The daily admissions to the adult and child cholera units has shown significant variability in the past ten days; whenever we think we are making some progress, the number jumps up again. The red sloping line shows the general trend since the beginning of the epidemic, and it is an increasing trend.
To a great extent, the number of new admissions is a bit misleading, as the other number which means a great deal to us is the total number of patients in the two units. Last Thursday’s low number of admissions, for example, came on a day when the number of people in the units was almost 80, one of the highest in recent weeks. In most cases, it is possible to discharge adults in 2-3 days and children in 3-4 days, but the patients, such as the elderly and the very young, are very vulnerable and their length of stay may be longer.
Patients with any cholera-suspected symptoms arrive through the day and night, but most arrive at the end of the day and during the early evening. Patients with both symptoms (vomiting and diarrhea) are immediately placed on an IV. If vomiting is not present, they are offered Oral Rehydration Serum (ORS), and are seated on benches near the nurses’ station. Approximately one-quarter of the patients in the units are only receiving ORS, either because of light symptoms on admission, or of reduced symptoms toward the end of several days. Whether their symptoms are mild or serious, they are all concerned, because they all know that some people have died of the disease, and there are so many things that they do not know or understand about cholera.
The total number of patients in the two units is our core measure of the work load of the nursing staff, and of the use rates for the most essential materials which are required to sustain these patients. Most of the items which we need on a regular basis (for example, we use about 300 bags of Ringers Lactate IV every day), for the cholera units are available from organizations in Haiti, but it requires constant phone calls to find out which one has the items we need, and to send a truck there to pick them up, often dodging election-related roadblocks and marches. Much of the essential needs are being stockpiled in the major cities, in anticipation of a surge in demand there in the near future.
Many international and multinational organizations have arrived in Haiti to respond to this new challenge, and HAS is fortunate to have long-term relations with many of them which facilitate communications. Project HOPE continues to support HAS with valuable personnel, including nurses, as well as materials. The International Medical Corps has been to HAS almost every week, with tents, cots, pharmaceuticals and expendable materials, as well as six Haitian nurses from the South which has not yet been hit with an outbreak. UNICEF has been a long-time partner of HAS, and they are very responsive to our needs for medial materials.
Our assessment of the situation, aided with the perspectives of the CDC research team, is that the pattern of need for care for cholera patients will not decline significantly in the immediate future, and may even continue to increase. We have begun the renovation of the former Boutique building so that we can transfer the adult cholera unit out of the main hospital and turn that area back to the ambulatory care clinics. This has been a significant undertaking, involving the installation of plumbing and removing interior walls to create a ward space. Edward Rawson and Jimmie Tinsley (Facilities Engineer) have led a large team of workers on two shifts (day and night) to get the work done by the end of the month, and this represents the first significant renovation for patient care in a number of years. We hesitated to do this, but now recognize that there is no option, as cholera care will be a significant feature of our services into the future.
The HAS annual board meeting will take place in Pittsburgh in several weeks, and the cholera experience will figure prominently in our discussions about the future scope of services at HAS. Currently, the demand for services seems to be almost infinite and the reality is that our resources are finite.