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When the earthquake devastated Port-au-Prince, Haiti, ten months ago and left over a million people homeless there was considerable media coverage about the possibility of an epidemic of cholera developing.  Because vast numbers of people were living in tent cities with unsanitary conditions, they were at extreme risk for an epidemic then. The reason why cholera didn’t strike sooner is simple. It takes an infected person to initiate and spread the disease and apparently no one had cholera.

Cholera is a disease which is spread by human waste and because cholera causes intense diarrhea, it is easily spread by fecal matter laying about. There were lots of children running around in these tent cities and it would be impossible to monitor them constantly to prevent them from drinking water they found when they were thirsty and from pooping and vomiting when they were sick and had to go. The lack of instantly available and convenient fresh water and the lack of toilets and a good sewage disposal system to eliminate the waste from the toilets, such as would exist in these tent cities, makes an epidemic virtually inevitable once a single person has the disease. Therefore, the obvious way to control cholera was to provide excellent toilet facilities, inform the children constantly on proper disposal of fecal matter and if a single case of cholera occurred anywhere near this disaster zone to blast the area with the available medical treatments. [Update: 2011 12 08. Also to prevent children from drinking foul water place bottled water everywhere there are children. A child should have a bottle of clean water visible at all times.]

A couple of weeks ago there was a story on TV by a reporter visiting the storage facility for the medical supplies appropriate for this disease located in Port-au-Prince. The reporter was giving the functionary in charge a hard time because he wasn’t releasing some of the large supply of medicine he had on hand to send to a town outside of the city who were reporting some cases of cholera. He said he couldn’t release any of it because it was being stored for a serious epidemic right there in his city. “But if you send the supplies to the town just down the road to prevent the few cases from spreading there won’t be a giant epidemic here.” To which there was the typical bureaucratic response, “I have to take care of my own business and not other people’s problems.”

So, now that the epidemic is taking off, there will be a major disaster because more than a million people are at risk and cholera typically kills a large percent of those who get it if they are not treated. The coming disaster is not a bureaucratic oversight it is so much worse than an over-site I don’t know what to call it. How about murder, or genocide? One can only hope the people who could have prevented this disease but who clearly and intentionally did the wrong thing have the opportunity to suffer cholera themselves without the treatments and medicines which they refused others.

Another thing is bothering me at the moment. The lack of real information masquerading as good information. Here is a particularly egregious sample from the primary authority The World Health Organization (WHO)

Treatment of cholera

Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient’s life.

Left untreated, however, cholera can kill quickly following the onset of symptoms. This can happen at a speed that has incited fear and paralyzed commerce throughout history. Although such reactions are no longer justified, cholera continues to be perceived by many as a deadly and highly contagious threat that can spread through international trade in food.

That was the cure for cholera from the highly respected WHO web page and from the Mayo Clinic:

Cholera requires immediate treatment because the disease can cause death within hours.

  • Rehydration. The goal is to replace fluids and electrolytes lost through diarrhea using a simple rehydration solution, Oral Rehydration Salts (ORS), that contains specific proportions of water, salts and sugar. The ORS solution is available as a powder that can be reconstituted in boiled or bottled water. Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than 1 percent.
  • Intravenous fluids. During a cholera epidemic, most people can be helped by oral rehydration alone, but severely dehydrated people may also need intravenous fluids.
  • Antibiotics. Recent studies show that a single dose of azithromycin (Zithromax, Zmax) in adults or children with severe cholera helps shorten diarrhea duration and decreases vomiting.
  • Zinc supplements. Research has shown that zinc may decrease and shorten the duration of diarrhea in children with cholera.

It sounds good if you have a doctor prescribing these things to you and you are in a hospital but what if you are in a remote tent city and don’t have that option. What is ORS and those other drugs and can you make them at home? What is ORT and ORS?

They say the treatment for cholera is fairly simple. Plenty of fresh water with salts and sugar but instead of saying it that way, why not say, plenty of freshly boiled water with X sugar and X salts (?) per liter. That would be useful information. The problem of course was caused because the victim didn’t have clean boiled water, or clean sugar and who knows what salt they are recommending; just plain old table salt or some other strange concoction like in expensive sports re-hydration drinks. What does any of that actually mean to someone living in squalor?

Wikipedia, the amateur resource, gives much better medical advice on oral rehydration than the pros do for what can and should be done at home. The article is based on WHO and standard medical practice but is much easier to find without so much intermediary distractions and advertising. When people are sick they don’t have the time to wander around the internet with useless generalities; they want to know what to do right now and how to do it.

Here is the doctor’s formula for Oral Rehydration Solution (ORS)

(g/L) grams per liter — table salt 2.6, glucose 13.5, potassium chloride 1.5, trisodium citrate 2.9, and apparently a standard zinc “vitamin” pill. This of course assumes you have a gram balance scale available and can measure how big a liter is with some accuracy.

The at home preparation Oral Rehydration Therapy (ORT)

An example of a home formula is — 1 level teaspoon of salt, 8 level teaspoons of sugar, and (optionally) 4 ounces (113g) of orange juice; mixed into 1 liter of clean water. If the water source is questionable, it should be boiled for 10 minutes and allowed to cool before mixing the solution.

That is advice that would make a real difference for acute diarrhea and might save your life if medical intravenous electrolyte treatment isn’t available. The reason this recently discovered solution works so well at reducing deaths is because the intestine needs salt and sugar to pass water and salt back through the cell walls back into the body.

What are the lessons to be learned from this?

  1. Start with a google or bing search and then go straight to;
  2. Wikipedia for quick answers and then do the other sites as needed.
  3. Bureaucrats will do what is best for themselves rather than what is best for their clients.
  4. For serious problems you must take care of yourself and your loved ones.
  5. You need to have prepared yourself with good information not news blat.
  6. Treat diarrhea with 1 teaspoon salt, 8 teaspoons sugar in 1 liter clean water.
  7. When all else has failed be prepared for the riots such as are now occurring in Haiti and will get worse because of the continuing problems.
  8. Be somewhere else when the shit hits the fan, especially when the shit is laden with cholera.