"The Most Important Medical Discovery of the 20th Century"

Just a reminder — it wasn’t open heart surgery or sequencing the human genome:

A massive cholera outbreak in refugee camps on the border of India and Bangladesh in the 1970s exposed the limitations of intravenous treatment and paved the way for a radically different approach to treating dehydration.

In 1971, the war for independence in what is now Bangladesh prompted 10 million refugees to %ee to the border of West Bengal, India. !e unsanitary conditions in the overcrowded refugee camps fueled a deadly cholera outbreak characterized by fatality rates approaching 30 percent.’ Health officials from the Indian and West Bengal governments and relief agencies faced a daunting task: Conditions were squalid and chaotic, intravenous fluid was in scarce supply, treatment facilities and transportation were inadequate, and trained personnel were limited.’ Mass treatment with intravenous therapy alone would not halt the impending crisis.

Dr. Dilip Mahalanabis, a cholera expert at the Johns Hopkins Centre for Medical Research and Training in Calcutta and head of a health center at one of the refugee camps, proposed an alternative to the intravenous treatment. He suggested the camp use a new method of oral replacement of fluid, known as oral rehydration therapy, that had been developed in the 1960s in Bangladesh and Calcutta.

The science was as ingenious as it was simple: A solution of water, salt, and sugar was found to be as effective in halting dehydration as intravenous therapy. Dr. Mahalanabis’ team recognized the many advantages of oral therapy over the intravenous rehydration: It is immensely cheaper, at just a few cents per dose; safer and easier to administer; and more practical for mass treatment. ORT, however, had still not been tested in an uncontrolled setting, and skeptical health specialists cautioned that only health professionals and doctors should administer the new therapy.)

Mahalanabis’ team moved quickly to introduce the treatment to the 350,000 residents of the camp. Packets of table salt, baking soda, and glucose were prepared in Calcutta at the diminutive cost of one penny per liter of fluid.’ The solution was widely distributed, with instructions about how to dissolve it in water. Despite the shortage of trained health personnel, large numbers of patients were treated, with mothers, friends, and patients themselves administering the solution.

The results were extraordinary: At the height of the outbreak, cholera fatalities in the camp using ORT dropped to less than 4 percent, compared with 20 percent to 30 percent in camps treated with intravenous therapy.

From Millions Saved, case study 8: diarrhea in Egypt. Just re-reading it for a class.

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03 2011

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