Cholera

The Cholera Treatment Unit: home away from home

Cholera, at least in Seguin, has slowed to the point where Chris and Kyle let go of almost all the staff. Though it is supported by MSF (Doctors Without Borders), we are all in charge of keeping it staffed and running. Chris has been living there as the only one with medical experience…except, he left yesterday for the States. With Clayton gone, Kyle running errands in Jacmel and Port-au-Prince, and no teams here to help, I’ll be filling in. I'll have Qasim to translate, a guard to make sure I'm alive... and... that covers it.

I think it took maybe 30 seconds after Kyle left to realize I was very alone here. It took maybe 30 seconds more to get emotionally overwhelmed. To be at the CTU by myself was unnerving.

We call it "the prison". Seriously. It's easy to feel pretty alone there, with too much time to try and keep yourself occupied. A soccer ball (thanks Kyle) has saved the day twice now. Other than that, these three books keep my sanity intact:

A glimpse of my first 24 hours at the CTU:

1:00 pm
Qasim's call comes right at the end of Clinic. The CTU has received its first Cholera patient in 3 days. Kyle isn't quite done seeing patients, so I offer to head down right away. The patient is an older man who looks like death. He has severe dehydration...his entire face is sunken. I can't feel a radial pulse, he has severe skin tenting, and he is too weak to speak. He is so, so very anxious. That is never a good sign. We were informed by family that brought him that he is from Port-au-Prince, and had started vomiting several days ago. He was immediately placed in Plan C, which meant IV fluids. As I get my IV supplies set up, I pray and try to keep my hands from shaking. Getting an IV will save his life. Not getting one really isn't an option.

1:30 pm
It's too much pressure. With Qasim looking over my shoulder and trying to help, I begin to panic and can't get an IV. I thought I got one... the saline flush went in... but when I let the fluid run I watched it begin to fill around the vein and not in it. Dismayed, I try again. Four tries later, and it's time to call Kyle. I could care less about my pride. I simply feel terrible and need some help.

2:00 pm
Kyle finally manages to get a 24g in one arm, and half a 20g in the other. Good enough for us. Tape will hold it in. Thank you Kyle for saving the day.

2:30 pm
The patient is anxious and won't quit moving his arms. Kyle and I sit and hold him down for the better part of an hour, ensuring fluids are going in.

3:00 pm
I decide to lay down for a few minutes, then wake up to find Kyle gone. What a punk! He needed to get away after a long morning. I monitor the patient - making sure to get air out of his line, changing fluid bags, and setting drip rates per protocol (... or not... sometimes you just have to go with your gut). The patient has a bucket under him and two beside him. Cholera is not a gracious disease. At times, I just hold the patients hand because there's simply nothing else to do but put fluids in and watch the disease run its course.

4:00 pm
I can't take it anymore. I need to use the bathroom. Hello hole in the ground.


5:00 pm
The patient isn't doing great. One liter after another of fluids is given. He still has no radial pulse. I have no blood pressure cuff here either, which for my sake, I think I'm happier about. I think I'd rather not know.

5:30 pm
It's definitely getting cooler out, and I'm wondering how much warm clothing I brought with me. Kyle comes back. Hurray for company!

6:30 pm
It's dark out, so it's time to get the generator going. Of course it's not working, so I stand in the dark trying to set an IV drip rate (unsuccessful...it totally requires light) while Kyle goes about trying to fix it.

7:00 pm
Movie time! ... until Kyle's computer dies. This is sad moment for us.

8:00 pm
Kyle and I are huddled under a blanket on a cot in the pharmacy "building" (if you can call it that). Maybe tarp and a tin roof? Anyways, we're either reading or studying... or staring off into space. I think both of us are sick of trying to stay occupied.

9:30 pm
Kyle and I escape the CTU for an hour. The patient still has an hour and a half before the saline bag is empty, so we decide it's time to take a break. Kyle seems mentally exhausted to me (if I had to run two medical clinics I think I would be too) so I tell him I'm making a decision he is not allowed to argue with: I am spending the night at the CTU and he is staying at the clinic. I'm pretty sure he wouldn't have argued anyways :) Bonus: I got raisins from his secret stash out of the deal.

