Greetings from Peitite Riviere in the Department of Artibonite – just east of St. Marc. We are about 4 hours by car northeast of Port au Prince, Haiti – not far from the Artibonite River, the reputed source of the cholera outbreak that brought me to this area. I am with Theresia Sinaga and MarcDaly Joassaint, two members of our community in Solino.
The internet connection in Petite Riviere has been quite unreliable, one of the reasons you haven’t heard from me in a bit. The other is that we actually delayed our trip to Artibonite in light of the uncertainty regarding the progress of the epidemic. In fact when I last wrote the authorities had just reported five cases of cholera that had been discovered in metropolitan Port au Prince. That number increased to around 8 by the morning although we later learned that none of them actually originated in the city.
Given the uncertainty and the prospect that the epidemic was heading south faster than we were going north, we decided to stay in Solino – a slum area that is home to a camp of 6,500 people: our neighbors that live literally on our front doorstep.
We waited –and so did many others. The tension was palpable. People started to circulate flyers about proper hygiene and cholera while others used loudspeakers to blurt warnings about the hazards of eating raw food, etc. In fact, we – like many – decided to stock up on clean water and get out our chlorine tablets in order to purify what we might buy. We normally buy very big jugs of water at the market and then refill them at a very good price.
So off to the market we went. And much to our chagrin many other people had the same idea: the law of supply and demand kicked in. The amount of water jugs available had significantly diminished – a reality we encountered as we had to go from market to market. And the price was 3 times normal. Profiteering? In any case, it was a seller’s market.
On Sunday evening at 10 PM George, our night watchman and gatekeeper, showed up on our doorstep telling us that his daughter was very sick. She had been vomiting and had watery diarrhea for several hours. I immediately asked George to bring her to the community as she lived within walking distance. A mother of 6, Iselda left her children with George’s wife and came quickly – obviously very sick.
Theresia sprang into action per usual. Wearing gloves she checked the woman’s vital signs, assessed her overall condition and reported back to me that Iselda had a fever of 38.5 Celsius and was complaining of stomach pain with 4 bouts of “watery diarrhea” – a case of cholera until proven otherwise, particularly since no diagnostic means were available other than my clinical assessment. In any case, cholera is not something one wants to be wrong about – especially retrospectively, i.e, it can kill from dehydration and circulatory collapse within 24-48 hours.
Iselda was able to take small oral fluids and keep them down so we concocted a solution of sugar, salt, and bicarbonate – both to insure hydration and for the maintenance of her electrolytes. And I gave her an antipyretic and some doxycycline to treat suspected cholera. And then we waited – watching her closely for any signs of worsening. In fact, Iselda did not vomit anymore and had no diarrhea through the night. That was a relief for all of us. Iselda insisted that she wanted go home so the next day we gave her bars of soap, a sufficient quantity of our concoction, some water purification tablets and explicit instructions about hygiene and what to do in case her diarrhea continued. My clinical suspicion of cholera had diminished and she had no more diarrhea. In any case, with proper hygiene Iselda was much less likely to contaminate anyone. And her kids were showing no signs of the illness so there was a good chance that the acute watery diarrhea was viral in nature – something much more common than cholera anyway.
The concern about cholera led Doctors of the World, a medical NGO, to come to us and to propose the construction of a 4-bed cholera treatment unit on our property. Our premises are walled-in and thus somewhat isolated from the camp, which would help diminish the spread of the illness from the projected unit to the large number of people living on the other side of our walls. For their good we will likely collaborate with Doctors of the World.
Stay tuned for more from Petite Riviere.