Subscribe Editor's Note Search the Magazine | Prologues of Public Health Says Simpson, 85, in his coastal Georgia drawl, “I woke up. I thought: Cholera comes here every year. We know what’s coming. But instead of thousands of [potential victims], we’ve got 9 million.” Then, as he wrote in his memoirs, “The answer came to me with unbelievable clarity: oral fluids!”
Today, oral rehydration therapy, or ORT, is a common process. Add one packet of powder—containing salt, glucose, and other electrolytes—to water, and give people suffering from diarrheal dehydration as much as they can drink until they get better. But while ORT is revolutionary in its simplicity, the story of how it came into being is anything but. It’s a saga that involves at least a century of lethal missteps, international strife, global cooperation, physiological science, hard work, luck, difficult personalities, and the decades-long dedication of scores of medical professionals—many of whom had affiliations with the School. The morning after Simpson’s revelatory night, he called colleague Dilip Mahalanabis, ICMRT’s cholera expert, and shared his idea of using the still-experimental oral fluid therapy. The two decided that, based on the positive results from the Dhaka team, they would try it. Simpson approached the Indian Ministry of Health, which was eager to try the new therapy. Simpson cabled the National Institutes of Health, one of the funding sources for the ICMRT, and requested that the Center’s funds be diverted for use in the refugee crisis. NIH okayed it. Then the work began. Researchers converted the ICMRT library into a makeshift factory. They mixed local ingredients—table salt from the market, baking soda from a chemist’s shop, and glucose from a soft drink manufacturer—in packets and sent them to the camps, with directions to mix them with any water that could be found. It wasn’t feasible to use sterilized water, since it wasn’t available in the necessary quantities and severely dehydrated patients could die waiting for water to boil. “A lot of the water had Ganges River sand in it. We told them, ‘Just let the soil settle out,’” says Simpson.
It worked. Using only ORT, the fatalities due to cholera in the camps were less than 4 percent. When he saw the statistics sheets, says Simpson, “That was when the feeling of exhilaration came on. We’d really proved that oral rehydration worked.” Did he think, then, that ORT would change the world? Simpson leans over, his blue eyes still bright, and nods. “Uh-huh,” he says. ORT did change the world. The dramatic results from using ORT in the refugee crisis attracted the attention of both the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). ORT’s uses were soon expanded to include treating an even greater threat than cholera, childhood diarrhea. By the mid-1970s, WHO passed a resolution making ORT the world’s standard treatment for childhood diarrhea. By the 1980s, WHO and UNICEF had worked together to bring ORT to 130 countries and 99 percent of all children in the developing world. |
