This four-part adventure began with this Blog entry.
There, on horseback at about 2:00 AM on a moonless night, at the foot of the barely visible Havasu Falls, deep in the Cataract Canyon offshoot of the Grand Canyon, accompanied by a medical student and a few laypeople, we came upon a bunch of very sick kids. Two were experiencing bloody diarrhea and were nearly in shock, so we started our only packs of IV fluids with them, while we reassured and tried to comfort the dozen or so others who also had diarrhea.
Of additional concern was the health of the group of younger Boy Scouts, who had left earlier the previous afternoon on an overnight hike to a point several miles downstream, below Moody Falls. We suspected that we were dealing with a waterborne illness. Many of the Scouts had drunk water from the stream and nearby springs, and they had made a fruit punch from the same water. The younger boys had brought the punch with them. Luckily, they made it back later that morning just as they, too, began falling ill.
Communications were difficult. Since we were so deep in the canyon, we had no direct radio contact, and the only phone in the entire canyon was a hand-cranked wire line from Supai Village to Hualapai Hilltop. Messages had to be relayed by a runner between our location and a spot nearer to the village where there was radio reception with the Village. Most of the stricken campers were too ill to be evacuated by horse or mule, and none could walk out. After sunup we moved the sickest patients, and as many others as possible, to the flattened area above the falls, hoping to arrange a helicopter evacuation. However, the characteristics of the canyon as it heats up during the day cause very dangerous air currents. A helicopter from Grand Canyon Village made several unsuccessful attempts to land.
We therefore had the helicopter drop additional supplies, mostly IV fluids to treat and prevent dehydration. In the shade of trees that encircled the clearing on the plateau, we set up a field hospital and readied ourselves for a second night in the canyon.
As a precaution, I asked that the entire western part of the Grand Canyon be closed to visitors. By then the clinical picture suggested that the disease was bacillary dysentery, probably waterborne shigellosis. Some patients started recovering while others developed symptoms. Two were particularly ill and unstable, and we administered antibiotics to them empirically, in the belief that they might not help but neither would they hurt.
Thankfully, the helicopter was able to make several landings the next day, and those who had recovered enough rode out on mules and horses over the next two days. Both of the most serious patients were admitted to Grand Canyon Hospital and they recovered fully. One had a bloodstream infection with the organism, which proved to be Shigella sonnei. Nine out of 26 sick campers examined at the hospital still had the same Shigella organism in their stools.
What had been billed for me as a “VIP Orientation Tour” had turned into a pretty harrowing experience. The canyon stayed closed, and a little over two weeks later I returned with a team of epidemiologists and made a follow-up evaluation of the water and general sanitation. We concluded that the “hippies” from California had contacted the organism by drinking water from a well on their way out to Arizona. They fell ill after arriving, and had contaminated the latrines and even some of the surrounding open area with Shigella sonnei (bacterial dysentery) organisms. A rainstorm that night caused the privies to overflow into the pool under Havasu Falls, and the Scouts who subsequently arrived had simply continued the cycle of contagion by drinking raw creek water and using it to make Kool Aid (which they unwittingly and rather appropriately called “bug juice.”)
The water samples that we obtained from the creek on July 7 gave interesting results. Those from the very beginning of Cataract Creek, where the spring water gushes out from underground, was already quite contaminated by fecal coliform bacteria, with a plate count 108 colonies per 100 milliliter of water. This was probably due to the fact that this “first water” in the otherwise arid southern portion of Supai Canyon attracted many animals to drink there. Plate counts increased enormously, to 720 and more organisms per milliliter as the creek meandered through Supai Village and the many horse corrals and irrigation channels.
At a popular swimming hole just north (downstream) of the Village, the coliform count was even slightly higher, but it decreased to 650, and then to under one per 100 milliter as the creek bubbled over the rocks and meandered through shady watercress beds and over Supai and Navajo Falls on the way down to Havasu Falls. Then, in the pool at the base of Havasu Falls, where the afflicted campers had obtained some of their drinking water, the fecal coliform bacteria increased to 1200 per 100 milliliter, the highest recorded among all the samples. We did not recover the causative Shigella organism, but this is not unusual as they are difficult to isolate as the latrines (presumably the major sourse of the contamination) had been chlorinated and over two weeks had passed since the epidemic That portion of the Grand Canyon remained closed to visitors for over three weeks, a harsh blow for the Indians who depended almost entirely upon tourists for their income.