HAS continues to receive new patients with cholera- at the same time, we are able to discharge approximately the same number, so our census of cholera patients remains fairly stable for the moment. Hand in hand with treatment, our focus has been on containment and prevention at the community level. We are fortunate to have well trained community health workers and volunteers – numbering over 1,500 – to bring a the crucial prevention message to people throughout the Artibonite Valley. HAS field staff are sharing educational materials with residents of their service areas, carrying the same messages which have been developed by the Ministry of Health. The local Verettes Rotary club, many of whose members are HAS staffers, has energized a community education and awareness campaign, including local radio stations, schools, and churches to pass messages about personal hygiene and water purification.
Over the weekend, the demand for services from our normal patients declined, and this provided us with the opportunity to review our current approach to managing the cholera patients. Initially, we had admitted cholera patients to the Observation Unit, and after stabilizing the patients for one or two days, transferred them to a transition and discharge unit in the courtyard. Children with cholera were cared for in the former physical therapy class rooms, next to the pediatrics unit, but many children were outside in the halls.
HAS designed a plan whereby all of the patients with cholera were assembled in the courtyard, and access to that space was restricted to clinical staff caring for these patients. The pediatric patients were transferred to a single large room in the annex, with closed access. Now, as Monday starts and we begin to receive the normal flow of outpatients and continue to care for the hospital’s 130 inpatients, we are actually operating two hospitals – one for patients with cholera, and one for the remaining patients. The halls of the hospital have been cleared of the beds which had been filled with cholera patients, and the flow of medical personnel and patients has returned to normal. A large tent which was donated by the International Medical Corps has been set up outside the hospital as a triage and treatment center for non-cholera patients, in order to reduce the number of patients in the hospital.
Because of restriction in travel to and from Port-au-Prince makes it difficult for the amputees to get to HAS, the Hanger team of prostheticians and physical therapists has joined the hospital staff to provide patient support services, to allow the nurses to focus exclusively on clinical care. The technicians repaired a number of beds in order to make them available for the patients, prepared and distributed oral rehydration solutions, and providing logistics support.
The spirit of thoughtfulness, consideration, and respect which was so clear in the days following the January earthquake is in full view now, where patients and their caregivers have to find spaces to live and to accommodate to the demands of the disease. Despite the large number of people in the cholera areas, they are very quiet. Whenever possible, we teach as we provide care – we explain the ways in which the disease can spread, and provide information which they can share with others when they get home. We have been asked by the many media organizations about the panic about the outbreak, and they are surprised when we tell them that there is no panic; people are curious about how they got sick, and about how their neighbors can prevent, but they absorb that information, and begin to plan for what they will do when they get home.
The CDC team which is conducting epidemiological surveillance was at HAS yesterday, establishing a framework for mapping the geographic course of the disease. They will return next week and use HAS as a base for their analyses in this region. The origins of this outbreak are a mystery, but are not a primary question at this time. What is of most concern will be the modes of transmission. In our area, the initial cases were from men who were working in the rice fields in the lower Artibonite River, who traveled to HAS to receive care for the disease. More recently, cases have involved young children. These families, who live closer to the hospital and also near to the river and its canals, report that they had been drinking from wells in their courtyard or at their neighbors.
The coming week will be very instructive in terms of the broad direction of this disease, both in our area as well as in Port au Prince (where new cases have been reported) and in other parts of the country.