These are The Times of Cholera

cholera

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Fifty-six minutes later, i was still seated on the toilet seat, there were no signs the diarrhea was about to stop. I called reception with news that i was “a little unwell”. A member of the support staff showed up in my room, dressed in his work coveralls and boots. Thanks to him, i was bundled into the hotel van, and rushed to the Nairobi Hospital. “It must be botulism”, i remember telling the attending doctors in the accident and emergency. We had been served cold rice (yeah they serve cold rice in big hotels too), and i was certain it was botulism. A doctor mentioned cholera, but i brushed him off. It never occurred to me that i could get cholera, not from such a big hotel. That a hotel would promise so much and deliver cholera instead? But then i had overestimated it. After they deposited me and my stuff in the hospital, they washed their hands clean. They even refused to refund the money for the days i didn’t spend in the hotel.

The doctor performed a random diagnostic test for cholera (bless his soul!) The test turned positive! I was stunned! I thought i was dreaming. I had read about cholera, handled a case or two, now i was suffering from it. I would have discounted the test results. But my stool was the classical rice water stool of cholera; water with flecks of stool.

I was started on intravenous fluids and antibiotics. I remember calling my husband in the middle of it all. He had just received news that his father was very ill and there i was with news that i had cholera! I can still hear the shock in his voice as he asked me if i was in the hospital already. I can imagine how deeply it hurt him. Lying in the hospital miles away, i could see him pacing the house wondering how to be in two places at the same time. I have never known what lie he had to say to our children.

The Nairobi county executive commissioner ministry of health officials visited at a time when almost thirty three of us; doctors, nurses, and community healthcare workers had been admitted to various hospitals in Nairobi county. We had been attending a conference on lung diseases in a hotel in Nairobi. They were sympathetic, at the verge of tears, they promised to get to the bottom‘of the matter’, to do “something”. It broke my heart when they would later go to national television and rubbish the whole issue, deny the possibility of a cholera outbreak, call what we were suffering from ‘mere food poisoning’ and suggest that it was food we eaten in unconventional places that was responsible. In other words, we had been careless. That stung. Lying in bed with stool leaking out of my rear on its own accord, I remember asking myself why anyone who had seen me in that state would lie without even blinking.

I was moved into isolation unit on Friday morning. I had never put myself in the shoes of someone in isolation unit until i  found myself in there, this time not as a doctor but as a patient. If I say isolation was lonely, i would be understating it. But then the English language doesn’t have a better word for ‘the state of being alone in a room with just your thoughts to keep you company’.

Visits to your room are minimized and each time anyone shows up, they come dressed from head to toe in a protective gear that is designed to make them close enough to you, yet as further away from you as is possible.When they walk in, all you see is just their eyes blinking from behind protective goggles. When they talk, their voices, coming from behind a face mask comes out filtered of emotion. The only touch that you get is from hands that are gloved. Keeping people in isolation is a great way of ensuring diseases don’t spread but it is also a sure way of making someone get depressed. Being in there was hurting. It was painful, and all these months later, i just don’t know how to put all that pain in words!

Saturday was my worst day in the hospital. First off, i woke up hungry. I was getting my appetite back, but i couldn’t get anyone to bring me food. Nairobi Hospital is understaffed too! I remember calling for a nurse so many times that i gave up. I was made to understand later that they were all busy attending to emergencies. That got me thinking; no one, not even we the middle class withour insurances are safe. I mean i was in Nairobi Hospital paying an arm and a leg for staying in the isolation unit (my insurance doesn’t cover isolation so i had to pay out of my pocket). I expected to have at least one nurse assigned to me. But there was none to spare. That is why we need to speak up when public hospitals close for months on end. We need to make some noise because when they are shut, those without money don’t get help. We need to make some noise because we pay taxes.

