In theory it makes sense, but man oh man, in practice – it has the potential to be a real circus.
For example, we have tents set up in essentially an open field, with plastic sheeting floors. Have you ever tried washing a plastic sheeting floor in a dirt field with patients and vomit buckets all around you, and chlorine foot baths that everyone has to dip their feet into before entering the site? Using a bucket of water and a squeegee. Guaranteed chaos, right there. Worse even, have you ever tried to coordinate someone else to do it, when you don’t quite speak the same language, linguistically and otherwise?
Rehydration bags hanging on fence posts.
But everything seemed to be going smooth with numbers of new patients going down. Our treatment centres had only 4-7 patients in them by now. Then the water pump in one village broke and everyone started drinking from the river. Hello oral-fecal contamination! Boom – 21 new cases the next day. 13 new cases 2 days later. We only have maybe 10 beds! So, patients are literally laying on the ground, on a mat, on a plastic woven grain bag, on a flattened cardboard box. Or directly in the dirt, which is now pretty much mud because we just tried cleaning the plastic sheeting floor with more-than-instructed amounts of water. And we haven’t quite finished the new laundry platform so women are washing clothes and dumping the water in the dirt. Again – a three-ring circus in the cholera ward!
The IV rehydration bags are everywhere! Massive bunches of bags hanging from tree branches, from fence posts, or held up limply by the patient’s care giver. The nurse can now barely keep up in replacing them as each patient goes through about 7-8 per day!
A patient laying on the ground (beside the latrine) vomits on one side, rolls over, and 15 minutes later vomits on the other side. The superstar hygienist rushes over with his chlorine spray solution and pulverizes the ground where the vomit is, and on his way back to his post at the main entrance sprays the backside of patients with continued diarrhea.
Hastily fashioned cholera beds.
One phrase from the MSF Cholera Guidelines kept flashing through my mind: “Cholera treatment centres can become main sources of contamination if hygiene and isolation measures are insufficient.”
Fortunately, our circus was fairly short-lived. We quickly found more beds, finished the laundry platform and revamped our floor-washing techniques. Oxfam is now busy distributing chlorine to households and has repaired the well. We asked the Ministry of Health for more nurses (paid partially by MSF), and hired more hygienists. I just wished we had those buttons that read “In training – thanks for your patience.”!