I interviewed a Tufts Medical Student about the issue in Haiti because she has recently traveled to Haiti and first hand experienced and treated patients affected by the Cholera Epidemic. This is our interview-
Do you think that this Cholera outbreak will end anytime soon, or do you think it is going to keep spreading?
Unfortunately I don't think that Cholera will end anytime soon. I think that we will continue to see a residual amount of Cholera in Haiti for at least the next 10-20 years. There will be times when morbidity and mortality (illness and death) are high due to the natural disease which is associated with fluctuating outbreaks. There will also be times when the disease is relatively silent, hiding out in the more rural communities that lack basic medical care and the capability of diagnosing the condition as cholera. Additionally, I think that the Domincan Republic will soon see their first case of Cholera and will similarly be affected by the disease. Hispaniola is a relatively small island with limited isolation between the two countries, both of whom suffer from a similar breakdown of public health infrastructure that allows for the spread of cholera in the first place.
Why is this disease so hard to stop? Why do you think it spread to Haiti in the first place?
Cholera is transmitted via fecal oral route, meaning ingesting stool particles from a person who is sick with cholera. The disease is relatively easy to treat in resource rich health care settings. The most important treatment is rehydration of the patient who is sick and can be losing up to 15 liters of fluid a day. I attached a photo of a cholera patient surrounded by bottles of waters showing how much hydration is needed to keep the patients alive. You can imagine how tough it is to provide this much fluid in resource poor settings like Haiti.
Unfortunately I don't think that Cholera will end anytime soon. I think that we will continue to see a residual amount of Cholera in Haiti for at least the next 10-20 years. There will be times when morbidity and mortality (illness and death) are high due to the natural disease which is associated with fluctuating outbreaks. There will also be times when the disease is relatively silent, hiding out in the more rural communities that lack basic medical care and the capability of diagnosing the condition as cholera. Additionally, I think that the Domincan Republic will soon see their first case of Cholera and will similarly be affected by the disease. Hispaniola is a relatively small island with limited isolation between the two countries, both of whom suffer from a similar breakdown of public health infrastructure that allows for the spread of cholera in the first place.
Why is this disease so hard to stop? Why do you think it spread to Haiti in the first place?
Cholera is transmitted via fecal oral route, meaning ingesting stool particles from a person who is sick with cholera. The disease is relatively easy to treat in resource rich health care settings. The most important treatment is rehydration of the patient who is sick and can be losing up to 15 liters of fluid a day. I attached a photo of a cholera patient surrounded by bottles of waters showing how much hydration is needed to keep the patients alive. You can imagine how tough it is to provide this much fluid in resource poor settings like Haiti.
(this is the picture that is being talked about above)
Cholera is easily controlled in countries that regulate sewage disposal and provide access to clean water. Sick individuals who use rivers and streams to go to the bathroom contaminate the water that is often used by others in the village for drinking, cooking, and washing. This is one way cholera is transmitted from one host to many others. Vibrio cholerae, or the cholera bacteria making people sick, is killed by chlorinating water sources. Therefore the solution to eradicating the spread of this disease- clean water sources- is not a novel one specific to cholera. Establishing public health infrastructure to provide sanitation efforts would significantly decrease the spread of cholera, as well as many other infectious diseases endemic to Haiti.
I attached two photos.... one with a few cots leaning up against the tree. You can talk about how these are the typical cholera cots with a hole cut out of them where a bucket is placed underneath to collect stool and measure fluid loss. The second photo is one of myself with some Haitian nurses and doctors working in the cholera isolation unit. As I mentioned cholera is fecal oral transmission route, however you see these workers covered head to toe with bacteria as though it were an airborne infectious disease. This highlights the great deal of fear in the Haitian community, even amongst educated healthcare workers, about contracting the disease.
Cholera is easily controlled in countries that regulate sewage disposal and provide access to clean water. Sick individuals who use rivers and streams to go to the bathroom contaminate the water that is often used by others in the village for drinking, cooking, and washing. This is one way cholera is transmitted from one host to many others. Vibrio cholerae, or the cholera bacteria making people sick, is killed by chlorinating water sources. Therefore the solution to eradicating the spread of this disease- clean water sources- is not a novel one specific to cholera. Establishing public health infrastructure to provide sanitation efforts would significantly decrease the spread of cholera, as well as many other infectious diseases endemic to Haiti.
I attached two photos.... one with a few cots leaning up against the tree. You can talk about how these are the typical cholera cots with a hole cut out of them where a bucket is placed underneath to collect stool and measure fluid loss. The second photo is one of myself with some Haitian nurses and doctors working in the cholera isolation unit. As I mentioned cholera is fecal oral transmission route, however you see these workers covered head to toe with bacteria as though it were an airborne infectious disease. This highlights the great deal of fear in the Haitian community, even amongst educated healthcare workers, about contracting the disease.
(This is sally Greenwald who i interviewed)
(This is a picture of the cots leaning against the tree.)Do you think it would be too chaotic and dangerous to travel there?
I think that care needs to be taken whenever you travel to a developing country in which you have less government regulations on criminal behavior. I have been to Haiti 7 times over the last three years and have always felt safe and respected by the Haitian people.
Once someone has symptoms of Cholera, how can they be treated?
Basically a rehydration- IV serum if the patient can't keep up with oral rehydration. For very sick patients antibiotics such as Doxycycline can be used, but again the focus is on rehydrating the patient.
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