The city of Dhaka is surrounded by water, but it is so polluted that very little of it is drinkable. That, plus the very poor sanitation across the city, means that the people of the Bangladeshi capital not only have to scramble daily for clean water supplies but are also regularly in danger of the silent killer that is cholera. In Dhaka's Cholera Wars filmmakers Orlando de Guzman and Andrew Marshall visit the hospital that is bringing hope to the millions vulnerable to cholera in Bangladesh and elsewhere. Here they write about the experience.
If you don't like hospitals - and who apart from health professionals does? - then you would hate Dhaka Hospital during one of the Bangladeshi capital's regular cholera epidemics.
Last October, when we filmed Dhaka's Cholera Wars for Al Jazeera, the emergency ward was seething with men, women and children, many of them severely dehydrated and fighting for life. Patients moaned as nurses connected them with intravenous needles to bags of saline. Hospital orderlies pushed away trolleys piled with buckets of diarrhoea and vomit.
And all the while more patients arrived, by wheelchair or stretcher, or half-carried by fretful relatives, until they spilled out into makeshift wards set up in the parking lot.
It looked like pandemonium, but it wasn't. The Cholera Hospital, as locals call it, is efficient and deceptively high-tech. Look closely, and you will see that medical staff track each patient with handheld computers. And it is unrivalled at treating large numbers of patients with potentially fatal diarrhoeal diseases such as cholera.
"If you arrive alive at our hospital," its director Mark Pietroni told us, "then you leave alive."
We quickly realised that what we were filming was not a hospital, but a factory of miracles. Its staff save thousands of lives.
Dhaka has two cholera outbreaks each year: roughly, one before and one after the monsoon. Left untreated, cholera can kill in hours and it spreads quickly, which is why it so terrifies people.
"You can start being ill at ten the morning and be dead by two in the afternoon," says Pietroni.
But treat it promptly, and even the sickest patients make a full recovery. Patients who were stretchered into Dhaka Hospital were walking out - albeit gingerly - within 24 hours.
Dhaka Hospital is part of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), a world leader in its field. One morning, while filming around the centre's sprawling compound, a grey-bearded figure shambled past. "That's Richard Cash," explained a staff member in a reverential undertone. "He should have a Nobel Prize."
Now 70 years old, Cash pioneered the use of oral rehydration solution (ORS), a simple mixture of salt, sugar and water, to treat cholera and other diarrhoeal diseases. ORS is thought to have saved more than 50 million lives.
A potent treatment
Today, ORS is the primary weapon in Dhaka Hospital's fight against cholera. Treatment is free, but that does not mean that only the poorest go there. So do affluent Bangladeshis, who know the hospital's no-frills appearance belies a standard of care offered almost nowhere else. We often saw sick children cradled by mothers in fine sarees and gold jewellery.
While we were filming in Bangladesh, another cholera epidemic was raging in Haiti, which had been devastated by a powerful earthquake in January 2010. By late October, the Caribbean country had reported about 3,800 cases and 280 deaths, a mortality rate of more than 7 per cent. During the same period, Dhaka Hospital probably treated at least half that number of cholera patients, and we did not hear of a single death.
We left Bangladesh with a new appreciation for the staff of Dhaka Hospital and the ICDDR,B - and for the people of the world's most densely populated large country. The poverty of Bangladeshis, and the disasters they endure, is well-documented. We hope that Dhaka's Cholera Wars also shows their courage and resilience in the face of an age-old disease.