Blog Entry Number 5, Day Number 20
Blogees (any of you still reading!),
I am working at THE cholera hospital this year in Dhaka (literally icddr,b is the best cholera hospital in the world-and has pioneered lifesaving treatments). With the monsoon season slowly ending (will it ever end?!), we in Dhaka are going through what is the second of a biannual cholera epidemic. The first epidemic takes place just around start of the monsoon, which begins approximately in April. icddr,b typical sees around 500 patients everyday. All of these patients are treated for free, and many go home in a day. During cholera season, that number shoots up to 1000-1,200. The capacity of the hospital doubles, and beds are put wherever they can find space. This entails the parking lot, the lobby in the main entrance; anywhere. By the way, this is what a cholera cot looks like…
See the hole in the middle? That’s where you place your BE-hind if you are unlucky and get cholera. The hole goes down to a bucket. The bucket sits and waits to become full of stool, at which point an orderly comes and places a new bucket under the bed. The bed above was empty, but gives you a feel for the privacy a patient gets here. The floors are not wood laminate with views of the city like in some private hospitals in Minneapolis. A single room? Yeah, we have one. It’s called the short stay ward. You and several hundred other people will be in a single room which looks like a warehouse. It will be loud, crowded, and constantly busy. However, the care is delivered effectively and very efficiently. Despite the high number of patients in these wards with diarrheal disease, they do not smell in the least bit. The ventilation and constant diligence of the orderlies are owed for this. Several hundred people are saved every day, at the cost of about 15 dollars. The icddr,b is truly remarkable, and a model for delivering care to masses of people cheaply and effectively.
So, I’ve heard of cholera. Is it, like, a virus or something?!
Cholera is caused by a bacteria called Vibrio cholerae, which causes profuse, watery, diarrhea. This translates to deadly, dehydrating, diarrhea (DDD). Patients literally lose liters upon liters of fluid from this DDD. Today, my boss told us at lab meeting that a patient at the Mirpur Hospital (a hospital part of icddr,b near the Mirpur slum area in Dhaka) required 35 LITERS of intravenous fluids over a period of four days in order to keep him hydrated during a bout of cholera. 35 LITERS. Can you even imagine how that must have felt for this poor man? Because antibiotics are so readily available over the counter, often times only severe cases refractory to home treatment arrive in the hospital. If we see 500 MORE patients everyday at icddr,b during cholera season, and these are only severe cases, then there is a lot of cholera out there in Dhaka/Bangladesh. This is hard to imagine coming from a place with a sewage system, clean drinking water for all, and nothing even close to the slums that can be found here. Food poisoning would cause an uproar. A case of cholera would cause a riot at the department of health.
For the medical crowd, I have included a picture of ‘rice water stool’ below. ‘Rice water’ is how cholera diarrhea is described. It is very characteristic of infection with cholera. If you see the stool below, you will understand the name (not for the faint of heart). You may be asking, ‘why do you have pictures of stool on your computer, Johnson?!’. Well, a former lab member asked me to go to the hospital to take a picture of a cholera cot and stool. The pictures I took will be used in a scientific review paper on cholera that my colleague is writing. I had agreed reluctantly do carry out this task….I went down to the hospital to try, eventually.
Me to Bangladeshi nurse, “ahh, yes, hi, can I take a picture of some rice water stool?”
Bangladeshi nurse ……….blank stare………
Me, showing my ID badge and acting as serious as possible, “I am from the lab. It’s for a scientific paper.”
Bangladeshi nurse ………..several words I could not understand………….
Me, “ok then, I will be back….”
Meanwhile, every patient in the short stay ward had stopped whatever they were doing to stare at me, the tall, awkward, white guy. I retreated to the lab, defeated.
Eventually, I spoke with a friend who knew an employee in the clinical area who speaks English. This kind man told me to come before lunch and he would have good specimens for me. Just before lunch (mmmmm, stool), I went back down to the hospital and met up with him. We walked up to a patient bed he had previously marked. He had a few words with the patient, which I assume were:
“we are going to take pictures of your stool bucket. do not be frightened”
An orderly pulled the bucket to the side of the bed, and I started snapping away. I was not sure how to frame the shots. Never have I artistically tried to take pictures of a bucket of stool, but this was for a journal, so I had to try. After snapping off some pictures frantically, I turned around to find the entire ward staring at me again. Who is this strange white man who comes to Bangladesh to takes picture of our stool? I was thinking the same thing.
If that wasn’t enough, my stool guide had picked another patient to terrorize, just in case the first few pictures didn’t turn out. Across the short stay ward we walk, people staring at me the whole time. I’m weaving in and out of beds, smiling at people as non-awkwardly as possible. We reach the next cholera patient. Same drill. The orderly is about to pull the bucket away from under the bed when my guides yells:
“WAIT! It’s running!”
The patient had active cholera. Removing the bucket may not have been a good idea at this time, so we moved on. Across the ward we walked, stares, smiles, the occasional wave, or ‘your country?’. I get asked this often. But in this setting, I did not want to reveal my country of origin, otherwise they may forever associate Americans with stool photographers.
Onward we went, to the next patient, who provided a great picture for this paper. WHEW. After shaking my guides hand, I was dismissed. Not before I thanked my guide for his bravery and assertiveness. I walked out of the ward as fast as possible and found the nearest sink to wash my hands in. I did not touch my food at lunch. I used a fork and a long spoon.
And for those who stuck with it: here’s that bucket o’ stool, rice water stool, that is. Enjoy.