Hospital doctor’s medical mission to Haiti targets cholera
[December 28 2010] -
On her latest medical mission to Haiti, Hospital of Central Connecticut internist Susan Levine, M.D., M.P.H., went face to face with cholera, setting up cholera treatment centers in two villages.
For Levine, of West Hartford, it was “baptism by fire” as she taught Haitian nurses and doctors, with a translator’s help, how to treat the bacterial infection that has become epidemic in the country since ravaged by an earthquake this past January.
“In the two weeks I was there I probably saw over 800 patients and not a single death, which I think is amazing,” says Levine, in Haiti from Nov. 18 to Dec. 3 as part of an International Medical Corps (IMC) trip. During her first visit last March, also through IMC, she worked at the University Hospital in Port-au-Prince, running a 22-bed ICU.
On this trip, however, Levine’s sole emphasis was on treating victims of cholera, a condition she had not previously treated. There have been more than 109,000 cholera cases and more than 2,400 deaths from it, according to a Pan American Health Organization mid-December report.
“It’s such a tragedy that so many people have died of cholera because it’s so easy to treat,” says Levine, who says the bacterial infection is largely contracted by feces-contaminated water. Most who acquire the infection, she notes, do not develop severe vomiting and diarrhea; those who do can become severely dehydrated. “The key to treatment is aggressive and rapid fluid hydration,” she says.
Treatment measures followed World Health Organization (WHO) protocol, which calls for hydration and a single dose of antibiotic for those severely dehydrated. At the towns of Verrettes and Ennery, where treatment centers were set up, patients were assessed for treatment by level of dehydration. Patients in Plan A, those least ill, stayed in a tent and were given oral rehydration salts. For Plan B, treatment was more aggressive with weight-based oral rehydration salts. Plan C patients were severely dehydrated and rapid infusions of large volumes of lactated ringers were often required.
In tandem with IMC’s treatment centers were community education and sanitation efforts. Levine says IMC hired hundreds of local citizens as community health workers who would go door to door with a bullhorn, telling residents to wash their hands and go to a bathroom in a space separate from their dwelling. Fearing for themselves and despite precautions, Levine says it took time for Haitian nurses to feel comfortable treating patients. She wasn’t worried about contracting cholera, which is contagious, as she took precautions, namely wearing gloves and frequent hand washing.
This being her second mission trip, Levine says there were no surprises. “I would say things are better but it was, in my mind, a trip of hopefulness and instilling a sense of self-reliance within the local medical community.”
“The people were incredibly grateful for the care they got. It was an incredibly calm and gracious experience.”
Levine, who practices at HCC Kensington Primary Care, says her master’s of public health degree allowed her to appreciate the global approach to the cholera epidemic, recalling that an epidemiologist collected data to help ensure the medical team’s treatment was appropriate.
“It’s always good to have a broader awareness of other people in the world and what they’re going through,” says Levine, whose husband cared for their three young sons while she was away. She’s thankful for the trip, which she says was a humbling opportunity, and looks forward to her next medical mission.
“On some level, we have an obligation to contribute to the world around us,” she says.
Susan Levine, M.D., M.P.H., pictured in Ennery, Haiti.