(July 8, 2011 - by Ralph Kurtenbach) The seven members of the second medical team from Ecuador this year are treating patients at a cholera treatment center in Cité Soleil, Haiti, after their arrival Tuesday, July 5. This is the eighth HCJB Global Hands team to travel to Haiti from Ecuador since a devastating earthquake struck near Port-au-Prince on Jan. 12, 2010.

Members of the eighth medical team from Ecuador to visit Haiti since the January 2010 earthquake (back row, left to right): Clara Chuma, Dr. Richard Douce, Ralph Kurtenbach; front row: Ruth Telenchana,  Ana Villacrés, Juanita Buñay. Not pictured is Paulyna Orellana.

The healthcare workers are physicians and nurses from a Quito hospital and a clinic operated by HCJB Global Hands, helping in Haiti for two weeks.

The latest medical team to arrive in Haiti is being led by Dr. Richard Douce, an infectious diseases specialist who observed that “even though cholera is a tragedy it is actually gratifying to treat cholera patients. Most of the people that are going with us have worked in healthcare most of their professional lives and we rarely see such immediate results that we do with cholera.”

One of the nurses is Clara Chuma who works in the intensive care unit. Another, Ruth Telenchana, is bilingual in Spanish and French. In earlier short-term, cross-cultural work, she traveled to the Republic of Congo to assist in hospital administration at Pioneer Christian Hospital in Impfondo. A third nurse, Juanita Buñay, works at a satellite clinic associated with Hospital Vozandes-Quito. “Their main function will be to start IVs,” Douce said.

All three nurses have been involved in Corrientes since it was launched by HCJB Global and other partners in late 2009. Corrientes is a coalition that is working to train Latin Americans to serve as bi-vocational Christian workers throughout the world.

Along with Douce, family practice physicians Paulyna Orellana and Ana Villacrés are working at Cité Soleil. Orellana has graduated from two residency programs in surgery and family practice, and Villacrés is now in her second year in the family practice residency at Hospital Vozandes-Quito. The team is accompanied by Ralph Kurtenbach who is handling logistics and communications. The cholera treatment center is operated by Samaritan’s Purse (SP).

“We try to replace whatever amount of water and electrolytes the patients lose because of diarrhea,” Douce added. A medical team headed by Dr. Mark Nelson in June administered 108 liters of IV fluids to a single patient before he recovered.

“I was involved in the cholera epidemic we had here (in Ecuador) in 1993, and found that while cholera is a tragedy, I very much enjoy saving lives,” Douce related. “People arrive half dead and they respond fairly rapidly to treatment.”

“The mortality rate [of cholera patients who come to facilities operated by] Samaritan’s Purse is less than 0.7 percent, so the mortality is probably lower than in other treatment centers. They’re very well organized,” said Douce. Until the 21^st century, cholera epidemics often had a mortality rate of about 50 percent.

“Now that we understand the pathophysiology involved, the mortality of cholera epidemics around the world has fallen to less than 1 percent,” he added. “It’s a very treatable disease.” A dose of antibiotics is administered against the cholera bacteria, with much of the rest of treatment consisting of rehydration.

Much of the patients’ spiritual care is left with SP chaplains. “We’re just going to be servants helping save their lives and hope that Samaritan’s Purse and the Holy Spirit work in the people’s lives,” Douce said. “But in the process we’ll be doing Christian fellowship every day. In my previous experience, it is an opportunity to help us (team members) to grow spiritually.”

During their missions career in Ecuador, Douce and his wife, Marian, have also served short-term at a missions hospital in Malawi, helping with HIV/AIDS patients.

Source: HCJB Global

(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

(June 3, 2011 - by Ralph Kurtenbach) An international team of medical professionals is set to leave Ecuador on Saturday, June 4, to spend two weeks responding to an urgent need to care for cholera patients in Haiti.

Dr. Mark Nelson helps cholera patients during an outreach in November 2010.

