Sunday, December 5, 2010

Love During My Time of Cholera

The news out of Haiti in regards to the current cholera outbreak continues to be a concern.  People continue to contract the disease, suffer, and for some; die.  The outbreak appears to be spreading and given the living as well as sanitary conditions in Haiti its spread is no surprise.

As a child I remember reading stories of people suffering and dying from cholera in WWII prison camps or in Southeast Asia jungles.  From school history books, I learned of historical cholera outbreaks in America as well as in Europe due to the lack of proper sanitation facilities and procedures.

Cholera to me was an old historical disease of far away places that as a person living in Connecticut I had no reason to fear.  Cholera was a disease of the old and primitive world.  Cholera, in the modern world, was a disease found only in exotic lands such as Bangladesh - so I thought.

In September 2007, I started working on a project in northern Vietnam.  I was assigned to a project in the Halong Bay area not far from the port city of Haiphong and about 3 hours north of Hanoi.  Once again the exotic and distant lands that I learned of during my youth from books, newspapers, television, and movies had become part of my life experience.  Just as I had visited the "lost" Inca city of Machu Picchu, rode upon the waters of Lake Titicaca, climbed the ruins of Angkor Wat, and enjoyed the natural wonders of America as well as Canada, I was enjoying the opportunities of a far away land.

I arrived in Vietnam in early September, and after settling into a rented villa I returned to Thailand in Mid-October for a weekend in order to bring Duang back to Vietnam.

Later in the year I attended a special dinner hosted by our Chinese client in their facilities at the job site.  The "Team Building" dinner was held on a Friday night and besides copious amounts of vodka and beer, there were many seafood dishes.  Some of the seafood was raw and we ate it without hesitation or concern.  After an uneventful weekend, I returned to work on Monday morning.  During the morning, I started to not feel very well.  After lunch, I was very sick.  Getting sick at work is never a pleasant experience.  Getting sick at this particular job site was extremely unpleasant.  Toilet paper was not stocked in the stalls; what you had to use was what you brought with you.  Worst of all, there were only squat toilets.  Western flush toilets did not exist at the job site.

Inside of each stall was a 8 inch high tiled raised platform.  A toilet bowl was built into the raised platform with the top of the bowl flush with the surface of the platform.  The contents in the recessed bowl were removed by opening a valve to let a stream of water flush the contents down the drain pipe at the bottom of the bowl.  I have used squat toilets but I am still fearful of two things when using them; dropping my wallet into the toilet, and soiling my clothes.  I address my fear of dropping my wallet into the toilet by removing my wallet from my back pocket and relocating it deep into a side pocket of my trousers.  As for my fear of soiling my clothing - I am working on convincing myself that the geometry ans well as anatomy prevent such a disaster from happening.  However I am not a true believer - yet.  As an added precaution; after I get in the proper location, assume the squat position, I use my right hand to grab and pull my trousers as well as underwear forward out of any perceived danger zone.  To date I have always been successful so I doubt that I will change my practice.

Being sick at both ends is always unpleasant but in Vietnam using a squat toilet it was even greater challenge and even more unpleasant.  I did not manage to make it to quitting time.  I had the company driver take me back home.

Duang immediately wanted me to go to a doctor or to a hospital.  I had severe vomiting and diarrhea.  I was unable to anything down or in me.  I had had amoebic dysentery before when I lived in Algeria so I realized that I did not have dysentery.  I did not have a temperature so I suspected that I did not have food poisoning.  I suspected that I had a 24 hour virus that would pass without intervention.

I tried without any success to keep myself hydrated the remainder of the day.  I made a home made batch of rehydration fluid - boiled water, sugar, and salt, but like everything else my body quickly eliminated it.  At bedtime, Duang attempted once again to convince me to immediately see a doctor or to go to the hospital.  I was still convinced that I had a 24 hour virus albeit unlike any virus that I had experienced before.  My diarrhea had evolved to cloudy watery discharge with a slight fish odor.  Most alarming was that each discharge was about one quart in volume.  I finally relented and promised Duang at 10:00 P.M. that if I were not better the next morning I would go and see a doctor.  As I promised her I could see that she was very concerned and had two streams of tears silently running down her cheeks.

