…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.