Rotavirus
This year was heralded in by an epidemic
of diarrhea with vomiting for children under the age of 2 years old. Rotavirus,
which probably caused this epidemic, may seem to be a mild illness, and even the brunt of jokes in other regions of the world, we had 32 children die in the first 4 month.
When Juan arrived in our office, we had just finished a long day of courses. When his grandmother uncovered his head I could hear myself involuntarily groan. This boy will be difficult to save. The
fontanel (soft spot) on his skull was sunken-in, his skin so dry that upon pinching it stayed risen like parched leather. He had not urinated for two days and his eyes protruded like the wizened face of an
elderly man. Worse yet, he had been born premature and was born premature and
was being fed a watered down infant formula. The mother did not even show up
for the first hour. He had been sick with vomiting and diarrhea, with a fever
for over a week. It seemed everything was stacked against Juan. I had that sensation I get too often; when I hear a faint fluttering heartbeat of a baby (or person) close
to death and we have to move precisely and rapidly or we lose the struggle for this life.
Frey and Teresa, two of our health promoters immediately prepared a quart (liter) of Oral Rehydration Solution. Fortunately, Juan was conscious enough for oral intake of fluids. He drank from a syringe steadily and with definite interest. Within
3 hours his vomiting stopped. By now the emesis had been largely due to the dehydration
and not even the original illness. Juan’s pulse was stronger, and his breathing
slower just from the fluids. We counseled the now present mother and the grandmother
as to appropriate fluids and feeding. They continued to give fluids every hour
and he was strikingly better by morning. Within 24 hours he was out of danger
from dehydration. The antibiotic given in his case is not necessary, nor appropriate
in the majority of similar cases we see. The dehydration alone is enough to kill,
but since many people see the children have more diarrhea as they drink fluids, the temptation is to think that the fluids
make the diarrhea. In actuality the loss of fluids with diarrhea and vomiting
is made worse when fluids are not ingested, as the body then pulls the fluids from cellular and extra-cellular spaces. Rehydration, and in particular oral rehydration, saves hundreds of thousands of lives.
The mixing of water, sugar and salt
saves millions of lives around the world. Packets of Oral Rehydration Solution
(ORS), promoted by many international organizations, provide a more usable format of electrolytes, but are frequently unavailable
in the communities we work in. Before we began to work in this region, only 4
communities had packets available, so no appropriate fluids we administered. Now,
our health promoters provide a cheap, readily available alternative. The health
promoter at the left is in his first five day course, where one of the mainstay themes is the recipe for ORS.
In meetings with government officials
over the following weeks I have repeatedly requested that the local population be vaccinated with the Rotavirus vaccine. However, the majority of the population in our area has not received even the basic
schedule of vaccines recommended nationally, which does not even include the Rotavirus vaccine. In the meantime, we are attempting to obtain over 900 water tanks (250 gallons each) as well as water filters
to provide drinkable water to the people who drink the river water as their first source of fluid intake. While boiling water is an alternative, it is a huge task (and an environmentally unsound one) to cut enough
wood just to cook meals, let alone to boil water. Water tanks and filters are
only an intermediate step before having treated water from a safe water source arrive to homes in pipes.
The government health department was
conspicuously absent during this outbreak, and even tried to deny the deaths occurred, so as not to seem as incompetent as
they are. During the worst of the epidemic we had no professional medical personnel
for our entire region of approximately 40,000 people. Meanwhile the Health Promoters
treated hundreds of cases, with over 25 children in serious condition being saved by their efforts. Yes, this painstakingly slow work of training Health Promoters is worth it, at least for Juan and 25 others
in the past months…
