Diarrhea, cha cha cha.

Day 22 and 23...Mosquitos really starting to be the bane of my existence, stomach problems leading to hunger strike (which is a crime because the food here is way too good to pass)...pressing on b/c there is still stuff to do and see!!! With every adventure there are few roadbumps but letting them stop you or slow you down is no way to honor the spirit of adventure itself! (so mom, stop worrying I will be fine..if anything a few pounds lighter!)

Today I am visiting my version of "GI Upset mecca"...the institution which invented oral saline. ICDDR,B (International Center for Diarrheal Disease Research, Bangladesh)...opened about 50 yeras ago initially as the "cholera hospital" because of the incredibly high incidence of cholera (a waterborne diarrheal disease--mainly found in places where the main source of water is contaminated). Through both clinical and bench research this institution has done quite a lot for the public of bangladesh and other developing countries around the world. They have invented my favorite/life-sustaining solution (oral saline) as well as a solution called Dhaka solution which corrects for the electrolyte imbalances which occur with severe diarrhea. Interestingly there are these funny looking beds for the patients with a hole in the center connected to a biohazard bag above a bucket..long story short...some patients are so severely dehydrated they cannot even get out of bed to go to the lavatory...ergo..bed with strategically placed hole.

The intake area is run by nurses--a patient comes in they state their name, age and village/city from which they hail..then their duration of diarrhea, what it looks like, have they taken any medications, how many packets of oral saline...and any comorbid conditions. Then the nurse will take a good look at the patient...she/he needs to check a few things off the list
1. eyes sunken in or not?
2. Pulse? Rapid, thready or strong?
3. "Jeeba dhekow" (show me your tongue)..is the mucosa dry?
4. Thirst?
5. lastly..nurse grabs a chunk of skin on the patients belly or arm to see how long it takes for it to return to normal...(do to it yourself, youll notice that you pinch your skin and it immediately returns to baseline..do this in a severely dehydrated patient and their skin has a doughy feel, loses it's elasticity and stays "pinched" for a few seconds)

based on these factors the intake nurse will decide if the patient will go to emergency revival by IV fluids, or to the outpatient area where oral saline and rice are given for a few hours then the patient is released with recommendations. After patients' fluid status is resuscitated they are shipped off to the short stay or long stay unit depending how severe their condition is..at that point they are seen by a physician and "rounded" on. The problems i've noticed during intake is that patients start taking antibiotics not knowing why or if they should..they are overusing or misusing them and this will lead to increased antibiotic resistance in the future (a topic which was touched upon in a noon session i attended that same day)

A couple of novel practices started here...it has been found that the use of Zinc has decreased duration and severity of diarrhea as well as future occurrence in children especially. Patients are given zinc as soon as they present up to 7-10 days after diarrhea has ceased. Also, oral saline has another form called rice-based oral saline. The basic concept here is that rice is a complex carbohydrate and is easy to digest...it is a part of the BRAT diet which is recommended when someone is having diarrhea (Bananas, rice, apples, toast).

ICDDRB is a very interesting place...there is a lot of money that goes into this institution. It has revolutionized the way diarrheal disease is treated here in Bangladesh. furthermore they are the leading institution here in developing such public health gems as the rotatech and rotrix vaccines for the Rotavirus (a leading cause of diarrhea). Treating diarrhea or any disease does not just end in treating the disease itself but finding ways to prevent it. Hence the ICDDRB has developed a public health agenda in which to improve drinking/cooking water...a campaign to educate people on how to decontaminate their water, remind them about good sanitation practices as well. Over time this campaign has been very successful and the incidence of Cholera has drastically decreased (its peak seasons being before monsoon and after monsoon season)..in fact rotavirus is becoming the leading cause of diarrhea here in Bangladesh.

However..interesting fact I learned today...the Leading causes of death in Rural Bangladesh
1. Heart disease
2. Malignancy
3. Respiratory Disease
4. GI disease
5. Diabetes
6.Parasitic and Bacterial disease

...Back to Dhaka Medical Tomorrow....the ER awaits.