Preventing and treating typhoid

Tens of thousands of earthquake survivors are now living in temporary settlements like this one--environments where a typhoid outbreak could spread very quickly.
Residents at a temporary settlement filling containers with clean water from a filtration system installed by Operation Blessing. Systems like these can help prevent a typhoid outbreak.

A 34-year-old man suffering from fever, diarrhea, fatigue, and acute pain in his abdomen recently arrived at the General Hospital (HUEH) in Port-au-Prince, where a Partners In Health/Zanmi Lasante-affiliated medical team examined him.

X-rays revealed a tear in the patient’s peritoneum, the membrane lining the abdomen. The diagnosis: typhoid.

Typhoid is a disease most often present in poor communities in developing countries. The illness is transmitted by the ingestion of food or water contaminated with feces from an infected person. The infection leaves a person dehydrated, diarrheic, and feverish. In more extreme cases, the bacteria can perforate the intestinal wall. The abdominal damage leaves the patient susceptible to a variety of subsequent stomach and intestinal conditions. If left untreated, the bacteria will spread to other organs. Perforations in the abdominal wall often require surgery.

Typhoid is not fatal if treated. The fatality rate in untreated populations ranges between 10 and 25 percent. A surgical team at HUEH operated on the typhoid patient that evening, and put him on a course of antibiotics. He is now recovering.

Although this patient probably contracted the disease before the earthquake (his symptoms first started about 2 months ago), physicians in Haiti worry that the unsanitary and crowded conditions in the displacement camps surrounding Port-au-Prince could fuel outbreaks of typhoid. Tens of thousands of people are now residing in such settlements where typhoid can spread very quickly.

PIH/ZL, the Haitian Ministry of Health, and other partner organizations are working to prevent such outbreaks by finding ways to provide clean water and sanitation. In addition, having medical facilities with surgical resources that are able to treat patients suffering from typhoid is also a concern. The collapse and severe damaging of various major medical centers in and around the capital has seriously limited surgical resources.

Dr. Natasha Archer, a PIH physician currently working at the HUEH, recently sent an email calling attention to the 34-year old patient, and stressed the importance of having capable medical facilities.

Sent: Sunday, February 07, 2010 8:56 AM
Subject: Overnight events

This is an example of the excellent care volunteer teams with PIH have been able to provide for the people of Haiti 24 hours a day, 7 days a week. It also highlights the desperate need for the access to essential and emergency surgical care in resource-limited settings. With the tragedy in Haiti and resulting lack of clean water and food, a number of typhoid cases will present to the hospital in the next 6-12 months if not years to come. Many of those will lead to abdominal perforations that require surgical care and thus the development of anesthesiology and surgery departments at the General Hospital. It is critical that we continue to focus our efforts on acquiring funds to develop and maintain the education and training of such physicians in resource-limited settings.  It will save lives. 

--Natasha

Dr. Archer is a medical resident at Brigham and Women's Hospital.