The Lady in the Wheelbarrow--April 2012
As I left St. Catherine’s Hospital several days ago, there was a distraught sweaty man standing a few in front of me. He was next to an unconscious lady in a wheelbarrow.
I was not startled because this is a common way of transporting sick people in Cite Soleil.
Wheelbarrows.
I reached for her neck to see if she had a carotid pulse. It was weak…but it was there.
I asked the man what was wrong. He told me that the lady had a sudden and constant onset of diarrhea and vomiting the day before. She had been "bien prop" (very well) the day before that.
She had cholera.
Her name is Lucy (made up name) and she is 26 years old. She is from Soleil 13.
The man pushing the wheelbarrow wanted to enter the hospital but the guards said no and were keeping the green doors closed. The guards said there was no doctor inside, but I knew differently since I had been working with the MSPP (Haitian Public Health) doctor in the Emergency Room (ER).
I insisted that there was a doctor inside so the guards slid the gate open and the man pushed the lady in. I guided him to the area outside the ER.
The Cholera Treatement Center (CTC) at St. Catherine’s is closed. Doctors Without Borders (MSF) staffed the CTC and it saved the lives of thousands of people in 2011. But now there is no place close for the people in Soleil to go when they get cholera…. like Lucy.
We parked her outside the ER and I rallied the ER doctor and nurse who responded immediately. Lucy looked like death and barely responded to painful stimuli.
We were able to start an 18 gauge angiocath in the back of her left hand and and 20 gauge angiocath in the right ankle saphenous vein as it hung it below the handle of the wheelbarrow.
I handed the bags of Ringer's Lactate to people close by the wheelbarrow who held them high and squeezed the IV fluid into Lucy.
The ER doc calmly told the man who had pushed Lucy through the filthy crowded streets of Soleil that St. Catherines’s does not have a place for cholera patients and she would need to go to MSF-Holland in a Delmas neighborhood in PAP. The doctor gently told the man that Lucy needed to leave. There was nothing more to do here.
The man looked incredulously at the ER doctor. He could not push her the four miles to the CTC.
I asked the hospital chauffeur who drives the van for hospital employees if he would take Lucy. He said no.
So we hung another bag of fluid and pushed Lucy out through the hospital gate to the street in front of the hospital. Jean-Claude, my driver, was waiting in his truck. We carefully lifted Lucy into the truck bed and slid her towards the cab. Two family members had arrived at that point and they supported Lucy and held the bags of Ringer's high over their heads.
In front of us was a crowd of about a fifty young men. They were watching a soccer game on a tiny television. They totally ignored Lucy and her struggle for life because they have seen too much death in Soleil.
Jean-Claude drove through the rainy streets of Port-au-Prince and about twenty minutes later we arrived at the MSF-Holland CTC in the Delmas neighborhood.
The IV in Lucy's right ankle had run dry but the other continued to function. The CTC opened their gates immediately when we honked and unloaded Lucy onto a dirty green stretcher.
I gave a quick history to the MSF doctor on call. Lucy was moving her arms now and her carotid pulse had slowed and was stronger.
She was placed in a tent. Lucy needed an ICU for shock, but she got a tent instead. However, we didn't complain.
MSF-Holland told me that during the last two weeks they were evaluating 20 new cholera patients per day in their CTC in Delmas. (MSF CTC's all over Port-au-Prince are seeing more cholera patients now during the rainy season.)
There is a good chance that Lucien will survive now. She has a 26 year old heart that can accept the volume that she needs.
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Conclusion and Questions:
Haiti is in the midst of the worst cholera epidemic in the world. This is not the way to save Lucy and many others like her from cholera.
If the man who had pushed Lucy in the wheelbarrow didn't have the strength or fortitude to get her to St. Catherine's Hospital, or if they would have shown up just a little bit later, they would have found no physician or nursing staff to help her. And Lucy would have died in the wheelbarrow.
How many people in Soleil never get the chance Lucy got? We will never know. They die hidden in the maze of the slum.
And when I have asked people in Soleil where is the closest CTC, no one has any idea.
Can't a CTC or a CTU be set up now in Soleil with basic equipment like IV catheters and Ringer's Lactate and a nurse or two to stabilize the Lucy's of Soleil?
Is this asking too much?
John A. Carroll, MD
www.haitianhearts.org
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