As we review the patient statistics in the adult cholera unit, we cannot avoid the reality that a large proportion of these patients come from three communities. One of these localities, Barbe, is situated on a high ridge to the south of HAS. Inaccessible by vehicle, the residents of that area must walk more than an hour down a boulder-strewn path to get to the HAS health center at Bastien. Since more than 40 patients have been admitted to the CTC in the past four weeks, and since most of them come from a single extended family, The HAS Community Health doctor, Alain Bien Aime, led a team up to Barbe to visit some of the families from which recent patients have come, and to try to determine what the conditions are which have led to this isolated outbreak. Unlike other communities from which many of our patients have come, this mountaintop community is far from the Artibonite River and its canals.
One of the families which we visited included a recently-discharged man, Shadraque Lormeus, who lives with his sister Gertude Nelcius, and her one-year old son. Their home is a pup-tent sized shelter made of layers of banana leaves. Inside, the bed is neat and the meager contents are organized. Asked if the shelter leaks, she smiles and says, “Yes, but it usually dries out in the morning.” Gertrude’s shelter has no latrine, and the family uses the neighboring rocky fields.
Asked about how she gets water, she describes a one-hour trek down a steep crevasse to a small spring, which, in this dry season, provides a meager flow. Edward went down to the spring with one of her neighbors, and saw that the women who come to fill their gallon bottles wait for a long time for their turn. In the meantime, animals and children relieve themselves on the rocks from where the spring emerges.
When she comes back from the spring, she opens up a small commercial packet with a white tablet, puts it in the jug, shakes it, and explains that in about a half-hour the water will be safe to drink. She received the packets from the local Kazek, an elected official, who regularly visits most of the homes in the region.
Later, we walked further up the ridge to visit the site of dispensary which has been managed during the past month with support from Oxfam. We met with a group of 15 health agents who were being briefed on techniques for safe management of burial practices for patients who died with cholera. Regrettably, a number of people from Barbe succumbed to the rapidly-acting disease before they could get down the hill to Bastien or to the hospital. The Kazek suspects that a number of the patients contracted the disease from the family members of people who had died with the disease.
As we were discussing strategies to reduce further transmission of the disease with the health agents, a group rushed in, carrying a man on a door. He was hallucinating, and was obviously in the midst of an acute cholera crisis, and was severely dehydrated. One of the visiting Polish physicians, Jaroslaw Korzybski, struggled to start an IV line in his collapsed veins. At last, first one line and then another were set, and his family carried the patient down the hill, with and with medical student Zachary Hartman, squeezing the IV bags to push as much fluid into the patient as possible, stopping periodically the renew the bags. When we reached the trailhead, Edward put the patient in the back of his truck with the doctors and a family member, and drove carefully down the rocky road back to HAS. By the time the rest of us got to HAS, the patient had absorbed a great deal of life-supporting fluid, and greeted us with a feeble wave and a warm smile.