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Haiti in a time of cholera

Desperate family members held up IV bags as doctors struggled to treat cholera patients.

Cholera outbreak, Haiti
Children await treatment in St. Marc, northern Haiti, amid a cholera outbreak, Oct. 21, 2010. (Thony Belizaire/AFP/Getty Images)

SAINT MARC, Haiti — Fathers became nurses and children lay side by side with grandparents as a deluge of violently sick cholera patients overwhelmed the staff at St. Nicholas hospital in this small Haitian town.

Desperate family members held up IV bags for the hundreds of patients lying on the floors of every corridor and hospital room available. All suffered from severe diarrhea and vomiting, some patients laid their heads in basins of water for relief from fevers that drenched their clothes with sweat.

“I’ve talked to all of my colleagues who are Haitian and they’ve never seen anything like this, on this scale, before,” said Koji Nakashina, an American doctor with Partners in Health, who was working at the hospital on Thursday. “There’s still a lot coming in.”

The death toll has reached 142 with more than 1,500 infected, according to local news media. Haitian President Rene Preval confirmed cholera was the cause of the outbreak, according to Reuters.

The source of the cholera has not been determined but the first known case occurred on Saturday in Mirebaleis, located in Haiti’s central region, according to government officials. It has since infected people in Douin, Marchand Dessalines and Saint Marc, all in the Artibonite region.

Fears are rising that if the disease spreads to the densely populated capital of Port-au-Prince 60 miles south — and particularly to the camps filled with tens of thousands of Haitians displaced by the earthquake in January — the death toll could soar.

“If that gets into Port-au-Prince that will spread much more further than what we get in the countryside,” said Yolaine Suruna, a coordinator for Haiti’s Civil Protection Department. “In the camps you have the situation of people on top of each other.”

The earthquake that struck Haiti on Jan. 12 took 300,00 lives and left 1.5 million people homeless and living in tents in miserable conditions and with inconsistent access to water. Haiti’s health system collapsed after the quake and sanitation systems — unreliable even before the devastating event — were further compromised.

The United Nations and humanitarian agencies feared outbreaks of disease in the ensuing months and until now, they had been averted in the country.

The Artibonite region had the highest numbers of displaced people from the earthquake, outside of Port-au-Prince.

The condition of the camps compounded by frequent rains and flooding in recent days “are perfect for a mass epidemic” said one Haitian doctor who did not want to be named.

Cholera is caused by the bacterium Vibrio cholera and is usually transmitted through food or water contaminated with fecal matter. Cholera is not common in Haiti and this is the first known epidemic of the disease here.

At least 600 patients were treated at St. Nicholas hospital on Thursday, many brought on motorcycles and pickup trucks and in the early stages of shock. “It’s very fast,” said Narka Tacas, a Peruvian doctor at the hospital, about the speed of mortality in cases she was treating. “The problems are huge, people are going into shock and having complications.”

Just then a man in his 30s was rushed to the front of a long line — his eyes rolled into his head as his brothers tried to resuscitate him by calling his name repeatedly. Tacas inserted an IV into each of his arms, handed both bags of serum to his brothers, and moved onto the next patient, a small girl.

“The physicians and nurses are fighting,” said Suruna. “They are trying to give as much water to the patients because they are losing water.” Fifty more nurses had been requested from Port-au-Prince, and tents were said to be on their way to create triage centers and shelter from the rain for the patients.

Meanwhile, at the hospital gates, security guards struggled to let people leave while keeping hundreds of other family members out in order not to completely overwhelm the hospital compound. Women who had lost a loved one left the hospital sobbing and wailing. One man made it to the hospital gates only to die before he could get inside.

Taking in the chaotic scene, all one of St. Nicholas' doctors could say was, “Beaucoup probleme.”

Read more GlobalPost coverage of Haiti.

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http://www.globalpost.com/dispatch/the-americas/101022/haiti-cholera-outbreak-epidemic