MSF treatment for diarrhoea

The treatment of diarrhoea is essentially the treatment of dehydration - which involves simply replacing all the fluid being lost. This process is called rehydration. MSF treats many patients using oral rehydration solution, called ORS. This is a mixture of glucose and electrolytes (such as sodium and potassium) that comes in sachets. Each sachet is stirred into a litre of water and provides the correct balance of electrolytes to rehydrate a cholera patient. It has been said that in global terms ORS is the most important medical discovery since penicillin. However, many of our patients, especially those with cholera, vomit so profusely that they cannot drink ORS. MSF therefore treats serious cases by putting in intravenous drips. These IV infusions contain fluid and electrolytes. Some patients lose fluid so quickly that they need two drips, one in each arm. The challenge for an MSF doctor or nurse is to find a vein in a profoundly dehydrated patient - for as the patient loses fluid their veins collapse. Treating serious cases requires a high degree of skill and experience. In most cholera outbreaks MSF teams are able to limit the case fatality rate to less than 1 per cent. Most forms of diarrhoea do not require any treatment other than rehydration. Cholera patients, however, are usually given an antibiotic called doxycycline, which has been shown to shorten the period of severe diarrhoea. Another form of diarrhoea, Shigella dysentery, also requires antibiotics, because of the serious complications that may accompany it.