watery brown liquid. The floor was wet in puddles. There was a full time mopping crew, but it didn't keep the floor dry. and that was the "observation area." Patients that were actually "admitted" got a cot with diarhea hole cut in it with a bucket underneath. That is where I found him.

He was doing better than I exptected after seeing all of the critical people in the observation room. Apparently, he had come in very weak, unable to walk, getting cramps from electrolyte imbalance, etc They gave him 6 liters of lactated ringers and he had felt much better. The clinic staff and then sent the family home and told them to come back in the morning. No one gave him a drink all night or changed his IV bags, so this morning they found him so weak he couldn't sit and could hardly talk. By the time I got their today, they had given him another 3 liters of fluid and he was looking a bit better. but still had only urinated one time in 48 hours.

The big problem was that there were no doctors and no nurses. They are all on strike. Well, I should say, almost no nurses. There were two nurse managers doing triage and two volunteer nurse techs starting IVs/changing bags. (Yesterday they ran out of IV needles and were sending families to buy there own at the closest pharmacy. They also ran out of IV fluids, but seem to be re-stocked now.)

There were a few red cross people maintaing crowd control/helping with registration. Doctors Without borders was maintaining the sanitation with chlorox in backpack sprayers, mopping crews, hand washing stations, wet bleach towels you had to walk across to enter/exit the building, etc. They were also mixing up and passing out O.R.S. (oral rehydration salts) as well as setting up tents for holding additonal patients. They were not doing any direct patient medical care, pretty much no one was. The nurse tech, just went down the row and started an IV on everyone and everyone one got lactated ringers as fast and she could change the bags. There were about 30 to 50 patients per "IV nurse" and that was pretty much the only nurse you saw. Needless to say, the nurse managers were not very happy people. But, how can you blame a public health nurse for not showing up to work when one month's salary won't pay for one day's bus commute and will only buy 1/2 of a loaf of bread...

To make a long story short, I am got the boy out of there after some red tape hassles and have him in the sick room of our clinic. I started him on PO cipro. After a few more liters of IV fluid, we have him urinating again. His viatals are stable . He Is now able to keep PO fluids down (still coming straight out the other end though...). I started him on cipro, am pushing O.R.S. fluids and have him on a maintence drip of ringers solution. He has family continously at the bedside, so I downgraded him to vital checks by me every 4 hours. I need to head back down there in an hour or so. Anyway. Praise God that I am still able to start an IV Keep us in your prayers. Foreign media and NGOs are tightly controlled in this country. I would be sceptical of the stats that they give on the severity of the outbreak. It is most likely much worse.

Luke