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SANJAY GUPTA MD
Deadly Cholera Spreading in Haiti
Aired October 30, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning and welcome. I'm Dr. Sanjay Gupta. Welcome to a very special edition of SGMD, reporting to you from Haiti.
Now, it's been about nine months since the earthquake. We spent a lot of time down here at that time.
We are back now because of the cholera outbreak which I'm sure that you heard of. It's killed hundreds. It has sickened thousands. As far as we know, from the people that we've talked to here on the ground, it is ongoing.
How exactly could this have had happened? What happened exactly? And what does the future hold for some many of the people living in these tents right over here behind me? That's the major concern.
Could these bacteria make its way to the capital city of Port- au-Prince and start to spread, start to infect lots of people?
We have a story of a beautiful woman, 22-year-old Saint Helene and her 15-month-old daughter, Cherie. They might be potentially be carriers, unwittingly carrying these bacteria from the areas hardest hit in the capital city of Port-au-Prince.
And could it be true that supplies, life-saving supplies, are actually sitting in warehouses when so many hundreds have died? We'll investigate that.
And we'll also have a conversation with a remarkable woman. Her name is Dr. Megan Coffee. She came here right after the earthquake, 10 months ago almost, and she never left. She's spending her own money to try and buy patient supplies.
Let's get started.
GUPTA: We start, though, with a tragic story, but an important one to remember as well. The anatomy of an outbreak: how would these bacteria potentially make its way from the rivers north of here, all the way to the capital city? And what does it mean for so many of the people that live here? Exactly what we wanted to find out -- and 22- year-old Saint Helene and her daughter taught us.
GUPTA (voice-over): The story of 22-year-old Saint Helene and her daughter sweet 15-month-old Cherie started like many others in Haiti: mother and daughter making their way around the country with the cholera bacteria possibly in their bodies. They are known as carriers.
(on camera): As things stand now, government officials have only confirmed a few cases of patients with cholera here in Port-au- Prince. And we came to this hospital and found this room in the back where all of the patients are suspected of having the infection. This is their version of isolation. Open windows, clustered patients and pretty unsanitary conditions.
(voice-over): This is where we first found Saint Helene and Cherie. She became suddenly ill, so thirsty, she told us, weak, her legs ached from dehydration -- classic symptoms of severe cholera. Her daughter Cherie quietly sleeps on a cot across the room.
Among increasing numbers of patients right here in Port-au- Prince now are being treated for cholera.
To see Saint Helene and Cherie travel to Port-au-Prince from the cholera-stricken area of Artibonite, an area that looks like this -- kids playing in water that is, well, dirty and now thought to be teeming with cholera.
The infections spread quickly. And even with the best of intentions, treatment was hard to get.
People here are desperate to get what little there is. There wasn't enough. And as a result, even more patients became ill.
But, you see, Saint Helene and Cherie weren't sick. They were fine. But they were unwittingly bringing the deadly disease to the Haitian capital.
Dr. Megan Coffee is an infectious disease doctor trying to prevent this exact thing from happening.
DR. MEGAN COFFEE, INFECTIOUS DISEASE PHYSICIAN: It's an hour drive for some people that come from areas that are infected. Everyone has family in Port-au-Prince. There's always a fear that someone comes either to get treatment or because they're coming here anyways, and then they live in tent cities. Their sewage and water supply can easily mix. There's a lot of rain here, and always the fear that it will just spread.
GUPTA: And it has. Mother and daughter taught us how an outbreak starts to worsen.
(on camera): Saint Helene and Cherie teach us something else: just how deadly and heart breaking this cholera infection can be. We came back the next day and learned that 22-year-old Saint Helene had died just one day after becoming ill. And we also know now that her 15-month-old daughter Cherie is sick. And she's also an orphan.
GUPTA: It's such a sad story for this 15-month-old. We were told that she's been transferred to the pediatrics ward where she'll continue to get treatment. And it looks like she's going to recover from this. They are going to try and find her a family with whom to live as well.
