Combating Cholera in Haiti
In October 2010, when a cholera outbreak erupted in Haiti, doctors from around the world responded to the outbreak, including Dr. Kwan Kew Lai. In December, she spent a week in the island nation, sponsored by Medical Teams International Disaster Response, treating cholera patients of all ages at the Northwest Haiti Christian Mission in St. Louis du Nord.
Dr. Lai is no novice to providing medical relief services overseas. In 2009, she worked treating HIV/AIDS patients as part of the Global Medic Force. Here, Dr. Lai discusses her experience in Haiti.
How did you learn about Medical Teams International Disaster Response?
I found out about the group immediately after the earthquake last year, when I searched the Internet for a team to go to Haiti to help care for patients there. I was asked to go with Partners in Development (PID) as a physician for their response team. MTI required me to formally apply to be on their team, which I did. They asked for descriptions of my previous experience with international work, as well as letters of recommendation. Last April, I was interviewed by phone, and later I was accepted to join their disaster response team.
In October, when the cholera epidemic began in Haiti, MTI contacted team members to go. But I was in West Africa at the time, completing HIV/AIDS mentoring work for the Institute of Human Virology, Nigeria, and Global Medic Force, Abuja, Nigeria, so I could not respond immediately. In December, I heard from MTI again, and they asked me to be ready to go in a few days. Our team included six doctors and a nurse.
Did you have any previous experience in treating cholera?
I had no previous experience in treating cholera patients, except that when I was in South Africa in 2009, near the border of Zimbabwe, I arrived at the end of a cholera outbreak among the refugees. So I did see a few cases in the hospital then.
What steps did the medical team take to avoid becoming ill themselves?
We used a lot of hand sanitizer; there were no sinks at St. Louis du Nord. We were vigilant about cleaning our hands between patients and before meals. MTI provided gloves, but they were used only for starting IVs and in cases when there might be possible contact with body fluids. No masks were required because cholera is spread via the fecal-oral route through contaminated food or water.
What were some of the challenges of treating cholera in Haiti?
There seemed to be a difference in opinion between Haitian doctors and visiting doctors as to how vigorously a dehydrated patient should be resuscitated. The World Health Organization guidelines were posted on the walls and I believe in giving fluids aggressively, but our Haitian counterparts seemed to be more conservative and tended to turn the fluids down. So there was an ongoing battle. Our team would turn up the fluids only to find the fluids turned down shortly thereafter.
The language barrier is an issue, because we did not have an interpreter with us all the time. It was especially difficult to communicate with the Haitian nurses.
The lack of accessibility to clean water continues to be a concern, especially when patients are sent home to unsanitary conditions.
There were also cultural differences. Some Haitians believe in fate. If a patient seemed to them to be dying, they accepted it and thought that it was time for him to go, so there should not be any heroic measures. However, to us cholera is an extremely treatable condition. Vigorous hydration can generally save a life.
What was your basic treatment strategy for most patients?
Our standard treatment strategy was to do a quick assessment of the patient’s state of hydration. Patients with severe hydration generally received an IV immediately. Patients who were moderately or slightly dehydrated, with no persistent vomiting, were generally encouraged to drink oral rehydration solution (ORS).
The elderly and very young cholera patients are at the greatest risk of dying from extreme dehydration. Patients who arrived at the clinic from long distances, and those who had been ill for several days, were also at increased risk of dying. Lack of clean water plays a major role in the spread of cholera. Malnutrition, which is common in Haiti, certainly does not help the immune system to fight infections. Near Port-au-Prince, we saw people washing their clothes and bathing in dirty river water; we were not at all sure where their drinking water came from.
