Deaths due to, "cholera”, in one of the African countries have been much in news since the past 2 months or so. In fact small outbreaks of cholera do occur in communities living in poverty and with no access to clean potable drinking water.

In India, outbreaks occur at times of festivals or carnivals where people gather in large numbers and stay for 2 to 3 days together. The cause being simply that the large number of people exceeds the sanitary facilities and safe drinking water provided by organisers.

Cholera is an infection of the intestines caused by a tiny germ called vibrio cholera. This germ stays in water of the sides of lakes and rivers and can also be in other water bodies.

It can stay in foods like vegetables and fruits and rice for about a week. In dairy products and meat, it can survive up to 4 weeks. This germ is killed by heat.

Usually one acquires the infection by drinking water harboring the germ. Others may get the infection by eating or drinking food substances or drinks, contaminated by the stools or vomitus of the patient. 

Contagion may also spread by other articles like plates, glasses or even phones, contaminated by the infective material of the suffering person.

Persons defecating on sides of water bodies are a big source of both acquiring and spreading the infection. Again severity of infection depends on amount of germs acquired and immunity of the person.

There is acute onset of diarrhea with vomiting. Diarrhea is profuse with liquid stools containing abundant mucous, which has been labeled as "rice water stools”.

There is associated vomiting, abdominal pain, muscular cramps because of salt loss from body and severe dehydration.

Illness is usually short lived, but if dehydration is not corrected in time it can kill the person. Thus we can say that cholera kills with, "motions.”

That is why many people die in communities during an epidemic. One should be vigilant enough to prevent him or herself from acquiring cholera. Raw vegetables, meat and dairy products should be avoided. 

If one is at all keen on eating salads, vegetables should be washed thoroughly preferably with warm water. Only those fruits should be consumed which one will peel himself before eating.

One should not use meat, milk and milk products unless they are from a known and reliable source. Drinking water should be boiled for about 5 minutes or more, cooled and then used. 

Though fuel is expensive, but it is a wise investment to boil water for remaining healthy. Other option is to use drinking water treated with chlorine tablets.  

Washing hands thoroughly is  very important before cooking, serving or eating food. God forbid, if someone falls sick with cholera in the house.

Those nursing him should be very alert about their own   and also the patient’s hygiene to prevent spread of infection. All stools and vomited material passed by the patient should be mopped and burnt if possible. 

Otherwise it should be covered with a strong disinfectant.  Contaminated clothes and beddings should be washed in hot water and dried in sunlight.

In case of lack of sunlight, one should iron them with a hot iron, before being reused. Nails of the patient and those nursing him should be trimmed.

This removes the risk of auto inoculation (infecting himself again) on part of the sick person from germs settled below nails. It also minimizes the risk of infection in his other family members.

Early rehydration by oral rehydration solutions and perfusions is life saving because deaths occur due to dehydration and electrolyte imbalance. 

Till the time one is able to reach the hospital, he or she can be given home made rehydration solution also. This can be prepared by boiling and cooling about one liter of water. Add about 8 tea spoons of sugar and ½ tea spoon of salt to it.

Encourage the person suffering to drink as much as he can. Bananas reduce intestinal motility and also provide potassium which a person looses in the loose motions and vomiting.

Therefore eating banana is also a very useful first aid measure for one suffering from cholera, till hospital care is available.

Of course, once a person reaches any health care center he will be given necessary perfusions and antibiotics and will return home recovered.

A word of caution here. One episode of cholera does not provide immunity from further infection. Hence if the unhygienic conditions prevail, re infection is possible.

Vaccine for cholera is available but it provides immunity for a short time only. Therefore it should not be relied upon to prevent cholera for a long time.

Best course is prevention of cholera for an individual. If sick, early and good rehydration provides guaranteed cure. So there is no need to be afraid of cholera.

It should be thought of as an unwelcome visitor whose entry one should try to avoid both at home and in the community.

Dr Pande is a specialist in internal Medicine rachna212002@yahoo.co.uk
Musanze – 3rd February 2009