Cholera is not something you can wish on anyone. Not even your worst enemy. No human deserves all that pain. Having diarrhea is bad enough. Having continuous diarrhea punctuated with vomiting is worse The worst thing is not even the diarrhea, it is that you are not in control. When you feel like passing stool, then you get just seconds before the sphincters relax. Cholera will make you run to the toilet but you will poop on yourself just before you sit on the toilet seat.

When i look back at that time, i shudder. At some point i thought i wouldn’t make it out alive. I thought about my children who had learnt about my illness from their friends who had seen, me on TV, speaking from the hospital bed. The ministry had insisted though that it was just an acute diarrheal disease. In fact, we never got the confirmatory stool test results from the hospital which is wrong. As a patient, i am entitled to know what was found in my stool. The country also deserved to know. We need to stop denying these truths. We need to accept that Weston, no matter who owns it, once served us cholera!

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This is no time for any disease outbreak

Nearly 50 people have contracted cholera while attending a health conference in Kenya’s capital (BBC). Most of those hit are doctors who were attending a science conference about lung infections in Weston hotel, one of the biggest hotels in the city. Our local news outlets have been hesitant in reporting the occurrence of this particular outbreak apparently because it hasn’t hit the usual places; slums and other informal settlements. This time round, the poor have got a reprieve. The gods must be aware that Kenyan nurses are on strike.

This is no time for a disease outbreak, certainly not a time to be hit by cholera. For starters, our hospitals are semi-locked if not completely locked, thanks to the nurse’s strike now on its fourth week. Our leaders are busy on the streets hurling names on each other in the name of campaigning, so nobody really cares. Cholera, unlike other diseases is very un- forgiving; it is a disease that will not hesitate to get done with you in a matter of hours! So, if you cannot afford Nairobi hospital or THE Karen, you are better off avoiding Weston Hotel for as long as possible!

So what exactly is cholera?

Cholera is an acute diarrheal disease caused by vibrio cholera (bacteria) that can kill within hours if left untreated {WHO}. That is right, cholera, unlike most diseases does not delay in killing, its victims.

SPREAD

Cholera is a fecal oral disease spread via ingesting food or water contaminated with infected faeces

Its incubation period varies from between two hours to five days

 

Symptoms of cholera;

Here are some of the symptoms of cholera;

  1. Profuse diarrhea –the stool is watery with flecks of white.

-it normally looks like water that has been used to rinse rice hence the name, RICE WATER DIARRHEA

  1. vomiting-
  • severe cholera without treatment kills about half of the infected people
  • death results from severe dehydration and electrolyte imbalance

PREVENTION

Because cholera causes death rapidly, it is always better to prevent it than to treat it;

Here are ways in which to prevent a cholera outbreak

  1. Hand washing- remember to wash your hands with soap and water after visiting the toilet, before handling food, before breastfeeding your child, and before you eat
  2. Water purification-sterilize water used for drinking, or cooking by boiling, or chlorination
  3. Antibacterial treatment of sewage
  4. Proper disposal of fecal waste, material used by a cholera victim e.g. beddings
  5. SURVEILLANCE—Cholera outbreaks/cases should be promptly reported to help prepare to contain infections
  6. Vaccination- there is a cholera vaccination that can be administered during outbreaks or to travelers traveling to cholera endemic areas. The vaccine is effective for about three months after it is administered.

TREATMENT

Victims of cholera should be isolated and treated away from other patients.

The aim of treatment is to restore fluid and electrolytes that are lost

This should be done in a hospital setting

  1. fluids – intravenous fluids is the main stay of treatment, oral fluids may also be given
  2. electrolyte replacement
  3. antibiotics- so as to shorten the course of the infection

The antibiotics of choice are doxycycline, septrin, ciprofloxacin, among others

  1. zinc supplementation- this reduces the severity of the diarrhea

CHOLERA IS A NOTIFIABLE DISEASE!

Any cases of cholera should be reported, whether they occur in a hotel owned by a vice president or in Kibera slums.