In Ecuador, physicians Dr. Mark Nelson and Dr. Mattias Egberth, along with nurses Kim Kirk and Sandra Paredes, moved quickly. They will travel to a rehydration center at Cité Soleil where cholera patients are already receiving intensive oral and intravenous rehydration at a facility operated by Samaritan’s Purse (SP).

HCJB Global’s Hermann Schirmacher received an urgent appeal earlier this week to help out at SP’s tent medical facility that is full of cholera patients. “They (SP’s staff) know us—that we’re very flexible,” Schirmacher said. “We’re agile, we can quickly put together a team, and we’re close by. We don’t have to travel across half the continent to get to the Caribbean.”

Dr. Mark Nelson urged prayer “that our team would work well together and for strength and wisdom in dealing with patients with complex cases.”

SP established the Cité Soleil rehydration center near Haiti’s capital to confront a cholera outbreak that began in late 2010. At that time HCJB Global Hands responded with two medical teams, one of which Schirmacher led in mid-December.

By Tuesday, May 31, the SP triage tent was completely full, according to the North Carolina-based mission’s website. “Our volunteer work crew came out to help hang intravenous boards and build another triage tent to handle the load,” the site reported. In just one day last week, nearly 100 patients were treated in the tent.

The cholera center is a 200-bed facility located near a church, school and clinic. It’s in an area where a large “tent city” was set up after Haiti’s devastating earthquake in January 2010.

Upon his return from a mobile medical clinic in rural Ecuador, Dr. Steve Nelson outfitted the team with antibiotics, oral rehydration packets and intravenous kits for fluid replacement, iron for anemia, antifungal medicines, asthma medications and vitamins to take to Haiti.

As with earlier HCJB Global Hands teams that responded to Haiti’s devastating earthquake and subsequent health crises, this team is also international. Nelson is a U.S. citizens with decades of overseas living—primarily in Venezuela and Ecuador. More recently, Kirk came to Ecuador from the U.S., and Egberth is a Swedish surgeon. Paredes is an Ecuadorian who had served temporarily at Pioneer Christian Hospital in Impfondo, Republic of Congo, in 2008.

Cholera causes severe, dehydrating diarrhea. During cholera relief work in Haiti last November (his third trip in 2010) Mark Nelson wrote, “It’s really sinister how quickly and quietly patients go down. The volume of fluid lost [goes] really fast.” Left untreated, the malady can kill children and adults in fewer than 12 hours.

The cholera strain that swept through areas of Haiti made its first appearance there in nearly a century. Among the first victims were people living near a U.N. outpost in Mirebalais.

This month a U.N. panel that investigated the 2010 outbreak found “circumstantial evidence suggesting that U.N. peacekeepers may have introduced a lethal strain of the disease into the Haitian population,” reported The Washington Post. The late 2010 outbreak killed an estimated 4,500 Haitians while sickening another 300,000.

Although team members don’t know exactly what to expect, their biggest concern could be the weather. “There is a 30-percent probability of a cyclone forming during the next 48 hours,” said Schirmacher. “I don’t expect any problem with our flight, but there could be heavy rains during our time in Haiti.”

Sources: HCJB Global, Samaritan’s Purse, The Washington Post

(December 17, 2010 - by Ralph Kurtenbach) It was the mother’s face that spoke to an Ecuadorian nurse about the seriousness of the condition of a little girl lying on the cholera cot before them.

The mother, who only speaks Creole, had brought her baby daughter to Bercy, a city near Port-au-Prince, Haiti, where cholera has reached epidemic proportions in recent weeks.

“She was able to transmit through the expression of despair in her face—and her gestures—her desire that I save this piece of her heart,” wrote María Isabel Manguia, a nurse who serves with HCJB Global Hands in Quito, Ecuador. She was part of the sixth medical team from Ecuador to visit Haiti since the devastating quake last January.

The girl lay on the cot, malnourished, her body flaccid. “At first I thought she was dead. Her skin was so cold—as cold as ice. She was rigid and unresponsive even to pain,” said Manguia. “But when I listened for a heartbeat I heard an almost imperceptible pulse that gave me hope.”