10:00 pm
Kyle is kind enough to escort me to the CTU. I can find my way there and back in daylight, but it's a different story at night. I'll learn. Or get lost, and then learn. There's just so many paths to take. And I am fantastic at getting lost. I was not blessed with sense of direction.

10:15 pm
I check on the patient. He is still losing a lot of fluid. Everyone else is sleeping. I hesitantly wake up Qasim because he doesn't realize I'm staying the night. They kindly make an extra bed for me.

11:30 pm
I am trying to sleep, but radios are going and people are singing and talking. The patients IV fluid is set to last about an hour or two, so I check accordingly. I figure I'll get in an hour to an hour and a half of sleep between each check-up. I have one of Kyle's phones to serve as an alarm. I'm being paranoid, but I have already almost put air in an IV line a couple times now. I fear falling asleep, and not waking up in time to change empty saline bags.

1:00 am
Time to check on the patient. Almost no fluid has gone in. The patient is bending his arms (despite the IV arm boards taped to it), which stops the flow of fluid. I try to be stern, and attempt to speak Creole. Alright, so I play charades. I shake my head no as I bend my arms, then shake my head yes as I straighten them. He nods. I tell him "Merci."

3:30 am
I'm exhausted, and up again to check on the patient. He's not sleeping well, and he keeps moving. If his arms aren't straight, fluids don't go in. His nod earlier apparently didn't mean what I thought. I'm losing this not so fun battle.

5:00 am
I wake up to the alarm again. Time to check on the patient and be up for the day. I try and get him to drink ORS (oral rehydration solution). When he came in initially, he drank 5 cups of it. Awesome. Now though, he throws up whatever goes in. He's not drinking enough.

7:00 am
I head back up to the clinic to: get some coffee, check in with Kyle, and get a few minutes away. Then it's back to the CTU.

10:30 am
Qasim and I sit around and start talking. We end up talking about life and what we believe in. The conversation came out of nowhere, but I suppose you get to talking about all sorts of things at the CTU. I decided Qasim is one of my favorites. He's kind and compassionate, and he's teaching me Creole with I am so thankful for! He has been at the CTU a month. Qasim told me this: "If white people are willing to come and help my people, then how can I, as one of them, leave? I had a dream of going to school, but God has given me a different dream right now. I can always go to school next year." He has a good heart.

11:30 am

The patient's family stops by to get an update. We can't let them in, but I ask Qasim to see how much they know about Cholera. Qasim gives a Cholera lesson in Creole and I hand them bars of soap. Cholera education, one Haitian at a time. It's all we can do. We try to reassure the family that he is improving, but inwardly I cringe because he's not improving as fast as I'd like. We've given him about 17 liters of fluids at this point, but he loses so much and he still looks dehydrated.

12:00 pm

Qasim and I escape the CTU and play soccer outside its walls. It is a fantastic way to get rid of pent up energy. When you let go and let yourself relax, you find sudden energy and laughter that makes the day instantly better. Soccer is sanity time.

12:30pm
Hallelujah, he has a radial pulse! And Hallelujah I get a break! Kyle is here to give me some relief time, so I'll be hiking back up to the clinic for food, a nap, and possibly a shower. It's been far too long since my last one. Let's reorder that: shower, nap, and then food.

1:00 pm
Back to the CTU. I am praying for my sanity, as I'll be having a lot more time to myself again. Kyle needs to go to Jacmel, so I'm being left to cover the CTU alone for the first time. God has thus far used all this time in incredible ways though, so I'm okay with it. When it's time to go home, I know I will instantly appreciate the community I have that here, is sometimes lacking.

3:00 pm
Igot my first IV. Success. :)

God is here.
God is good.
He's directing my steps and I'm excited to see where it is that I go.

Love, Janae