At 1:00 A.M. , I experienced my worst attack.  I sat on the western style toilet with a plastic bucket in my lap.  It was truly disgusting.  After awhile Duang entered the bathroom.  I told her to stay out.  I did not to be in the bathroom with myself let alone subject her to the situation.  She refused.  In the manner in which she refused to leave, I knew that further argument with her would be futile.  She stood by me wiping my forehead and neck with a cool damp washcloth while I suffered the ravishes of my ailment.

We spent a long and fitful night together, mostly spent in the bathroom.  At morning's first light, I called the Site Manager and informed him that I would not be into work that day.  Around 8:00 A.M. I called a Vietnamese friend and asked him to take me to a doctor or to the hospital.  I then checked the Internet for email messages.  As luck or good fortune would have it, there was a "Warden's Message" from the US Embassy in Hanoi.  The "Warden's Message" informed Americans living in Vietnam that the Vietnamese government had announced a breakout of severe diarrhea in northern provinces and that some of the cases had been diagnosed as Cholera.  That definitely piqued my curiosity.  I googled "Cholera" and researched the disease.

Cholera is a bacterial infection transmitted by fecal matter in water.  The most common means of becoming infected other than drinking contaminated water is to consume raw or improperly cooked shellfish. Yes, I had done that.  The incubation period for Cholera is 1 to 3 days after exposure.  Yes, I had eaten raw shellfish 2.5 days before the start of my illness.  Not everyone gets Cholera from an exposure.  The articles stated that several people could eat the same food and not all of them would be stricken with the disease.  Susceptibility to the disease was ties to acidity levels in the stomach, blood type, immune system vitality, and to a certain extent luck. Some people who live an areas where the bacterium Vibrio cholerae is widespread develop a certain resistance to the disease.  This appeared to also be my circumstance.  After exposure, some people will only develop a case of diarrhea while others come down with a very serious case of the disease.  A symptom of cholera is vomiting.  Yes I had that for sure and it was a reason why I knew that I did not have amoebic dysentery. The diarrhea associated with cholera is sometimes referred to as "rice water".  Yes, once again that applied to my condition.

One half an hour later, my friend returned to our home with a heavy set middle aged woman on the back of his motorbike.  He had gone to the hospital and brought back a doctor.  She had a small leather "Doctor's Bag" with her.  She was wearing a simple white head covering - the type that you used to see being worn by Russian or North Vietnamese Doctors or butchers in newsreels, documentaries, and films during the 1950s and 1960s.

The doctor examined me in our bedroom with my friend translating and Duang witnessing.  After checking my vital signs, she rubbed my temples with a medicinal oil and then rubbed some of the same oil on my abdomen.  Since I knew that she was either a Buddhist or an atheist, I did not panic in mistaking her oil treatment to be part of the Catholic Church sacrament of Extreme Unction also known as "Last Rights".  I was feeling bad; very bad but I didn't feel last rights were warranted at that time.  She then cut some white patches of paper and placed them on my temples.  I had seen that before - it is the method of giving people medicine for headaches.  The doctor gave me an injection to help stop my vomiting.  I told her that I thought that I had Cholera and as luck would have it, I had another episode while she was examining me.  She asked that I not flush the toilet until after she inspected the contents.  She confirmed that I did have Cholera.  She told me to return to bed and she would return at 1:00 P.M. and check on me.

As the hours went on, I could not keep anything in me.  Although I was no longer vomiting, my diarrhea was unabated.  I also realized that I was becoming dehydrated.  When I pinched the skin at the top of my hand it very slowly returned to shape - a sign of dehydration.  I was also becoming quite light headed - another sign of dehydration.  More importantly, I realized that I was developing a rapid pulse.  Light head and rapid pulse are also symptoms of electrolyte imbalance due to the flushing of essential mineral from the body by the profuse diarrhea.

As promised the doctor returned at 1:00 P.M. .  On this visit she brought some IV bags to infuse me.  After taking my vital signs she announced that I would not be going to the hospital.  She said that I previously had a lower than normal body temperature.  If my temperature had not returned to normal by the afternoon, she was going to admit me to the hospital.  Lower than normal body temperature can be a symptom of Sepsis (massive infection).  With that concern removed, she focused on treating the Cholera.