Once an IV was started, the little one began to respond—the “Lazarus effect” as it is called by those HCJB Global Hands workers returning from short-term trips to Haiti where the mission works with Samaritan’s Purse.

“I was happy to see the little spark of life that still remained begin to increase rapidly. Her sunken eyes and her skull-like face were transforming,” Manguia observed. “Her body began once again to move as she raised her hand and sought her mother’s arm. In that moment I could see anew how wonderfully loving our divine Creator is.”

But team leader Hermann Schirmacher is new to all of this. He can wire an office for electricity, establish computer networks and do a host of other things. However, watching someone die is another matter for the husky, jovial German, on his third trip to Haiti in the last nine months.

“One of our patients was a 70-year-old man who never recovered from the damage of the cholera bacteria,” he wrote, “After having received four liters of fluids, he passed away. Tears filled our eyes and sadness gripped our hearts.”

“Today my heart breaks for a child,” Schirmacher also wrote, adding that he attempts to keep emotions in check so his work is not affected. “The case of Emilien was different,” Schirmacher said of a 7-month-old boy whose father brought him to the cholera clinic at Bercy.

“His pulse was weak and he had cholera. The mom had died two months earlier leaving the father as a single parent with three children,” he wrote.

“I’m going to prepare a letter so the child can be delivered to someone who can take care of him,” the father told Schirmacher. “I can only take care of the 4-year-old and the 7-year-old.”

Orphanages in Haiti have many children whose parents were victims of either the January 2010 earthquake or the cholera outbreak of late October.

Working in the patient triage area, Manguia has been training to start IVs, and a Haitian nurse named Maxi has been a quick study on the procedure. She, in turn, has begun training others. This is critical as Manguia and the team will soon head back to Ecuador, where she’s a head nurse in the emergency room at Hospital Vozandes-Quito.

Manguia wrote to her own little girl in Ecuador, “My dearest daughter Genesis, I am doing what you asked: ‘Save the dark-skinned people, Mommy. Save a whole bunch of them!’”

Source: HCJB Global

(December 10, 2010 - by Ralph Kurtenbach) Treating Haitian cholera patients during a 13-hour overnight shift was tiring enough, but several Ecuadorian physicians found their napping afterwards interrupted when the call came to get up and go.

Writing of the short “night” earlier this week, team leader, Hermann Schirmacher said some had just dozed off when their hosts charged into the room saying, “You have 10 minutes to get ready and leave immediately to go to Bercy to relieve a medical team. By tonight we think there’s a possibility of protests.” Such protests are often accompanied by blocked streets and highways in Haiti.

This HCJB Global Hands team represents the sixth medical team from Ecuador working in Haiti following the devastating January 2010 earthquake. Schirmacher, a Paraguayan of German heritage, has led half the teams. Challenges have arisen before. His October team’s return to Ecuador looked tenuous as Hurricane Tomas raged through the Caribbean.

Thankfully, this team’s flight out of Port-au-Prince occurred without incident. Team members had only seen a few cholera patients, but the subsequent team focused solely on cholera patient care as the disease spread. The teams’ host, Samaritan’s Purse (SP), has also shifted all of its response to cholera patient care.

Having missed supper before their overnight shift, team members didn’t like the prospect of eating military meals-ready-to-eat (MREs) once they arrived in Bercy. But team leader, Schirmacher met this challenge. “I told the chef to hurry up so I could take along a decent meal for them,” he recounted, adding with a smile. “If not, I was going to take him along with us! We managed to pack on ice a nice meal with salads and some canned drinks.”

“We arrived at Bercy and reviewed the patients of the other shift,” Schirmacher continued. “This was quick so as to get them on their way to the SP base before nightfall.” Then with all patients stabilized, Schirmacher and the team sat down for a meal.

Other team members included family practice medical residents Dr. Ruth Jimbo and Dr. Betsabe Tello, family physician Dr. Joe Martin Isabel Manguia and two nurses, María Isabel Manguia (head emergency room nurse) and Silvia Ilcachiat from Hospital Vozandes-Quito.

