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NATALIA's DIARY FROM ANGOLA
Natalia Rojas is a nurse from Sydney who recently started writing a diary about her experience working in Médecins Sans Frontières (MSF) emergency response to the cholera epidemic in Angola. Since the 13th February when the first case was found in Boa Vista shantytown in Luanda, 30,000 people have become infected and 1,100 have died; now the disease has spread to 11 of the 18 provinces in the country (over 15% case fatality rate in some places*). Natalia writes from MSF’s cholera treatment centre in Caucuaco, a large poor suburb in Angola’s capital city, Luanda. *In urban settings, a case fatality rate of >2% is considered indicative of poor/bad case management. After 2 weeks of intervention this rate should improve. Fri 5th :: Sat 6th :: Mon 8th :: Wed 10th :: Sat 13th Another baby died today and it should have been preventable. Everyday I try to make the rounds and see all the patients so no one dies and yet everyday I fail. A lot of people are dying around the centre, everyday we have mothers who are bringing their children in to the centre. I think that sometimes they believe we can still help even though they have already died. Sometimes the baby dies on the way and other times they have heard the message that people who die of cholera pose a risk to the rest of the family and community if the proper disinfection procedures are not followed. They bring their dead baby into the centre so that they can save the rest of the children or maybe themselves. We also had a child die in the middle of the night but no one could tell me what happened. We work blindly sometimes, guessing what is wrong with patients because we are not able to do all the tests we could do if we were at home. I am not just talking about cholera now because a good number of patients have associated illnesses; maybe malaria or respiratory infections, HIV/AIDS or maybe even typhoid. These patients are the unfortunate ones who do not fit suitably into our cholera treatment protocols, otherwise they would get better and go home quicker. I am being very dark at the moment - it is just that there is so much death. Let’s hope tomorrow is better. Today was a better day than yesterday because no one died during the night or during the day. The antibiotics arrived today and I was able to treat the more difficult cases in the centre, especially the patients who have another illness on top of their cholera.** I tried to do a small consultation with every patient today but I couldn't, we just have too many patients and I am constantly running from one tent to the next. Our bed capacity is now 220 and all of the beds were full at one stage, but now it’s nice to know that there are a few empty beds. The number of new cases coming to the centre is reducing thankfully, although I’m not getting too excited yet as this can change at any moment. MDM [Medecins du Monde] is doing active case finding around Cacuaco, and there are still too many people dying at home. A lower incidence may mean that people are not able to get to the centre but we are hoping this is not the case. Somehow I am not so tired today, although my feet are aching. I think it’s because I’m on my feet all day and we are walking on stones. The ground of the centre is laid with stones as the ground was sand originally - the stones are very good for getting rid of the cholera that is left on the ground. The bacteria can’t survive for long on the stones and in the sun. ** Antibiotics are not the first-line treatment for cholera and are only used in those patients who are most severely dehydrated. Most patients will recover from rehydration treatment either orally or intravenously. Other antibiotics used in this setting would be used to treat pneumonia and upper respiratory tract infections. The centre was very busy again today but no deaths during the night or during the day! Most people are still coming from Paraiso or Pescadores - I wonder what its like to live in a place where so many of your neighbours are getting sick. We had a little baby come in with cholera and a very severe pneumonia. We treated for both conditions but I am more worried about her pneumonia. I was very happy though to have Ceftriaxone available for patients, a very effective antibiotic, that I hope saves the little baby's life. I am very tired today, I was going to take a day off but I instead joined MSF’s mobile team and visited health centres belonging to the government***. We went to assess whether they knew how to manage cholera cases, and it seems like they know how but they have very little resources available to them to deal with the outbreak. They lack everything, particularly transport to transfer patients to our cholera centre. Most patients go directly to our centre and find their own means of transport. The baby who came in with severe pneumonia and cholera went home today. She was back to normal, thankfully. Cholera is quite amazing sometimes as people react to it in different ways. For example a man in his 40's was brought into the centre today unconscious. I knew he wasn't dead because he was still breathing and his pupils were reacting but I was really scared that we were going to lose him. I and another nurse cannulated him in each arm and infused two fast bags of Ringers solution, an intravenous fluid to rapidly rehydrate him****. In 30 minutes he regained consciousness and a few minutes later walked to his own bed. The human body can be so resilient. Another case was a 24-year-old man had died from vomiting. He was getting better but then the nurse called the MSF doctor and when I walked in he was already dead. It looks like he died because the nurse did not know how to do basic airway management and place the patient in the recovery position. He was sitting up (held up by his brother) and the vomit went right back into his lungs and drowned in his own vomit, as he was not placed in the recovery position. Anyway, it’s all for the cause and I will try to write something happy next time. *** MSF started sending a mobile team to the government's health posts around Cacuaco to see if patients are being referred on time and to the right place; to MSF’s cholera treatment centre. They have discovered 26 new cases per day in another poor suburb in Luanda, called Viana. MSF plans to go there and start another cholera treatment unit that is smaller than a centre but able to provide essential care on location. ****Each bag of Ringers lactate is one litre. MSF calculates that the stock of Ringers lactate required for each patient admitted to a cholera treatment unit is 8 litres in total. MSF allows for oral rehydration solutions (ORS) of 10 litres per patient. The cholera cases are officially decreasing in Luanda and in the provinces! I can definitely see the difference in the centre - it is truly amazing how quickly it has decreased. Today we had a family of five children, the mother and all five children have cholera. The father is the only one not sick. Fortunately three of the children are much better but two still require intensive care. The mother was vomiting today so she is also on IV fluids and I will know how they all are tomorrow. The numbers of new cases has reached 30,000, and there are still new cases developing in other parts of the country. As far as I know it hasn't yet completely exploded anywhere like it did here in Luanda however MSF is not taking any risks and is setting up centres around Angola where cases are being reported. I hope that the cases keep on decreasing as they have been and the government invests some money into the living conditions of their people. No one should have cholera - all they need is decent water and sanitation.
Another baby died today and it should have been preventable. Everyday I try to make the rounds and see all the patients so no one dies and yet everyday I fail. A lot of people are dying around the centre, everyday we have mothers who are bringing their child in to the centre. I think that sometimes they believe we can still help, and sometimes the baby dies on the way and other times they have heard the message that people who die of cholera pose a risk to the rest of the family and community if the proper disinfection procedures are not followed. They bring their dead baby into the centre so that they can save the rest of the children or maybe themselves. We also had a child die in the middle of the night but no one could tell me what happened. We work blindly sometimes, guessing what is wrong with patients because we are not able to do all the tests we could do if we were at home. I am not just talking about cholera now because a good number of patients have associated illnesses; maybe Malaria or respiratory infections, HIV/AIDS or maybe even typhoid. These patients are the unfortunate ones who do not fit suitably into our cholera treatment protocols, otherwise they would get better and go home quicker. I am being very dark at the moment - it is just that there is so much
death. Lets hope tomorrow is better. » Read about other featured projects
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