There is no cure for Cholera.  There is a treatment for Cholera which is to keep the patient rehydrated while the infection runs its course in 24 to 48 hours.  Since I was initially unable to keep myself hydrated orally and by the afternoon I could not physically drink enough to keep up with the fluid loss from diarrhea let alone make up for the deficit that I was experiencing, I needed to be infused with fluids and electrolytes.  The coat rack from our bedroom was brought to the side of the bed and used to hold the IV bag.  The doctor hooked me up to the IV equipment and watched over me.  When the second bag of IV fluid was completed, she left - around 6:00 P.M.  Talk about personalized medical care!  The entire afternoon, Duang remained at my bedside.  She wiped my brow and held my hand - the hand not associated with the IV.  A patient could not have hoped for a better nurse.

I spent the next day regaining my strength and was good as new the following day.

The medical statistics are that fewer than 1% of the people who get prompt, and adequate fluid replacement die.  However more than 50% of the untreated people with severe Cholera die.  Antibiotics are sometimes used to expedite the treatment but antibiotics are not required to prevent death.  Fluid replacement is essential to prevent death.  In severe cases of Cholera the patient needs to be infused with fluids to maintain blood pressure and electrolytes while the infection runs its course.

From my personal experience with Cholera, I have a greater appreciation of how people who are in prison camps or do not have access to medical care can die from this disease.  I believe that if I had not gotten treatment when I did, I would have died within 24 hours.  The insidious nature of Cholera is in how rapidly it can become fatal.  The symptoms are no more severe than a normal virus infection or case of food poisoning but it is rapidity that the infection dehydrates the body that is the major risk. To ignore it or to deny treatment for a short time is really a matter of life or death.

In the case of Haiti there also a problem of containing the outbreak.  Cholera is not passed directly from person to person.  It spreads through contamination of water and food consumed by others or I would imagine direct ingestion of infected fecal matter. In my case in Vietnam, I had access to adequate sanitary facilities.  We had plenty of clean water and soap for washing our hands and disposing of waste.  Duang and others in my presence were only at risk of infection by me if my fecal matter some how entered their digestive system - extremely improbable.  However living in a tent city or refugee camp in Haiti neither provides an adequate means for disposing of waste matter, preparing foods in a sanitary manner, or ensuring clean water for drinking.  There is no wonder that the outbreak continues and that it is spreading.

My experience demonstrated to me that you do not have to have multi-million dollar facilities to treat most diseases.  I was treated in my own home.  The victims in Haiti have neither which stacks the odds further against them.

My experience with Cholera demonstrated to me that promptly seeking medical attention can be a life or death decision.  I had waited perhaps too long but adequate medical care was readily available.  The people in Haiti do not have adequate medical personnel or sufficient supplies readily available.  Any delay on their part can have dire consequences.

It was this experience that I realized or perhaps it was that I accepted that Duang was truly committed to our relationship - for better or worse.

I had experienced her love during my time of Cholera.


  1. That was an interesting read. It reminded me of an episode in early 2002 (or late 2001. I was living in BKK at the time, but had traveled up to Nakhon Phanom province with a friend who had some business to attend to there. We'd stayed at a hotel in town, mainly because on arrival i was not feeling well, and 'not feeling well' in the primitive village her family lived in wasn't all that attractive a choice.

    I deteriorated overnight, running a high fever, feeling freezing cold, perspiring buckets, shivering like mad and feeling very sore, joint pains. I was sponged down frequently, given water and electrolytes to drink, and ate aspirine. Next day, still very weak, we visited the family in the village, but I was only 505 compus mentus . No diarrhea, no vomiting. I thought myself malaria, but it subsided after a few days. A few weeks later, back in my own country, I consulted my GP. he consulted a tropical disease centre, who suggested I'd probably had a bout of Dengue.

    Very scary to be in a remote place with minimal medical facilities, minimal language ability, and be sick as a dog.

  2. Yes it can be very scary getting sick in remote places. Thank goodness for the Internet where we can research our symptoms and evaluate the treatment that we are getting. I find myself learning more and more about medicine the older that I get.