The sunken eyes of hovering death

Diarrhoea kills. This tragic fact of present reality is something I first encountered long ago while working in the paediatric emergency ward as a medical student.

Diarrhoea kills. This tragic fact of present reality is something I first encountered long ago while working in the paediatric emergency ward as a medical student.

Since then I have faced it again and again. It is usually young children who are most affected, and in North West Frontier Province it is no different.

But, no matter how many times I see it, the face of a severely dehydrated child is still shocking – a gaunt, tortured reminder that our world continues to fail some of its most vulnerable citizens.

Perhaps the greatest irony of this tragedy is that the problem persists despite the fact that the solution, the life-saving treatment, is so very simple: rehydration.

We know an impressive amount about diarrhoea and how it kills. We understand the mechanisms through which viruses and bacteria damage the cells lining the intestine causing the rapid loss of vital fluids and electrolytes; we know how and why this drives the body into a dangerous acidotic state and how, despite the body’s best efforts at compensation, this can all too easily push a patient towards hypovolaemic shock (state of shock due to a loss of blood volume because of dehydration, bleeding or vomiting), respiratory exhaustion and death.

But for the majority of sufferers, all this wonderfully advanced knowledge is unnecessary. All that is needed is fluids, fluids and more fluids. Mostly, this fluid can be given orally – no fancy equipment or high tech facilities required – and caregivers and parents can be easily trained to do this in the home at the first sign of trouble with a high degree of success.

The fact that children continue to die throughout the developing world from this so easily treatable disease points to just how much work still needs to be done to meet the healthcare needs of the global population.

The problems include contaminated water supplies, absent sanitation systems, limited access to healthcare and education and the compounding problems of inadequate housing and malnutrition. They are some of the factors which continue to culminate in another sunken-eyed face – a face in which it is possible to literally watch life slip away. And unlike the treatment for diarrhoea, these problems leading to the disease are far from simple.

Many MSF projects world-wide deal with aspects of this ongoing challenge: whether it be task-specific cholera treatment centres (CTCs), maintaining safe water and sanitation in camps for displaced populations or establishing hygiene education programs in the forgotten corners of failed states.

In NWFP we maintain our CTC here in Dargai in a constant state of readiness and while, thankfully, we have yet to deal with a full-scale cholera epidemic during my work so far, we see cases of diarrhoea with severe dehydration (from cholera and other causes) on an almost daily basis.

I think it is a testament to the quality of our work here and the commitment of our staff that we have lost very few of these patients, but I still find myself looking down into the face of imminent death far too often.

I would love to live in a world where no child would die like this. But since this is unlikely, at least for the foreseeable future, I will have to be satisfied to work with an organization that is facing this challenge head -on and I have to hope that, with time and effort, we will get there.

The recommended formula for making Oral Rehydration Solution to treat diarrhoea at home is as follows: to one (1) litre of clean, safe water, add eight (8) level teaspoons of sugar and a half (1/2) level teaspoon of salt. Mix and give regularly by mouth to those with ongoing diarrhoea. Teach this to everyone you know. It saves lives.