Onz

With every trip to Haiti I like to think that I leave a little bit of myself down there and bring a little bit of Haiti back with me.  Sometimes it's very tangible like dropping off medication or gifts.  Most of the time what I bring back is pictures and memories.  In turn I use to tell stories to let other people experience Haiti.  As some of you may know, Rachel and I just finished our much anticipated clinic trip to La Fit.  This was a site never before explored by CHI.  I'm not even sure that this site had seen a United States team of clinicians.

The clinic was a raging success.  But I'm not writing about our clinic, yet.  I'm writing about something I brought back with me from Haiti... #Cholera.  I didn't notice much of anything immediately upon my return to Iowa.  Rachel and I spent the weekend with her family and celebrating the wedding of two of our best friends in Wisconsin.  I certainly "re-acclimated" myself to American food and drink faster than normal, but seemed to tolerate it well.  I've had issues with this process in the past.

Our water source was captured rain water.

It hit me just under a week after my return.  My stomach had been a little upset off and on, but nothing like this.  I woke up in the middle of the night and had to go.  You know those commercials about the "going problem" regarding male prostate issues?  I had a going problem for the twosies.  I couldn't sleep.  I literally had to go to the restroom eleven times from the early morning till noon.  I finally started with Loperamide, which slows down intestinal motility.  All that did was increase my abdominal pain.

As a medical provider I'm used to telling people to use oral rehydration therapy.  Antibiotics don't help with most causes of diarrhea and IV fluid is for extreme cases.  So that's what I tried.

I felt miserable.  My stomach was cramping.  I thought I was going to throw up every time my body moved.  I reached for the zofran.  It helped, but my abdominal pain just increased.  It seemed like my GI tract was full of evil and due to the medication I was taking it had nowhere to go.  Thought it was going to dig out like the baby in Aliens.  And then the fevers hit.  I was chilled to the bone and shivering during June in Iowa.  I broke into a cold sweat.  I chased it with Ibuprofen and tried to sleep on the couch under four blankets.

I broke down and texted Dr. Buresh:
"So, I've pooped like eleven times today.  Don't feel great.  No blood.  Drinking enough to still pee.  Traveler's diarrhea?  Or something else?"

Before he responded I was already leaning towards cholera.  During my clinical encounters in Haiti, the number 10 was my cutoff.  If a mother or patient complained of diarrhea but it was less than 10 times per day I assumed it wasn't cholera.  I had 11 in the span of 12 hours.  I became patient number 654,737 to contact cholera in Haiti.  I downed a double dose of Cipro and fell asleep on the couch watching The Hangover Part 3.

I dreamed about La Fit, but not about tracking the source of my infection.  I woke up the next day dehydrated.  Mucous membranes were not moist.  My radial pulse was quicker and weaker than normal.  My first stop was to the bathroom.  Rachel fixed me an electrolyte cocktail to help me regain my fluids.  I was lethargic.  I walked to the car to find my wallet and threw up after having already taken a zofran.  My fevers returned.

As I laid sweating on the couch I couldn't help but realize how fortunate I was.  Yeah, I said it #Fortunate.  I was miserable.  But I was suffering in the comforts of a 900 sq ft apartment with a big screen tv playing sports center.  My girlfriend was doting on me to make sure I was taking enough fluids.  When it looked like I was struggling she actually called Dr. Buresh to arrange some IV fluids.  I was living it good.  I had Ibuprofen for my fevers.  I had antibiotics on call.  I had loperamide and zofran.  And best of all.  I could count on the fact that the water I was drinking from the tap wasn't filled with gram negative bacteria that would just prolong my illness.  I had it way better than the Haitians.

I know.  Major revelation, right?  But I had never had a disease like cholera before.  A disease basically eradicated from the U.S. but common in many nations without proper sanitation.  I've never been dehydrated and unable to ingest enough fluids.  In my survey one of the questions was "When someone has diarrhea should they eat or drink more, less, or the same as usual?"  I commonly got the response that they should eat less because "they have no taste in their mouth."  There have been times that I've not had an appetite when I'm sick, but I have never had quite the repulsion of food that I have with this illness.  Even flavored water got detestable.  And all it is is sugar packets and tap water.  Awful.

And I think about Haitians who are stuck in their one room house with mud walls and a leaky tin roof.  I think about how the only time they have access to medicines like Ibuprofen, Tylenol, and basic antibiotics is when we hold a clinic.  I think about how we don't pack medicines like Loperamide and Zofran because they aren't cost effective.  I think about how they drink the same water they got infected with initially in order to rehydrate.  I think about how if they want to see a physician they have to walk five hours over a couple mountains and pay more money than they can truly fathom.  Most of the time when they see a physician they then have to send their family out to scour the city pharmacies looking for all the supplies they'd need for treatment.

There is just so much to take for granted when it is second nature.  But every now and then you gotta get the poops to bring you back down to Earth.  Unlike many Haitians, I'm going to recover from this illness and be just fine.  Until I travel again I won't have to worry about drinking contaminated water.  I can take comfort in the fact that every time I poop I get to flush the evidence far away.  I know that I can purchase some Ibuprofen or Tylenol in bulk for a trivial amount of money.  I've been #Blessed from the get go and it is my duty to share my blessings with others.