We had our grand round today-both the infectious disease team and the microbiology staff. We went to see a patient, who may well be the first cholera case at Bara, related to the outbreak in Zimbabwe. There have been plenty of cases up in the northern region of South Africa-the Limpopo area which borders Zimbabwe. And there have been a smattering of cases at Jo'burg hospitals (JHB General and HJH), but none at Bara. Which seems a bit unusual... But the cases at the Gen and HJH have been patients who were seen in the MSF (Doctors w/o Borders) clinic in the heart of Jo'burg, and they refer patients to the Gen.
So, it was a great bedside (well, not at the bedside, since the voluminous diarrhea makes it somewhat distracting to talk at the bedside) tutorial on Cholera. In addition to all the stuff that would bore most people (pathogenesis, treatments etc) we also looked at the Zim statistics.
Consider this:
-only 10% of people with Cholera are symptomatic. There are a reported 30,000 cases of cholera. Which means that that the actual number of cases, based on the reported 30,000 is therefore 300,000 cases. Take into consideration that Zim is falling apart, that there is poor disease reporting, and that people are likely not accessing health care, and the figure of 30,000 reported cases is likely a GROSS under-reporting.
-that the expected death rate of cholera is 1%. It doesn't take any special, drastic measures to treat. Simply rehydration alone, and antibiotics for those severely ill. But, the overall death rate in Zim right now is 5%. BUT the death rate in the community (i.e., those not in treatment centers) is estimated to be 55%, of those who have been diagnosed.
I say that this is "aka the world is f*cked up," because there is plenty of bad news in the media these days. (Though I have to admit that I spend less time on my favorite news sources-the BBC and NY Times, and simply look at major headlines to see what new f*cked up problems there are). The Economy. That guy who stole all the money. Gaza. Iraq. Pakistan. Iran. The US. Unemployment. Somali Pirates. Jacob Zuma. The Denver Broncos.
But this is f*cked up:
"healthcare" in Zimbabwe-as per BBC
Cholera: 2,204 died since August
Anthrax: Eight deaths since November
HIV/Aids: Estimated 400 deaths a day
TB: Brain-drain has practically closed the national testing laboratory which now has only one staff member
Maternal mortality: Risen from 168 per 100,000 in 1990 to 1,100 in 2005
(Please read the full article at http://news.bbc.co.uk/2/hi/africa/7826304.stm and also check out http://physiciansforhumanrights.org ).
So, our one patient with probable cholera will have an uneventful course at Bara. He'll get his hydration, and antibiotics, and he'll head home in a few days. But had he been in Zimbabwe, there's a good chance he could have been #2,205...