There's no question the death toll from cholera continues to rise. This epidemic is by no means over, which makes it all the more startling that life-saving supplies could be sitting in a warehouse when so many people are sick. We'll investigate that next.
Stay with SGMD.
GUPTA: We're back with SGMD.
Right now, medical teams are working around the clock to try and save lives. That's the thing about cholera. Give them early treatments, you save them. If they don't get that treatment early, too many of them die.
But what if you couldn't get your hands on the life-saving supplies no matter how hard you try? Great doctors and nurses are trying to do just that. Sometimes, a lot of red tape gets in the way.
GUPTA (voice-over): How could this have happened? That's what Julie Santos wants to know.
JULIE SANTOS, HAITI RELIEF WORKER: You have someone there, someone here, let's connect the dots.
GUPTA: She's talking about trying to contain the outbreak of cholera. Hundreds have died. Thousands are still in need of treatment.
(on camera): I mean, this is where you are told to come and get supplies. You arrive here and you're -- I mean, there's patients waiting, what happens?
SANTOS: Well, there are patients waiting.
GUPTA: There's patients waiting for these supplies.
SANTOS: Yes, when we are sending them to the hospitals down in Saint-Marc.
GUPTA (voice-over): Where patients are begging for hydration, clean water, the cheapest of supplies, and yet, medical relief worker Julie Santos still waits for hours for her paperwork to be approved before she can get the supplies.
(on camera): How can that happen? That all that life-saving supplies are being there and people -- so many people -- hundreds of people are still dying?
SANTOS: I don't know. I mean, I don't understand. I'm at a loss, really. I'm trying to figure out why. I can't really get a straight answer.
GUPTA (voice-over): I wanted to try to understand myself. PROMESS Warehouse, a World Health Organization facility, has the largest stockpile of supplies here in Haiti.
(on camera): What people have been waiting for hours outside and days in hospitals is this -- I mean, palettes of I.V. fluids, literally life-saving stuff to treat these patients with cholera, thousands of them. But it's not just that palette. Take a look at this whole warehouse, full, despite what's happening here in Haiti.
CHRISTIAN MORALES, PAN. AM. HEALTH ORG./WORLD HEALTH ORG.: If we send everything that we have here today, tomorrow we cannot answer for 800,000 cases in Port-au-Prince.
GUPTA (voice-over): Christian Morales has the enormous task of helping figure out who gets the supplies and when.
(on camera): Explain to me again how you see supplies here from July of this year, which is before the outbreak -- well before the outbreak.
MORALES: Why you do want to send it out before the outbreak?
GUPTA: Why don't you want to send it out after the outbreak?
(voice-over): We never did get a good explanation. But we saw were hydration salts and I.V. fluids still sitting in the warehouse.
(on camera): Did it go fast enough?
MORALES: They -- I think every -- in every operation like this, you can do things better. And there's a lot of lessons to be taken from this and the country needs to be prepared for what is coming because the likelihood of spreading of this epidemic is very high.
GUPTA (voice-over): And that's something we heard over and over. This epidemic is by no means over.
(on camera): The thousands of people who are saved is a great success story, but hundreds of people have died. And they would say, look, I don't understand how all these organizations could have supplies and hundreds of people still died. You would say what?
MORALES: Well, again, we have given away to everyone who has come here to us for supplies.
GUPTA (voice-over): But not on this day for Julie Santos. Her paperwork was never approved. And no one could tell her why not. She leaves the warehouse empty-handed.
GUPTA: There's no question in the third world distributing aid is difficult. There are so many different challenges here. But I want to point out again that, you know, we're not talking about expensive medicines. We're not talking about complicated technological equipment.
We are talking fluids and salts, rehydration salts. They are cheap. They are simple. They are easy to transport.
And for many people, they simply did not get there in time. It's part of the reason we are doing the story.
Somebody else who knows a lot about what's been happening here in Haiti for 10 months now is Dr. Megan Coffee. She's an infectious disease doctor from San Francisco. She packed up and moved to Haiti and had never left. We'll talk with her next.
