(June 24, 2011 - Ralph Kurtenbach) Water makes up a great percentage of the human body. That biological fact pressed itself upon Dr. Mark Nelson after working with a cholera patient who had received his 90th liter of intravenous liquid. "He is still dehydrated! Must be very difficult to lose and receive that much liquid [but] he should recover well," Nelson wrote after a 12-hour shift.

Ecuadorian nurse Sandra Paredes deals with a cholera patient.

Under the care of fellow HCJB Global Hands physician Mattias Egberth, the patient "still looked very dehydrated after liter No. 98," recalled Nelson. With another 10 liters-reaching a total of 108 liters (28½ gallons)-the patient recovered.

The physicians, along with nurses Kim Kirk and Sandra Paredes, finished a two-week stint helping at the Samaritan's Purse (SP) cholera treatment center in Cité Soleil, Haiti. They returned to Ecuador on Sunday, June 19.

The average patient stayed one to five days, according to Nelson. A loss of body fluids equal to 10 percent of body weight is severe; greater than 15 percent is life-threatening. If an average person weighs 70 kg (154 lb.), then a loss of greater than 10 liters is life-threatening.

"That puts the need to replace even just 20 to 30 liters into perspective, and 108 quite astounding," he said. "Of course at the cholera treatment center we were constantly replacing the fluid that is lost."

In just a short time, Nelson had made headway communicating directly with the Haitians. He wrote: "I ask the same five or six questions of all my patients, 'When did your diarrhea start? How many times today? Are you vomiting? Are you drinking? Are you pregnant?' And generally, I get the same type of answers."

He progressed to speaking what he phrased "cholera-Creole" and was able to treat some patients without the help of a translator. When the team first arrived on June 4, SP had received 180 cholera victims at its tent hospital. Later the patient load leveled off to about 140 patients.

"They start out lying down, get slowly stronger and then eventually go home," chronicled Nelson. "Some are better after 12 liters of fluids, and others take about 50. I'd say the average is 20 to 30 liters."

The cholera outbreak was confirmed in Haiti in late October 2010. HCJB Global Hands responded to an SP request for help by sending two medical teams from Ecuador.

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium vibrio cholerae. Often mild or without symptoms, cholera is sometimes severe. In such cases the patient may lose body fluids rapidly and experience dehydration and shock.  Without treatment, death can occur within hours.

"Often the patients who died were those that secrete the largest amount of fluids the fastest, and they died in 12 hours or less from onset of diarrhea," recounted Nelson. "The patients dying of cholera that we witnessed indeed were people who died very quickly after arriving at the center, even before being assigned a hospital bed."

Awash in patient symptoms, Nelson also noted the weather conditions, attempting to discern whether rains a day earlier could spread the waterborne disease and thus drive up the patient influx at the treatment center.

"The Samaritan's Purse staff informed us that 48 hours after heavy rains cholera cases spike," Nelson said. Haiti's rainy season lasts from May to November.

Each physician was assigned 35 to 40 patients and the help of two or three nurses. "The days are long but not too long," Nelson related. By 7 a.m. each day the HCJB Global Hands team began attending to patients, working until 6 p.m. Altogether Nelson said he'd see each patient three times throughout the shift, plus helping in triage as new patients arrived.

Plans are under way for another Ecuadorian team of medical professionals to unite with SP staff in July to care for cholera patients.

Sources: HCJB Global, Samaritan's Purse, Centers for Disease Control and Prevention