Episode: "Country Nurse"
LEONE | AFGHANISTAN
While treating a young boy with meningitis in this episode, Dr.
Rachel Hardwick, working in Afghanistan, says she sees a lot of
meningitis cases. What causes meningitis?
There are two types of meningitis: viral and bacterial.
Viral meningitis is less severe and usually goes away without treatment.
Antibiotics are prescribed for the more severe bacterial form of
the disease. Since Dr. Hardwick began treating the boy with antibiotics,
we can assume that he has contracted bacterial meningitis.
Meningitis is an infection of the membranes that covers
the brain and spinal cord. The most dangerous form of the disease
is caused by the bacterium Neisseria meningitidis, commonly called
the meningococcus. This germ is serious both because it is highly
virulent for the individuals it affects and because, unlike most
other causes of meningitis, it has the potential to cause epidemics.
The meningococcus resides in the nose or throat of
health carriers – people who do not themselves fall sick because
they have a measure of natural or acquired immunity. They can however
spread it to others, and classically this tends to occur during
the dry season. (Because the bacteria can attach itself to dust,
it can sometime be spread in this way.) If the meningococcus falls
upon a susceptible (non-immune) person, it can invade the tissues
of the nose and throat. It then multiplies rapidly and spreads into
the blood stream and up to the brain.
The case fatality rate for untreated meningococcal
meningitis approaches 50%, and even those people who survive may
sustain serious brain damage, causing disabilities such as paralysis
or deafness. Even when it treated early and appropriately, meningitis
is an extremely dangerous disease and the patient cannot always
be saved – the case fatality rate tends to be between 5 and
15%. Children under five and those with compromised immune systems
are most at risk.
In this episode, why does Mary Jo Frawley,
RN, working in Sierra Leone, have a hard time finding a vein for
an IV when treating a dehydrated child?
Finding a vein for an IV in a profoundly dehydrated
patient is extremely difficult because as the patient loses fluid
their veins collapse.
What is the benefit of treating a child with
water laced with sugar and salt?
Electrolytes are salts such as sodium and potassium
that are essential to the functioning of every cell in the body.
Diarrhea often causes a person to lose both water and electrolytes,
which can lead to potentially deadly dehydration. When the internal
organs lack both water and electrolytes, they will begin to fail.
Death from dehydration usually occurs when 10 to 15% of the total
body weight is lost.
The treatment of dehydration involves simply replacing
all the fluid being lost. This process is called rehydration. MSF
treats many patients using oral rehydration solution, called ORS.
ORS is composed of a mixture of glucose and electrolytes that is
similar in chemistry to a person’s “body water”
thus allowing for the quickest and most effective rehydration. It
has been said that in global terms ORS is the most important medical
discovery since penicillin.