GUPTA (voice-over): Best estimate, the quake displaced 1.5 million people, injured or crippled 300,000.
In the United States, the care of this man, Mildred (ph), received would be considered ordinary.
(on camera): When did you realize that you were injured?
(voice-over): Here, Mildred is an extraordinary success story.
(on camera): The worst injuries he had was actually to his leg. And I don't know if you can tell so far, but he's actually walking with a prosthetic here. This is what so many people here in Haiti have been wanting and waiting for, because so many amputations were performed.
(voice-over): Mildred is a success here because he not only received immediate acute care, but because there are resources for his recovery and this follow up, intermediate care. It's so important. But here, it is way too rare.
UNIDENTIFIED MALE: It's a trauma.
GUPTA: It's about the money. There's never enough. Eight organizations tell us they are saving so much of it for the long term.
But in the meantime, hospitals are dying and so are patients. The medical needs will not miraculously go away anytime soon, but there have been successes despite the obstacles.
Back with Mildred, he wants to show he cannot only walk, but he can also run.
(on camera): You all right?
That's just one of the difficulties you just saw here, simply navigating the road. He's obviously running but it's a very uneven surface.
(voice-over): Once left for dead, he is back on his feet, dancing again.
Dr. Sanjay Gupta, CNN, Port-au-Prince, Haiti.
GUPTA: And we are back with a very special edition of SGMD from Haiti.
I'm at a place that I know pretty well here, surrounded by patients with tuberculosis. In fact, these tents over here, light blue now. I remember when they were much darker about 10 months ago.
It's also where I got a chance to meet Dr. Megan Coffee, an infectious disease doctor from San Francisco. She's sort of the doctor here, the doctor of this TB ward. I got a chance to talk to her again.
Thanks so much.
GUPTA: Good to see you.
COFFEE: Good to see you.
GUPTA: You know, I've been fascinated with everything you've been doing over the last almost a year now. What made you come down here in the first place to Haiti?
COFFEE: Friends here in Haiti called me. I have a lot of friends who work in NGOs in Haiti and they just called and said, "We're here taking care of patients, we're not doctors, we're not nurses, can you come down?"
GUPTA: And you're practicing infectious disease and medicine --
COFFEE: I was finishing up my fellowship at U.C. in San Francisco and Berkeley. And they called me, I was able to get out of work about two weeks after the earthquake, and I came down and I started working in a field hospital, where it's mostly orthopedic injuries and infections afterwards.
And to me, as infectious disease doctor, this place seemed like there was a real risk for spreading infectious diseases. And someone who works here asked me to come down to the general hospital and said, we need other infectious disease doctors, because everyone who came was a surgeon or an emergency room doctor.
GUPTA: You know, I've been here a few times since then. You've been here throughout, pretty much.
GUPTA: I mean, a lot of doctors came and they left. What made you stay?
COFFEE: I have amazing patients here and I work with great nurses. I've always worked with Haitian nurses who work at the hospital. So it was a stable group that we work with. Not lots of volunteers coming back and forth.
GUPTA: What did your -- I mean, your family, your friends back home. I mean, how do they -- how do they take the fact that you made a huge move like this?
COFFEE: Yes, they think I'm a little nuts. But if you start to see the patients that I'm taking care of, I get a lot of people who are 16, 18 years old, who come in next to dead. I can give them medications. I can do just simple medicine, and they can get a lot better. And it's something that keeps you here.
GUPTA: Do they - do they -- have you ever worried about your own safety?
COFFEE: I always wear a mask, always concerned that I have to make sure I don't get TB. I'm actually still not infected, which is wonderful. And most people don't if you get exposed to TB regularly, you usually don't.
GUPTA: What about violence?
COFFEE: I've actually really never had any concerns. I know there's always this concern that in Haiti, there's violence. I can go out in the street at night, I can go out at night. I've never had any concern or risk here.
GUPTA: One of the things -- and you -- I follow you on Twitter. And one of the things you tweet about is the fact that it's still tough and sometimes just getting basic supplies can be a challenge. You've actually gone out and bought supplies with your own money.
