Cholera Is A Deadly Disease But It Has A Worthy Opponent

A hospital in Bangladesh is winning the war against cholera.

When cholera strikes, the disease moves much faster than most deadly infections. Thecholera bacteria causes the lining of the intestine to actively secrete fluid and electrolytes, which diminishes the body of the nourishment it needs to survive. Within hours, a cholera patient could be suffering from dehydration so severe the blood volume of the body shrinks until they go into shock or experience circulatory collapse, both of which can be fatal.

A few decades ago, cholera had a 40 percent mortality rate. Now, thanks in large part to work being done by International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), patients have less than a one percent chance of dying — if treated properly.

"We at icddr,b offering this help globally are often dubbed as cholera warriors," Dr. Azharul Khan, the head of hospital at icddr,b, told A Plus in an email. "Having had these opportunities to combat cholera both nationally and globally and save lives is an infinite and eternal satisfaction and priceless treasure of pride."

A child is weighed inside icddr,b.
A child is weighed inside icddr,b. ©GMB Akash/icddr,b.

The center, which is over 50 years old and was originally created by the U.S. government to work on health care issues on the ground, is now the most experienced hospital in the world in treating cholera. The World Health Organization estimates that cholera can kill as many as 142,000 people a year.

"We offer a unique combination of lifesaving, free-of-cost care which provides evidence for innovative clinical research," Dr. Khan told A Plus in an email. "We do not turn anyone away. The motto of this unique and largest diarrheal diseases hospital is 'no single patient suffering from diarrheal diseases should die from dehydration alone.'"

That mantra and the work it inspires aren't going unnoticed. This week, icddr,b will be receiving the Conrad N. Hilton Foundation's annual Humanitarian Prize of $2 million. Dr. John Clemens, the executive director of icddr,b, said the hospital was honored to receive such a prestigious award.

"The award will support our work on innovation for public health in developing countries," Dr. Clemens told A Plus. "Throughout our history, we have been an innovation hub for low-cost innovations that save lives in developing countries."

The list of those innovations is lengthy and impressive: icddr,b helped formulate a breakthrough study that showed oral cholera vaccineswere far more effective than injections, which the medical journal Lancet called one of the most important medical advancements of the 21st century, Researchers at icddr,b also proved that community health programs have a greater chance of success with female health workers on the ground. They were the first to show a tetanus vaccine in pregnant women was also effective on the newborn child. They even developed the low-cost ventilation system called a bubble C-PAP, a simple tool made of plastic tubes to help children with severe pneumonia in the developing world breathe. Pneumonia is the no. 1 killer of children in the developing world, and the mechanical ventilation systems in the developing are often unavailable in hospitals where these children live.

But, perhaps most importantly, icddr,b helped develop oral rehydration salts, also known as ORS. The treatment, which involves rehydrating patients with a solution of water, salts and sugars, is credited with saving more 50 million lives, according to Dr. Clemens. If given to a cholera patient quick enough, it can save their life without the more invasive treatment of intravenous fluids. 

"We basically have helped refine treatment for cholera where virtually no patients should die," Dr. Clemens said. "We are regularly called upon by WHO [World Health Organization] to send our teams of physicians and related personnel to provide training and assistance in these cholera epidemics."

Those epidemics have occurred in South Sudan, Haiti, northern Iraq, Ethiopia, Somalia, Zimbabwe, Mozambique and even amongst Syrian refugees. Because the disease only shows symptoms in one in 10 people, it can spread quickly before it starts taking lives. Cholera thrives in what Dr. Clemens described as squalid conditions, most commonly impoverished communities where access to clean water and sanitation practices are uncommon.

A child takes an ORS treatment. 
A child takes an ORS treatment.  ©GMB Akash/icddr,b.

Most recently, an outbreak of cholera has run rampant in war-torn Yemen, where more than 390,000 people have been diagnosed with the disease in three months, and 2,000 have died. Dr. Clemens is in the middle of discussions with WHO on how they can help get his team to Yemen in order to help.  

Meanwhile, at icddrb, Dr. Khan and Dr. Clemens will see about 300 to 350 patients in an average day. Over the course of the year, icddrb hospitals — with a staff of 4,500 people — will see more than 200,000 patients. Now, having so much success with cholera, they've expanded to treat other infectious diseases, internal child health, malnutrition, reproductive health, even health systems in non-communicable diseases. 

"One can well imagine the average number of smiles from cured patients that I encounter walking down the corridors," Dr. Khan said. "And it fills my heart in leaps and bounds to the fullest satisfaction of my mind."

Doctors at work in the icddr,b. 
Doctors at work in the icddr,b.  ©GMB Akash/icddr,b.

Dr. Clemens says that broader work, along with what they have accomplished on cholera, will be a great asset to not just Bangladesh, but also to the world. He noted that infectious diseases and the mitigation of outbreaks is something that can impinge upon populations living in the most affluent countries, as evidenced by the recent outbreak of Ebola in the United States. 

"It's now well recognized that geopolitical stability in the world depends on economic stability and the kinds of diseases that affect the developing world," Dr. Clemens said. 

Dr. Khan echoed that sentiment.

"As we saw with the ebola virus outbreak, poor surveillance measures, weak international collaboration and insufficient response capacity meant that it took many months to control the spread of the disease," he said. "On the other hand, best practices that have been developed and tested over many years in organizations like icddr,b can, and do, put a stop to the spread of disease in outbreak situations."

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