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Haitian Cholera Experience
I went to Haiti in the wake of the Jan. 12, 2010, earthquake, but those weeks treating mostly
chronic conditions barely prepared me for my return to the country Nov. 19. This time, I was
faced with acutely ill cholera patients requiring immediate life-saving treatment. The deadly
outbreak erupted in October, and by the evening of my arrival at J/P Haitian Relief Organization
housing in Port-au-Prince, more than 21,000 people were infected, with 1,250 deaths.
Early the next morning, J/P HRO co-founder Sean Penn received a call from Paul Farmer, MD,
PhD, of Partners in Health, who said, “If you don’t send us any of your doctors and nurses you
have available, people will die.” So our team of seven (four nurses, two translators and our
driver/security guard) set off on the three-hour drive along broken roads through the beautiful,
rugged mountains and countryside to Hopital Ste. Therese in Hinche.
I believe we were all shocked by the world we entered. Triage and short-term oral rehydration
tents were staffed by Cuban and Mexican physicians and nurses, and three additional tents
(men’s, women’s, children’s) and an old church served critical patients requiring IV rehydration.
Each facility held up to 24 patients. The cholera treatment center was fenced off, and an
attendant sprayed our shoes with a bleach solution upon entering or exiting. The church was
downwind from the pit where medical waste, patients’ clothing and trash were burned.
The heavy canvas tents had tarp floors that were wet from the nonstop mopping of human waste.
Tree roots and old foundations underneath presented trip hazards. Cots and cholera beds were
crowded inside.
Our combined medical team had four U.S. RNs, two Canadian RNs, one U.S. physician and a
small Haitian nursing staff. We became adept at positioning ourselves to start or manage IVs,
and we found creative ways to secure the IVs to the tent framework using pieces of rope. We
learned to place intraosseous infusions using a simple 16-gauge needle and to place external
jugular IVs when we could not find a peripheral vein. One of my most vivid memories is of a
member of our team, in what appeared to be a yoga position, starting an IV while a small dog sat
in the tent entrance and a chicken pecked at the ground beside her.
Working in the CTC at night provided additional challenges fewer staff; poor lighting; and a
constant cacophony from patients, animals, passing vehicles and occasional shouts from families
of arriving patients. The generators often stopped and left us in total darkness but for our
headlamps. During one blackout, a patient went missing from the men’s tent. His lifeless body
later was found by the fire pit. We never got a clear story about who declared him dead or moved
him.
We had no nasogastric tubes, no IV extension tubing, few IV poles, limited IV needle sizes, extra
large gloves and not enough beds. When patient gowns ran low, we offered items from our own
suitcases, then plastic garbage bags. We had to clean patients with bleach water and a mop.

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Haitian Cholera Experience I went to Haiti in the wake of the Jan. 12, 2010, earthquake, but those weeks treating mostly chronic conditions barely prepared me for my return to the country Nov. 19. This time, I was faced with acutely ill cholera patients requiring immediate life-saving treatment. The deadly outbreak erupted in October, and by the evening of my arrival at J/P Haitian Relief Organization housing in Port-au-Prince, more than 21,000 people were infected, with 1,250 deaths. Early the next morning, J/P HRO co-founder Sean Penn received a call from Paul Farmer, MD, PhD, of Partner ...
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