GUPTA: That's an amazing thing right there. So, you -- you just have your own money and go out and buy supplies --
COFFEE: People have given me donations. Different groups that have come in and see what we're doing here, see that all the patients need supplementary food, I get basic food from the hospital. I get basic supplies from the hospital.
But my TB patients are incredibly skinny. They need more food. They need more oxygen. They need more medications. A lot of them have AIDS, and getting them connected to all of the resources they need is just a lot of work.
GUPTA: It's amazingly heroic work, Dr. Coffee, I have to tell you because I feel like -- I feel pretty guilty when I'm not here and I'm sure just having people like you makes it better.
A lot of discussion lately about cholera.
GUPTA: You're an infectious disease doctor. Can you give me a little bit of an idea where the story goes from here? It's been a little bit over a week now. Do you think it's going to get worse, get better? What happens?
COFFEE: I mean, all of our fear is that this an incredibly mobile country and it's small country geographically. And there's always a fear that people come from the areas that are affected which are just of the north and west of here.
It's an hour drive for some people that come from areas that are infected. Everyone has family in Port-au-Prince. There's always a fear that someone comes either to get treatment or because they're coming here anyways, and then they live in tent cities. Their sewage and water supply can easily mix. There's a lot of rain here, and always the fear that it will just spread.
And then, what's been going on in the rest of the country is that there's a huge river
COFFEE: That can just flood all of the cholera all the way through. Here, there isn't just one water supply that will do that, but it might be little pockets. It might just be little flares.
GUPTA: The level of concern remains pretty high.
GUPTA: And we're going to keep our attention on it, as well.
GUPTA: Thanks so much.
COFFEE: Yes, thank you.
GUPTA: Great having you here.
GUPTA: And we're going to try to answer some of your questions, as well after the break. Stay with SGMD.
GUPTA: And we are back with a very special edition of SGMD.
We're in a tent city here in Port-au-Prince. We've got a lot of questions today and a lot of them about Haiti. Let's get right to them.
This question coming from Twitter, "Didn't we defeat this disease cholera years ago? Why, months after the earthquake, are still so many people dying?"
Well, a couple of points to make. First of all, cholera still exists in the world. In fact, the estimates are 3 million to 5 million cases a year, 100,000 people still die around the world from cholera. And no one is entirely sure why cholera is in Haiti right now.
But what most people seem to agree on is the reason it's become so bad is because of the conditions like this, squall-like conditions, people living in very close quarters. This is how a disease like this, an infectious disease like this, spreads. And that's the big concern sort of moving forward.
Second question is, "What is the government doing to inform people living in tent cities like this about cholera?"
This is a very interesting point, as well, because a lot of attention obviously on treatment of cholera. But I'll tell you, one of the most important things is simple sanitation, trying to make sure that you're not actually infecting the person next to you.
So, what you'll see around tent cities like this is megaphones. People actually talking about the fact that cholera exists and what they can do about it.
Sanitation, a big part of this. People actually just simply cleaning their clothes, washing their hands and making sure they can stay as sanitary as possible. It's not always easy, I'll tell you that for sure. But this is a big part of controlling the entire spread of this. Again, no one knows exactly where this is going.
I think we've got time for one more question. "Is cholera an airborne disease? Could someone be contaminated, travel to the United States, and start spreading it?"
Well, an important question and it's not an airborne disease, first of all. This is a disease that is actually often from contaminated water, for example. But, people can spread it.
And a couple of important points here. First, they can get the cholera infection and be perfectly healthy and have absolutely no symptoms at all. They're called carriers. They walk around with this particular infection and unwittingly spread it to other people.
The other point is that when you leave one country and travel to another country, you could possibly spread it that way, as well. It's not airborne, but it's actually a bacteria that's living inside you. So, again, basic precautions apply. They're trying to get a handle on things here, but obviously much more to come over the next several weeks. We're keeping an eye on what's happening with cholera here in Haiti.
We're going to have much more of SGMD after the break.