Cholera at St. Damien, in addition to being a disease, is also a location. Otherwise known as the St. Philomena Rehydration Center, it is located on the northern third of the Kay Germaine (special needs programs) property behind the St. Luc hospital on what was once a soccer field. Two years ago, as a year-long NPFS volunteer, I sat on a bench on that field and watched a St. Luc football match and gossiped with Maxo – it was a moment that was oddly similar to an American high school Friday night football game. Now, the large white tents that cover the field could resemble another American event, an Art Festival or weekend Home Show, but instead they are filled with rows and rows of cots with holes cut in them so the cholera patients can defecate directly into a bucket during bouts of sudden and explosive diarrhea.
As a medical student, I learned about cholera and how the profusely watery diarrhea and vomit is a result of an enterotoxin produced by the cholera bacteria that attacks sodium and potassium pumps which when working correctly, allow the body to absorb water. Otherwise, not only is dietary water not absorbed, but the water inside the patient’s body is drawn into the intestines and leaves the body by way of the aforementioned “rice water diarrhea.”
So, when I came back to Haiti to visit this December, I knew what the disease should look like and the patients do present precisely as the literature describes. What the literature does not describe, however, is how it feels to watch a 65-year-old woman vomit a waterfall of bile-green water for the fifth time in a day. I was working in the five pre-fab houses that are set up on the periphery of the cholera camp for the most acutely severe patients, and this particular woman had shown no improvement for the past three days. She had been there with her grown daughter who not only emptied the bucket when it was full, but then also cleaned her mother after each session of diarrhea in full view of the five other patients who shared her room. By the fourth day, my last day in the camp, her condition was finally improving. But, I was still heartbroken that she had spent so many days in such a miserable and degrading position.
In the next house, there was a little boy of 12 years who also took three days to improve unlike most who after a day of intravenous fluids (if they are even needed) are able to drink again. The boy was exhausted and slept most of the day so I talked more to his mother. She told me that of her three children, all had cholera and all were in different hospitals. On the third day of his admission, she explained to me with a smile that her first child was discharged two days ago, her second the day before, but “this one just couldn’t make up his mind to get better!” In the meantime, while her child slept, she would make rounds in the house with a total of nine beds, and help to bring water, empty buckets or clean the other patients who did not have anyone to care for them.
Cholera, now that it has been introduced to Haiti, will remain in the soil for decades to come. As proper sanitation and reliable clean drinking water is unlikely in the near future in the country, it will continue to make its way into water sources and continue to infect Haitians of all ages. The cholera camp at St. Damien, thus, is currently being transformed into a permanent establishment. The white tents are gradually being replaced with small houses so that the flooding rains that frequently plague the area will not ruin medical supplies. And hopefully, the patients will find a small speck of dignity in an otherwise horrific situation.