Haitian health officials claim the cholera epidemic has already claimed more than 2,120 lives, but U.N. Secretary General Ban Ki Moon believes the actual number of cholera infections and deaths could be twice as high as reported numbers. The disease is concentrated in slums and rural areas where accurate reporting is difficult.

The U.N. leader also cited estimates by the Pan-American Health Organization and World Health Organization that the epidemic could affect as many as 650,000 people in the next six months.

More than 60 patients were treated at the SP cholera treatment center in Bercy with 70 patients treated in Cité Soleil. “Usually 20 to 25 people would leave each day with the same number coming in,” Schirmacher explained. “Patients usually stayed two to three days.”

Since the cholera outbreak began in late October, SP teams have treated more than 3,829 cholera patients. Additionally, 20 water filtration systems have been installed in Cabaret.

Late on Tuesday, Dec. 7, thousands of people took to the streets in Port-au-Prince after first-round results of recent presidential elections were released. Demonstrations also erupted in several other cities.

Sources: HCJB Global, BBC, Samaritan’s Purse

(November 19, 2010 - by Ralph Kurtenbach) A medical team from Ecuador is traveling to the besieged Caribbean country of Haiti amid a death toll from cholera that is careening ever higher.

Up to 200,000 Haitians could contract cholera as the waterborne illness spreads, the U.N. reported on Nov. 12. Haiti’s Ministry of Public Health had put the death toll at more than 1,100 deaths earlier this week with nearly 18,400 hospitalizations. But, U.N. aid agencies noted that these statistics are several days old. The true number of deaths and hospitalizations could be even higher.

Earl Hartwig, a Canadian, is leading an HCJB Global Hands team that leaves Quito on Saturday, Nov. 20. He asks that people pray the seven-person team would flex to do whatever they’re assigned to by their host, Samaritan’s Purse (SP).

Hartwig also desires that “in whatever we do in the long hours and possibly in the disappointing moments when someone dies, that we will shine the light of Jesus to everyone who comes in contact with us.”

Two people have died in riots that erupted in the north, as protesters accused U.N. peacekeepers of bringing in the disease. The assertion has been denied by the U.N., but Haiti’s health experts have requested an investigation into whether Nepalese peacekeepers introduced a strain of cholera to Haiti which had documented no cases of cholera before October.

Luggage brought in by the HCJB Global Hands team was tightly packed with medicines, but even at nearly 500 pounds of pharmaceuticals they’re not able to transport everything requested by SP. They’ve packed some extra clothing or personal effects into carry-on bags; medicines occupy the rest of their suitcases. Team members with Hartwig include Juanita Buñay, Dr. Manuel Catani, Dr. Mauricio Coronel, Dr. Evelyn Hidalgo and Ruth Telenchana.

Four previous HCJB Global Hands teams have traveled from Ecuador in 2010. This marks the first trip to Haiti for Telenchana, a French-speaking Ecuadorian nurse. Her prior mission trips to Impfondo, Republic of Congo, for medical work saw her French put to good use. The team represents a cross-section of Ecuador’s society: Buñay, a nurse, is Quichua, and Catani, a physician in residency at Hospital Vozandes-Quito (HVQ), is Shuar.

Another HVQ residency physician, Hidalgo, will serve on the team along with Coronel who was mentored in medical missions by HCJB Global physicians. In addition, Buñay is being mentored through Corrientes, a Latin American missions mobilization initiative directed by Hartwig.

Since January 2010 SP has been involved in different aspects of Haiti’s recovery following a devastating earthquake. With the cholera outbreak, SP has shifted its medical efforts to focus solely on treatment of cholera patients and control of the waterborne disease. More than 10,000 SP shelters have been set up across the earthquake-affected areas. The mission has also provided sanitary latrines, water and nutritional training.

Sources: HCJB Global, VOA News, CNN, Samaritan’s Purse