There was a wedding...

…last night in Karagora, a tiny village about a thirty minute walk from the clinic. It was, by all accounts, a successful wedding. The celebration was festive, and people ate and drank. Specifically, they ate rice and beans and I do not know what else; and they drank a non-alcoholic brew made from the juice of bananas. A neighbor of the happy couple prepared the drink for the joyous event. Nurse Maneno (one of our best nurses, I should add) is a cousin of the bride. He was invited to attend, but, unfortunately, duty prevented him from doing so: he was on call at the clinic yesterday and last night. Yet it was much of his family that was in the wedding party. The bride and groom celebrated into the night, and we can only wish them the best in their married life.

I jump ahead in my narrative to this morning at 7 A.M. I was about to make rounds on the patients that I have in the hospital, among whom is a very ill, one year old girl. I approached the hospital corridor, and I was astonished to see at least 25, maybe even 30 men and women, all of whom were doubled over with abdominal pain in between bouts of severe vomiting. Here are pictures of that scene. You do not see some of the patients, who are off in the bushes vomiting.

The story is this: approximately six hours after the conclusion of the wedding, the entire village was awakened by the sounds of men and women screaming in pain. These same men and women were also retching uncontrollably outdoors. It was quickly apparent that all of the affected people had attended last night’s wedding. A decision was made to rent a truck to bring all of these sick men and women to our clinic. Where they got the truck I do not know. Suffice it to say that they got it.

The groom, who had been unaffected by this scourge, made a call to Cyriaque, who is the official on call doctor for the clinic this weekend. Cyriaque was informed that the truck was coming. I cannot imagine the ride up the hill with all of these sick patients. Cyriaque had been called at about 6 A.M., and the truck arrived at the clinic about 7 A.M. The patients were unloaded, and quickly triaged. It seemed that they were all equally ill.

I had not seen Cyriaque yet that morning, so I was unaware of the unfolding drama. That’s why I was so surprised to come upon the scene that was both chaotic and controlled, if such a thing is possible. There are two nurses on call each weekend day. The two nurses on call Saturday were the aforementioned Maneno and Feliaze. They should have left when the nurses on call Sunday, Peter and Joseph, came on duty Sunday. Instead, they stayed to help.

The four nurses worked feverishly to get I.V.’s into the 25 or 30 patients. We then opened boxes of Ringer’s Lactate I.V. solution. The solution was attached after the I.V. was inserted, and the patients were soon being effectively rehydrated. The patients were then placed on beds in the various wards. I show you one such ward with several of the affected patients. The other wards were similar.

I must give credit to the four nurses who worked so calmly and efficiently this morning. Their efforts were nothing short of heroic in the midst of what could have been a medical disaster.

It was obvious what we were dealing with: food poisoning. It was equally obvious that the onset of the illness was of acute duration: 6-8 hours after the responsible item had been ingested. Food poisoning that acute, especially one that manifested with vomiting and abdominal pain, was almost certainly caused by a toxin that was self-limited. The only treatment needed was supportive, meaning I.V. hydration. We were doing that. No other medication was needed.

Cyriaque and I did what the CDC might do in this case: we took a history of the food and liquid consumption. The dishes served at the wedding consisted of rice and beans, and perhaps some vegetables. Then, at what we might call the after-party, the banana drink made by the neighbor was consumed. It appeared as if the people who ate the rice and beans, but who did not go to the so-called after-party were unaffected. The people who went to the after-party, the ones who drank the banana concoction were the ones affected.

Cyriaque and I were driven in the ambulance down the mountain to Karagora, where the events took place. We were in search of the contaminated items. Here are pictures of the villagers, as they greeted and gathered around us.

We were fortunate, because there was still a remaining portion of the banana brew and the beans. The brew had been placed in a plastic bottle for us, and the beans in a plastic bag.

I show you a picture of Cyriaque talking to the villagers before we left. What Cyriaque is saying is that we don’t know what caused the food poisoning, and that no one should be blamed. The reason he is telling them this is because, if they think the neighbor who made the banana brew is responsible, there is a good chance that they will kill him.

I now show you another picture of the ambulance before we left the village. As you can see, the back of the ambulance is crowded with equally sick villagers. The truck had been unable to accommodate all the ill people of the village. These patients were taken to the hospital in Rumonge, because our resources had been stretched to the limit.

It seems as if the banana drink was the tainted item that caused the food poisoning. Yet we cannot be sure, because it also seems that there were others who were equally ill who did not consume the drink. Among those was the bride herself. We brought the samples of the food and the drink back to the clinic. However, we do not have the means for an analysis. We are hoping that there is a laboratory in Bujumbura that can do that. Knowing what caused the poisoning won’t change anything, but it is, if nothing else, of academic interest.

All the patients at the clinic received two bags of Ringer’s Lactate solution. Their symptoms have abated by now, and we should be able to discharge all of them by this evening. A medical disaster has been averted.

I have been told that this kind of mass food poisoning at events like weddings is not unusual in Burundi, especially in the outlying areas of Burundi. However, this was a first for our clinic. 

Just another quiet Sunday at the clinic.