We first heard of cholera cases in neighboring Cameroon in August and we began monitoring the situation in the corresponding border areas of Chad. By September there were cases reported here, but it seemed the Ministry of Health, with supplies from UNICEF and WHO and logistics support from Oxfam, were managing and the case numbers were stable. Then there was a spike, with 40 new cases per day in a single health centre! Enter MSF!
We sprang into action, but even so, the response may not be as springy as you might think. We need to first receive the information and make a decision to intervene. Then, we are a day’s drive away, need to load trucks with supplies and treatment and somehow round up enough bodies (preferably an MSF nurse or 2, a doctor/coordinator and a logistician, plus several Ministry of Health counterparts) to actually deliver treatment to patients. While MSF does essentially have people “on stand-by” for this type of situation, they are essentially standing by in Europe or at best, in the capital city. But, three days after the first sign of a major peak, we were on the ground, in action. Not bad, I’d say. As for myself, infection control is paramount in a cholera epidemic, involving fairly involved protocols for disinfection. That is where the watsan comes in!
We are now supporting 4 different Ministry of Health health centres, by operating a cholera treatment centre (CTC) at each. Oxfam, WHO and UNICEF continue to participate in the response as well.
Our CTCs are basically a torrent of plastic sheeting, IV rehydration bags and chlorine. Everything from fences to patient tents to latrines to medical “offices” are made from very expensive, high quality plastic sheeting from Europe. Precious stuff and after any MSF intervention you are bound to see scraps of it throughout the neighboring villages, patching a leaky roof, providing a ground sheet to dry beans/maize/peanuts/millet, serving as a sleeping mat, or even a bicycle seat cover. Somehow acquired.
Entrance to plastic sheeting Cholera Treatment Centre. Wastezone on the left and Oxfam water bladder in front.
Ringer lactate is the be-all and end-all of cholera treatment. It is a simple saline solution given intravenously to moderate and severe patients – up to 8L per day for 3 days. So, loading the truck to send medical supplies is quite a task if each patient needs 24L of treatment, and there is a peak case load of 40 new patients per day. You do the math! One patient who arrived at the CTC only inches away from death received 6 litres in one hour! Dripping furiously into both wrists and his groin. He was amazingly discharged 48h later.
And my personal favorite – chlorine! While medical treatment is easy, infection control is more complicated. We need 0.05% chlorine solutions for hand washing stations; 0.2% for foot baths at the entrance to each room and for spraying beds, clothes, floors, showers, and the like; and then 2% for dead bodies and when anyone produces “rice water” (vomit or watery feces). Each bed has a hole in the middle with a buck underneath to catch as much as possible. If you can actually make it to the latrine, you’re almost cured! In addition, each room (observation, hospitalization, recovery, and neutral area), should be isolated from the other with separate pathways, latrines and disinfection facilities.
Spraying hands and feet with chlorine solution at entrance to CTC.
Oxfam did most of the plastic sheeting, the medics handle the IV bags and I am pretty much in charge of chlorine and disinfection control. And my bleached out pants can attest to that!
My "cholera pants"