Never Say Never--Cholera in Haiti--2023
cholera
One of Haiti’s rainy seasons is upon us and more people come to the clinic. They twist and writhe in their chair as if in pain. Their eyes are sunken and their peripheral pulses are weak to absent. And then their heads flop to the side as they sink back into oblivion.
Where have I seen this before? Ah yes, 10 years ago during the largest cholera epidemic in the world—right here in Haiti.
Selfishly, taking care of cholera patients in Haiti during the 2010s was one of the top medical experiences I have ever had. And one reason for this was that it was so easy and cheap to treat. For patients who were not real sick, oral rehydration solution was fairly easy to concoct. And for the minority of patients who were quite ill, IV fluids would resuscitate the vast majority of them. For example, a small child or young adult who appeared in shock, sometimes on the verge of cardiac arrest, IV fluids saved the day.
I did not think that I would ever be able to take care of cholera patients again since the Haitian cholera epidemic was considered over in 2022, having not seen a confirmed case since 2019. After being introduced to Haiti by UN forces in 2010, official figures say cholera infected 800,000 Haitians and killed 10,000. However, I have always thought that these numbers were low due to underreporting for a myriad of reasons.
However, during the fall of 2022, cholera reemerged in Haiti and has sickened tens of thousands of people and killed hundreds during the past year. I am in Haiti now working at a hospital that has a Cholera Treatment Unit (CTU). And since February 2023, this hospital has documented approximately 200 cases admitted to this Unit.
Since the disease has not changed how it hurts people, patients respond to treatment the same way they did last decade. After placement of an IV, which is opened wide, their restlessness and discomfort dissipates and their blood pressure and mentation quickly improve.
And CTUs have not changed either. Patients lie on boards with a hole cut in the middle—the so-called “cholera cots”. The heat is intense inside the CTU and flies constantly harrass the patients. And their family caregivers—wives, mothers, and grandmothers—constantly swat flies off their loved one’s faces and mop the floor around their cot. The CTU is an inhumane place but the vast majority of people find their lives again in these Units.
Looking at these cholera victims as they fight for life makes me horrified and sad. Thoughts flit through my mind. How do they endure this? Do they know they should not suffer like this? Have I become immune to accumulated Haitian suffering? I know these patients have names because they are written on their dossiers…but does the rest of the world know they have names? Or are they just a statistic—a number? If they survive, I wonder if they have dreams. Will they ever reach their full potential? And are Haitians still in servitude to unknown masters?
I think I know the answers.
So a few more days go by. And these cholera victims slowly start to sit up again and interact with their environment. They flash a thumbs-up sign and almost smile. And it is time to go home again—often back to their privation, which allowed cholera to infect them in the first place.
In medicine, an unwritten rule is that you “never say never.” And so it goes for cholera in Haiti.
John A. Carroll, MD
www.haitianhearts.org