Today is a holiday – All Saints’ Day, as is tomorrow, the Day of the Dead. The hospital’s outpatient service is closed, but patients still arrive, either to the Cholera hospital, or to the regular hospital. Urgent cases are seen in the sal dijans (salle d’urgence, or emergency room), which is aptly named, because it is merely a room, off the primary care waiting area. If the patient’s condition appears to be serious, the patient is transferred to the Evaluation, Diagnostic and Treatment room, a bay of about 25 beds under the direct observation of several physician extenders, nurses and physicians on call.
Patients with the symptoms of cholera proceed directly to the cholera reception area, where they are evaluated and either started on an IV drip, or offered oral rehydration solution, depending on the intensity of their symptoms. According to our visiting CDC team, as many as 80% of the persons affected by cholera do not show serious symptoms, and do not require substantial rehydration, or do not come to the hospital at all.
We watch two trend lines every day; one is the daily census, as this indicates our work load for cholera patients, and the other is the new admissions for each day. The daily census reflects a stabilization at about 30 patients a day for the past three days. The new daily admissions also reflects a stable pattern at about 15 patients a day for the past 4 days, and there appears to be a balance between admissions and discharges. This pattern is apparently similar to that seen at the two other major cholera hospitals in this region, at St. Marc and Petite Riviere, although the total number of patients is higher at each of these facilities.
Many patients arrive with rather minor symptoms, receive oral rehydration and leave the same day (these do not show up on the admission or census figures). Several of the newly-arrived patients reflect a pattern which had caused us some concern. They were the caregivers of a sick person, who were exposed to the patient’s effluents while caring for them. While I was translating for a writer from Newsweek today, we talked with a woman who had arrived with serious symptoms yesterday. She said that she had cared for her 16-year old daughter who had died on Thursday, and she had prepared the daughter’s body for her funeral. Now she apparently also has cholera. This person-to-person transmission of the disease is of great concern to the Ministry of Health, the CDC, and the Pan American Health Organization, all of whom are tracking the trends in our area with great attention. Their great fear is that the disease will spread in this way to the large camps of refugees in Port au Prince and nearby.
As if Haiti could not emerge quickly enough from one disaster to prepare for another, we are all watching the progress of Hurricane Tomas, as it drifts Westward just to the south of Haiti, with a forecast by the NOAA for it to turn sharply to the North on Thursday to connect with the southwest peninsula of Haiti, where the frequently-battered cities of Les Cayes and Jeremie are located.