The sheer magnitude of that loss was a global tragedy, but it was made even more tragic because a relatively simple treatment for severe dehydration existed, one that could be performed by nonmedical professionals outside the context of a hospital. Now known as oral rehydration therapy, or O.R.T., the treatment is almost maddeningly simple: give people lots of boiled water to drink, supplemented with sugar and salts. (Americans basically are employing O.R.T. when they consume Pedialyte to combat a stomach bug.) A few doctors in India, Iraq and the Philippines argued for the treatment in the 1950s and 1960s, but in part because it didn’t seem like “advanced” medicine, it remained a fringe idea for a frustratingly long time.
That finally changed in 1971, after Bangladesh’s fight for independence from Pakistan sent a flood of refugees across the border into India. Before long, a vicious outbreak of cholera had arisen in the crowded refugee camps outside Bangaon. A Johns Hopkins-educated physician and researcher named Dilip Mahalanabis suspended his research program in a Kolkata hospital lab and immediately went to the front lines of the outbreak. He found the victims there pressed against one another on crowded hospital floors coated in layers of watery feces and vomit.
Mahalanabis quickly realized that the existing IV protocols were not going to work. Only two members of his team were even trained to deliver IV fluids. “In order to treat these people with IV saline,” he later explained, “you literally had to kneel down in their feces and their vomit.”
And so Mahalanabis decided to embrace the low-tech approach. Going against standard practice, he and his team turned to an improvised version of oral rehydration therapy. He delivered it directly to the patients he had contact with, like those sprawled bodies on the floor of the Bangaon hospital. Under Mahalanabis’s supervision, more than 3,000 patients in the refugee camps received O.R.T. therapy. The strategy proved to be an astonishing success: Mortality rates dropped by an order of magnitude, to 3 percent from 30 percent, all by using a vastly simpler method of treatment.
Inspired by the success, Mahalanabis and his colleagues started a widespread educational campaign, with fieldworkers demonstrating how easy it was for nonspecialists to administer the therapy themselves. “We prepared pamphlets describing how to mix salt and glucose and distributed them along the border,” Mahalanabis later recalled. “The information was also broadcast on a clandestine Bangladeshi radio station.” Boil water, add these ingredients and force your child or your cousin or your neighbor to drink it. Those were the only skills required. Why not let amateurs into the act?
In 1980, almost a decade after Bangladeshi independence, a local nonprofit known as BRAC devised an ingenious plan to evangelize the O.R.T. technique among small villages throughout the young nation. Teams of 14 women, each accompanied by a cook and a male supervisor, traveled to villages, demonstrating how to administer oral saline using only water, sugar and salt. The pilot program generated encouraging results, and so the Bangladeshi government began distributing oral hydration solutions in hundreds of health centers, employing thousands of workers.
The Bangladeshi triumph was replicated around the world. O.R.T. is now a key element of UNICEF’s program to ensure childhood survival in the Global South, and it is included on the World Health Organization’s Model List of Essential Medicines. The Lancet called it “potentially the most important medical advance of the 20th century.” As many as 50 million people are said to have died of cholera in the 19th century. In the first decades of the 21st century, fewer than 66,000 people were reported to have succumbed to the disease, on a planet with eight times the population.
