Quotes by Nalin
“Then, suddenly, it hit me. Oral therapy had to work, it was the methodology that was the problem - fluid losses had to be replaced with oral solution volumes that matched or slightly exceeded the volume of losses. I remember a chill going up my spine when I realized this, together with the overwhelming sense of how important this would be to the countless patients who were continuing to be at risk of death in remote, resource-poor affected areas around the globe. And I also sensed that anything that would work in cholera would certainly work in the host of less severe, though often fatal, acute watery non-cholera diarrheas.”
“Previously I had a great love for clinical medicine, but I found myself being drawn toward research. That surprised me, because I never thought of myself as a researcher. I applied to the National Institute of Health’s (NIH) Department of International Research and was offered my choice of 19 different laboratories around the world to work in. My experience in Guyana led me to choose a laboratory focusing on tropical, particularly infectious diseases. Toward that end I developed a protocol for an epidemiological study of blood serum to examine the prevalence of antibodies from viruses transmitted by arthropods in individuals with various cancers, compared to matched healthy controls. This was to have been done at the Middle America Research Unit in Panama. Unexpectedly, the director there turned out to be a PhD. of the type who is averse to M.D.’s, and he made it clear that, though he could not criticize the protocol, he did not want to accommodate me under acceptable terms. Just then, Dr. Howard Minners, to whom I reported at the National Institute of Allergy and Infectious Diseases, returned from a trip to East Pakistan (now Bangladesh) and told me that I should consider switching there, as they were doing exciting work on cholera. Initially somewhat aghast (I had just finished brushing up my Spanish for Panama and had no idea what it might be like in East Pakistan) I acquiesced and, of course, never later regretted the switch.”
“It was my habit before undertaking any scientific research project to conduct an exhaustive literature search so as to know the full extent of past work, positive and negative, and to uncover leads for future research buried in the literature.”
"I often found myself drawn back to the immediacy and ingenuous charm and humor of devotional folk images, and to the wholly satisfying formal integrity of the vessels used in their worship: pots to be filled with holy Gangetic water or with milk offerings for serpents…smoking camphor tablets swung by dancers before the goddess during puja…brass platters with mirror like polish for offerings of Bengali sweets; incense holders…a cornucopia of vibrant forms; and simple bowls which, when struck, hum with a resonance evoking another era and another reality."
Quotes from the Lancet medical article titled Oral Maintenance Therapy for Cholera in Adults
“Our findings indicate that an oral solution containing glucose and electrolytes can eliminate the need for over three-quarters of the intravenous-fluid requirements in the therapy of acute cholera in adults. The ingredients of the oral solution are cheap and widely available in virtually all areas affected by cholera. The solution need not be sterile and it can be made up with any suitable drinking-water. Ingredients could be pre-weighed and stockpiled for use in cholera epidemics.
“The drastic reduction in the need for intravenous fluids which results from the use of an oral therapeutic solution should make it possible for cholera treatment centers with limited supplies of intravenous fluids to reduce the mortality from cholera to a level previously not possible in the absence of abundant intravenous fluids. Mild cases of cholera (without shock) may be treated with oral solution alone.”
In the Field in Bangladesh
“Patients were dying in their villages because the only hospital was run by Christian Missionaries, and the local mullahs had preached that any Muslim who went there would be branded with the sign of the pig. So we had to go out to these remote villages with our intravenous solutions and try to coax some parents to let us use them in the huts. A few finally let us do this, and the results were so dramatic that rumors circulated that this could not be cholera after all, because they had never seen a cholera outbreak where anyone survived!”
“There was a single-story brick and cement building of several rooms for the hospital, on a slip of land which had been picked because of its history as the center of annual cholera outbreaks. The hospital was connected to the bazaar itself by a rickety bamboo and slat wood bridge over a canal, and boat people, a kind of riverine nomadic Bengali gypsy clan, often moored their boat homes on the bank. The hospital was then run by one doctor, the late Mizanur Rahman, who had trained his helpers and nurses to treat the patients and run the place. We visiting investigator young turks were housed on a floating barge inherited by the hospital, whose barred windows were a reminder of its previous incarnation as a jail boat under the British Raj. It was inhabited by some of the largest roaches I had ever seen. One had to be careful during meals, as the local crows were expert at suddenly swooping down on unsuspecting diners and making off with the food. Ambulance boats would come in and go out over the day ferrying cholera patients to and from the hospital.”
“You receive patients who are about to die, in fact, not infrequently are technically just dead, with no detectable pulse or blood pressure, but with heart and brain still on the edge of irreversible fatality, and within minutes, using standard intravenous fluids matching the ionic composition of their losses, often with added glucose to ward off hypoglycemia, they come back to life. Terminal patients typically received the equivalent of ten percent of their body weight in intravenous therapy to correct shock, and then they continued to receive intravenous fluids. Tetracycline or other appropriate antibiotic capsules were also given, to shorten the duration of diarrhea to about 32 hours on average. This therapeutic miracle stood in sharp contrast to the outcomes of typical emergencies back home in New York: heart attacks, strokes, perforated ulcers and the like, where treatment often failed, never brought an immediate turnaround, and often proved merely palliative or with major ancillary complications.”