August 29, 2011
Lessons Learned from Haitian Nurses in a Cholera Treatment Center — Katie Fillo, Staff Nurse, MGH


Katie Fillo, a staff nurse at Massachusetts General Hospital for the past seven years, traveled to Haiti in July with staff from MGH’s Center for Global Health.   At Hopital Albert Schweitzer in Deschapelles, Haiti, where lay nearly 300 cholera patients, Katie learned from Haitian nurses how to rapidly assess the critical needs of patients who depended on their immediate interventions to live. 


“Bwè le serum” I repeated, for what must have been the hundredth time that afternoon and lifted the pitcher of passion-fruit-flavored oral rehydration solution to fill the young woman’s Styrofoam cup.  After watching her take a few sips of the bright pink liquid, I only had to shift slightly in order to fill the cup of the man lying in the next cholera cot.  The afternoon sun was beating down on the UNICEF tent making the interior even steamier than the courtyard outside.  The tent, filled with over 20 patients and their caregivers, was one of five in the Cholera Treatment Center (CTC) at the Hôpital Albert Schweitzer.  In addition to the five tents, the CTC consisted of an administrative building that had been converted to five patient rooms to house pediatric patients and some of the sicker adults, and a tarp-covered patient care area adjacent to the building.  The day I arrived in Deschapelles in mid-July the CTC had a census of 196 adults and nearly 100 children.  While the volume of patients did not represent the peak of the situation, it was still straining the limited resources of the hospital and community.     


I was asked by Project Hope to travel to help provide relief to the nurses who had been tirelessly working seven days a week caring for the overwhelming number of patients with cholera.  Cholera, a bacterium that is usually transmitted through contaminated water or fecal matter, causes vomiting and profuse diarrhea in affected persons, often resulting in rapid dehydration.  The treatment of patients who had cholera was not overly complex: it consisted of assessing each patient, then assigning him or her to one of four treatment protocols based on the clinical findings.  People with mild dehydration could be treated with oral rehydration solution, a mixture of potable water, salt and sugar, while those patients with more severe dehydration required intravenous rehydration.


Nurses in the admissions area were responsible for first assessing patients coming from their communities and then initiating the appropriate protocol.  During my time working at the CTC I observed as my Haitian colleagues adeptly placed peripheral intravenous lines in patients who were so dehydrated that they did not even have a radial pulse.  As patients were transitioned to one of the rooms inside the building or one of the tents, the nurses continued to closely monitor their condition and adjust their treatment protocol as needed.  These are just two of the numerous ways the clinical skills of my Haitian colleagues impressed me during my three weeks.  I learned from them how to efficiently survey a tent of patients in order to identify the individuals who are the sickest as well as to rely on my assessment skills to prioritize interventions rather than worrying about obtaining more clinical data. 


Among the patients my Haitian nurse colleague, Chandelerie, and I cared for that day were two mothers in their early twenties who had children only a few steps away in the pediatric ward.  These women had brought their children to receive care and had been at their cots without respite until they collapsed from cholera-induced dehydration. By 10 pm, one of the women had vomited copious amounts of rice water-appearing fluid into the bucket next to her for the third time in as many hours.  This woman’s big brown eyes appeared sunken and she looked overwhelmingly fatigued.  Clearly, she was losing much more fluid than was being infused by the intermittent dripping of her intravenous bag.  Chandelerie came up next to me to assess the woman.  She looked at her eyes and then pinched the skin on her chest; when she released her fingers a little tent of skin remained which indicated severe dehydration.  “A flôat?” French for fluid bolus, I asked Chandelerie.  “A float,” she confirmed. I opened the stopper on the intravenous fluid all the way so that the solution would flow rapidly into the young mother.  Together we had made the decision to proactively treat her worsening dehydration and she began to look more alert after just fifteen minutes of the brisk infusion. 


Although I do not know if this young woman improved and returned home with her daughter afterwards, I suspect she did.  This woman, like so many others that I cared for in collaboration with my Haitian nurse colleagues, would recover because the nurses demonstrated profound skill in the clinical care they provided and dedication to their patients. It was not until I finished working my last evening in the Cholera Treatment Center that I reflected how I had begun to embody the clinical expertise and leadership that so many of the nurses I worked with personified. 


In Boston, Katie Fillo works on a medical unit providing care to vulnerable populations from Boston and the surrounding communities.  Her undergraduate degree is from the University of Pennsylvania and she has a Master in Public Health is from Tufts University.  This fall Katie will begin a doctoral program at Brandeis University in Social Policy


The views expressed in this posting represent the opinions of the author, Katie Fillo, and not necessarily the views of her employer, the Massachusetts General Hospital.


For a prior blog post on MGH staff service in Haiti, see July 20, 2011 Mass. General Hospital Staff to Stem Raging Cholera at Hospital Albert Schweitzer in Haiti — Boston Globe, WBUR, MGH.