cholera.

Last Friday night I got a call from Big Paul late in the evening. We have only met one time face to face, but he and his partner Little Paul call me often trading around supplies and sick patients. They were recently featured in Men's Health magazine and have become known at Port-au-Prince's Cowboy EMT's. When these guys ask for help you know they really need it.

Paul told me that he had recently (as in two days before) returned from St Louis de Nord, a small town in Northern Haiti that was being taken over by the cholera epidemic. He said he was leaving tomorrow, possibly at 7am on a UN chopper to get a medical team up there. We need nurses, he'd said. Can you help?

Having come off of a particularly difficult week and really wanting to get out of the hospital I told him I'd try. A few hours and couple phone calls later Elinor and I were committed and leaving at 3pm the next day. I was excited to do some hands on nursing and not have to be in charge of anything for a week. Although I confess I was extremely nervous, knowing very little about cholera.

Our team of six nurses, three EMT's, two logistics people, and one fresh graduate from med school arrived in the dark to St Louis. It didn't take me long to figure out that no one had any clue what they were doing. We created our own work schedule and some of the team went straight to the clinic. I was on at 4 am.

I can hardly express the anger, frustration, desperation, and sorrow of the five days following. What an unbelivable disease. Everything you read about cholera says it's all in the fluid resusitation...but no one seemed to know how much. For five days we played a guessing game. We won a lot. But always felt like we were losing. I have never seen death come so quickly and so unexpectedly.

Old people and children were obviously the most vulnerable. Although we were all taken aback when an 18 year old boy died rather unexpectedly. Trying to get patients who weren't vomiting to drink was maybe the biggest challenge. Everyone wanted an IV but there were times when we were down to five liters of fluid and it was impossible to give everyone what they needed. A sweet old man I was caring for asked me for soup and a cola with salt in it (craving salt showing his dehydration). I managed to track down and feed him some soup for lunch, only to have him die not five hours later. I left for a bathroom break and a woman I'd more or less admitted who had been talking to me on my way out the door died while I was gone. We lost 19 people in four days/five nights. I can't decide if that's sounds like a lot or not. But when you remember every face it's hard to brush off.

I don't understand where the world is. The Red Cross, WHO, and even MSF are absent in St Louis. There are no protocols or plans. Patients come in on their linen covered in feces and after they die their family takes it back home. Little old ladies were mopping up their husbands waste without gloves on, and children were eating from bowls next to their poop buckets.

There is no education, no pamphlets, no structure. A group of five or so English speaking (educated) teens stopped Melissa in the street and told her they didn't understand. Where is it coming from? I heard one say. How did this start and how do we stop it? They were clueless to the fact that it's in their water.

I was perhaps most angered by the fact that the Northwest Christian Mission where we were staying houses a old people's home and an orphanage. Over eight of the elderly from their home were our patients. At least five of them died. No one has yet to test their water! I won't be surprised if they are all taken by cholera in the next month.

When we left today there were two new paramedics to take our place. TWO people to care for over sixty dying patients for a twelve hour shift. Where is everyone?

Are people just tired of hearing about Haiti's problems? Do they think that since they helped with that whole earthquake thing they've done their good deed for the year? Cholera is wiping out the regions the earthquake didn't touch and it seems that there is a whole lot of talk and no action.

I do not think the clinic we worked in should be functioning. It's completely unsafe and ill run. I have no doubt that it's spreading as much cholera as it's treating. But that being said, those people would be dead if it wasn't there. I don't believe the rumors that the UN started this mess, but regardless of the source they need to be doing something about it. This disease is here to stay and unless drastic measures are taken to educate and treat the Haitian people tales of the earthquake will die out as the stories of cholera flow through the streets.