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Part 3: Nigeria – Responding to a cholera outbreak

29 Mar 2018

Australian nurse Liam Correy describes how Médecins Sans Frontières scaled up activities to respond to an outbreak of cholera in Borno State, Nigeria. 

My planned sleep-in and three-day long weekend of rest was disturbed at 6am with a loud knock on the door. It was the project medical coordinator and newly arrived Cholera Treatment Centre (CTC) doctor. “Liam, we have run out of IV sets. Can you find some, and come and help? And can you find some more staff?”

With an outbreak of cholera in the state, Médecins Sans Frontières set up a CTC and oral rehydration points. Most cholera patients came from Muna Garage, a camp for people displaced by the conflict between the Nigerian army and Boko Haram. Following heavy rains, the camp flooded, making the already poor sanitary conditions even worse.\

"Cholera treatment needs to be managed but has a basic tenet: people die from dehydration in cholera. Rehydrate them and they will live."

We had an urgent need for additional competent staff to join the cholera response. Normally the recruitment process for daily workers would require announcing the vacancies, assessing the CVs and motivation letters, and conducting interviews and written tests. But with this growing outbreak, we were asked to reassign some of our experienced staff to the emergency.

The role I’d fulfilled until this point had been to supervise the nursing activities at an Outpatient Therapeutic Feeding Centre for children with severe acute malnutrition. From the team of 25 I recommended two colleagues who had excelled in their roles to join the cholera response until additional international staff arrived and more national staff were recruited. 

My first recruit was Aba, a school teacher who had started work with MSF as a crowd controller. He had learned fast and two months before had started in the role of nurse aid. The second recruit was Isaac, a data recorder turned nurse aid who had a bachelor degree in physics and had shown a hardworking and fast-learning attitude. Nurse aids attend to basic patient needs, monitor and record vital signs, and assist with nursing and medical procedures under supervision.

They both answered the call and later that day attended training and commenced duty. They were eager to learn and put their training into practice in the CTC. Cholera treatment needs to be managed but has a basic tenet: people die from dehydration in cholera. Rehydrate them and they will live. 

"At regular intervals throughout the morning, a pickup truck converted into an ambulance would arrive with six to eight patients in the back"

Over the weekend the centre expanded from 20 to 100 beds. Each new tent that rose from the ground was full of patients within hours. Triaging patients, putting up IV fluid bags and recognising and monitoring how the patients responded to the treatment, Aba and Isaac, along with the rest of the team, saved lives with each application of their new-found knowledge.

On our third morning together a newly erected tent stood empty. Within minutes we had it filled with beds. At regular intervals throughout the morning, a pickup truck converted into an ambulance would arrive with six to eight patients in the back. The most dehydrated were carried straight in, the others could wait. Within two hours we had a patient in each bed receiving lifesaving rehydration fluid. 

One three-year-old girl was in a severe state of dehydration. She had lost consciousness and was barely breathing; her veins had collapsed, which meant we wouldn’t be able to administer the hydration she needed through them. So instead, we drilled a needle called an intraosseous into her leg bone. With Aba and Isaac’s assistance the fluid started flowing freely and within five minutes the girl regained consciousness and started crying. A few hours later she was sitting up in bed and looking around.

At the end of the week I sat down with Aba and Isaac to discuss their experiences. There was new light in their eyes. They relived the many experiences of seeing people who looked just like their friends and family so close to death, only to come back to life in response to the medical interventions that they helped provide. They said they had felt as though they were as important as doctors and that they were so proud to be able to work with MSF.