Love in the Time of Cholera

Sierra Leone has been in the news recently because of the cholera epidemic spreading throughout the country.  It started in Freetown but cases have now been documented in all the districts except one.  Our hospital has not been immune. 

A couple weeks ago I was down in the OB ward, getting ready to go home at about 9:30pm.  I was literally walking out the door when one of the nursing aids came and asked me to see a patient that had just come in. I walked down to the ER (ie the bench outside the nurses station) to see what was going on. 

The guy in front of me was a young, healthy looking guy, but was in rough shape.  He said he had just arrived from Freetown that day, and had been vomiting and having diarrhea since that evening.  As soon as he said he’d come from Freetown, a little light went off. I’d just come from Freetown myself and had seen all of the signs posted and heard the radio announcements about the cholera epidemic, what people should do to prevent it, when to go to the health center, etc, so it was higher on my radar than it usually would have been.

Of course I’ve seen plenty of diarrhea and vomiting cases….but this guy seemed a little different.  During the interview he had leave a couple different times to go vomit and or use the bathroom.  When the cholera episodes first started appearing, I took to ole’ Google and researched the signs as well as how to treat it.  It’s actually a simple treatment of IV fluids and/or oral re-hydration salts.  Oftentimes people will add an antibiotic because although it isn’t curative, it has been shown to decrease the duration of the diarrhea and vomiting. 

I admitted the guy and started him on IV fluids and the antibiotic and called one of the docs to let him know what I was suspecting.  He agreed with my plan so we put the guy in a private room and started his treatment.  I went down to see him the next afternoon and was doing much better. The day after that he was discharged.

We didn’t see much else that we suspected could be cholera until about a week or two ago.  At this point we’ve had four confirmed cases and others that were probable cases but we didn’t have the testing to confirm it.  We’ve made some changes to the hospital now and have moved all the women down to the OB ward so we can have the womens medical ward for the male cholera patients and the womens surgical ward for the female cholera patients. 

While cholera is relatively simple to treat, it can be extremely deadly. The fluid loss is just so extreme that if it’s left untreated for 24 hours, it can kill.  Since patients aren’t always quick to come to the hospital (see other bazillion posts about patients coming too late) it can easily kill. It’s also very easily transmitted (oral-fecal transmission….yum!) 

It turns out that trying to contain cholera isn’t easy!  Now me, I hear cholera and I think hmm…I don’t want to go anywhere near that!  When we realized that we were seeing multiple cases, we decided to limit visitors and only allow one visitor per patient.  We went up and down the wards kicking patients out, but they kept finding their way back in.  My friend explained that if you ask a family member to leave the patient, they automatically think that the patient is dying and so will do whatever they have to to be near the patient.  He had one family member that he had repeatedly asked to leave, but kept coming back.  Later when he asked this family member if the patient was drinking the ORS (oral re-hydration salts) like he was supposed to the family member said that yes, he was drinking it, but the family member had also started having diarrhea so was drinking some of it as well.  Frustrating!!!  We’re currently working on getting some better security and educating the community on the various dangers.  The WHO came a few days ago to see how we were handling things and the government is supplying free IV fluids to the hospital for all the cholera patients.  We’re very grateful that we haven’t seen any deaths (although we were fearful for one guy in particular!) and our patients are improving. 

Ironically, last week was a red letter week for me, as I received 3 different marriage proposals.  It had been awhile!  To be fair two of them were by one person who initially wanted me for his son but when I said he was too young offered to marry me himself.  This was of course after I’d already met his wife.  It must be true what they say.  Cholera is in the diarrhea….love is in the air.