22 June 2012
Twenty dead. How many more to go? How this crisis ends will depend on a variety of factors. Namely, the virulence of the V. cholera strain that is wreaking havoc on our community, the immune system of the residents who are potential victims, the availability of diagnostic and treatment modalities in our health centers, the health officials’ will to make use of every available resource to battle this scourge, and the concerted effort of all citizens in disseminating the necessary know-how to fight it off.
Cholera is a disease synonymous with poverty, ignorance and filth. In countries where sanitation infrastructure is well in place, cholera is merely read in history books. But in a small community where 20 people die from the disease in a matter of a few days, we know we have a lot of work to do.
Once, cholera was thought to be a punishment from God for the sins of man. Like the plague that descended from the sky on Egypt to kill every first-born son, it was a manifestation of a vengeful God bent on getting even. But science has gone on to prove that there is more to this illness than an eye for an eye, a tooth for a tooth.
Cholera is caused by Vibrio cholera that we could ingest from food or water contaminated by the feces of patients with cholera. We do not necessarily have to eat their feces. There are many ways for fecal matter to find its way to our table. A waiter who did not wash his hands after coming from the toilet, a leaking septic tank 5 meters away from a broken water pipeline, a fly that perched on your rice, a neighbor who throws soiled diapers into the neighborhood vacant lot, and so much more. This is one case where ignorance is never bliss.
Once it gets inside our mouth, it gets into the stomach where most of the bacteria are killed by gastric acid. The few that survive are brought to the intestines and begin to multiply. These start to manufacture a protein that interacts with the host intestinal wall cells. It prevents Chloride ions from entering the cells leading to an accumulation of Sodium (Na) and Chloride (Cl) in the intestines. This creates a high osmotic pressure that sucks water into the lumen at a rate of 6 liters per day.
From the pathogen’s point of view, this is a sure-fire method for the propagation of its species. Six liters of heavily infested watery stool will most likely be able to infect another unwitting human being, in turn perpetuating the cycle. But from the host’s point of view, six liters of water expelled from a species with only 5 liters of circulating blood will mean certain death. The reason patients die within two days of onset of diarrhea. Four IV lines (one on each limb) are sometimes not enough to save their lives.
So what can we do to win this war between the microscopic pathogen and the ignorant host? First of all, inform the ignorant so that he avoids the pathogen in the first place. Our short term goals would be frequent handwashing, stringent sanitation in the kitchen, stringent sanitation in the toilet.
Our long term goals would be (attention health and government officials) fixing our water systems whether they be the pipelines that bring clean water to us, or the pipelines that take the dirt away. Far, far away, never to come back.
Once we are able to do this. Once we get used to doing this, maybe we can be assured of passing on to our children a community that doesn’t have to worry about what and where to eat and what not, what and where to drink and what not. Because if we really think about it, it will be our children who will suffer for the sins that we grown-ups have committed. And it wouldn’t even matter whether death would descend from the sky, or rise from underneath, and kill them through the very food and water that’s supposed to keep them alive.