Upon the request of the host nation, we visited Farahad Clinic which was converted to to a cholera hospital to take care of a recent outbreak of cholera in Djibouti. To date there were over 500 cases of water diarrhea with 170 confirmed cases of cholera. The majority of cases appeared to come from Balbala and the migrant areas of Arhiba. Patients arriving with water diarrhea were initially screened in this first building.
After being screened, samples were sent to the laboratory below to determine if the sample was positive for cholera.
Farahad Clinic has set up a temporary tent hospital, dirt floors (GP medium for pediatric patients and GP large for adults), but in fair condition. Approximately 15 beds with metal frames and without mattresses provided care for the patients. Approximately another 15 litters without stands (8 drying on the wall and 5 on ground in use with patients).
Currently there were an estimated 15-20 patients (including family combinations) noted at the clinic with many flies, 2 portable hand wash stations, hard station triage area, and a hard station lab. A shoe sanitation wash station at exit to the makeshift isolation area.
Most persons infected with v. cholerae do not become ill, although the bacterium is present in their feces for 7-14 days. When illness does occur, about 80-90% of episodes are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhea. Less than 20% of ill persons develop typical cholera with signs of moderate or severe dehydration.
Cholera remains a global threat and is one of the key indicators of social development. While the disease no longer poses a threat to countries with minimum standards of hygiene, it remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed. Almost every developing country faces cholera outbreaks or the threat of a cholera epidemic.
Water and environmental sanitation is of utmost importance during cholera outbreak.. One should drink only water treated by ebullition, chlorination or filtration. House and public areas should be kept tightly clean. Pest control measures should be applied against flies, cockroaches, and rodents which can spread the bacteria. Hands should be washed frequently with soap and water, especially before eating or handling food and drinks, after defecation and after handling sick persons, their belongings or their dejections. In these developing countries, the community should be instructed to use appropriate latrines. the latrines should be regularly inspected. Solid and liquid waste should be treated and disposed of properly, by incineration or burial.
During an outbreak, all community members should be informed about the disease. The community should be informed that cholera is a highly communicable disease, caused by a microorganism and spread from one person to another through food, water and soiled hands and other items. An apparently healthy person can harbor cholera germs and transmit them to other peoples or contaminate food and water when hygienic conditions are defective. The germ is easily killed by heat (boiling water, cooking food) or by other disinfectants such as chlorine. Washing hands with soap and water help get rid of germs on hands.
For Americans traveling to developing countries like Djibouti, the Doxy antibiotics given to prevent molaria may help against molaria. However, since some strains are antibiotic resistent, medication should not preclude individuals from using good hygiene practices.
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