Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Cholera Outbreak Training and Shigellosis (COTS) Program

The Cholera Outbreak Training and Shigellosis (COTS) Program is an educational program that focuses on the treatment of infectious diarrhea—in particular cholera and shigellosis. An excellent description of the Program was authored by Davidson H. Hamer from the Center for International Health and Development at Boston University, in the journal Clinical Infectious Diseases (Volume 49, Issue 2, page 323) in 2009. I have updated the write-up slightly to reflect the Program’s transition to a web-based educational program:

The COTS Program

Edited by D. A. Sack, D. S. Kauk, R. A. de Leeuw, E. J. Nelson, J. Pelikan, Md. J. Chisti, and L. Henning Sponsored by the United States Agency for International Development; the International Centre for Diarrhoeal Disease Research, Bangladesh; and the Institutum Tropologicum Helveticum

The Cholera Outbreak Training and Shigellosis (COTS) Program, version 1.0, is a web-based educational program for individuals, nongovernmental organizations, and ministries of health. Although the focus is on cholera and shigellosis, this interactive educational program provides useful basic information on the general management of acute diarrhea.

The COTS Program consists of three major sections: Knowledge Base, Virtual Hospital, and Virtual Classroom.

The first of these provides useful general knowledge about diarrhea, detailed information on the clinical manifestations and management of both cholera and shigellosis, a brief review of malnutrition, and an extensive overview of how to contend with a large-scale outbreak of diarrhea. The Knowledge Base has some excellent practical components, such as how to assess dehydration and clinical photographs. Each chapter contains sidebars with questions and key concepts, and ends with a brief quiz to test the participant's understanding of the material.

The Virtual Hospital is an interactive program that allows users to acquire practical instructions on management of a diarrhea outbreak. It includes role-playing with pocket-sized cue cards. This is full of innovative and practical tips, including demonstration videos for setting up a facility and staffing (with detailed job descriptions) for emergency situations.

The Virtual Classroom contains exercises, important phrases for translation, case studies, a photo gallery, and links to landmark articles in the literature on diarrhea. The Virtual Classroom requires Adobe Acrobat Reader for viewing the classic diarrhea articles. There is a wealth of useful articles, including the World Health Organization-UNICEF guidelines on diarrheal disease treatment policy in multiple languages, sentinel literature on oral rehydration therapy, and excellent reviews on a variety of aspects of diarrheal disease.

The COTS Program is an excellent resource for clinicians and students interested in learning about the basics of diarrheal diseases, cholera, shigellosis, and management of diarrhea in complex humanitarian emergencies. This user-friendly educational program should prove to be a highly useful tool for nongovernmental organizations, government health authorities, and international agencies for the provision of their employees with a solid, practical understanding of how to prepare for and manage outbreaks of diarrhea in resource-poor settings. Given the persistence of cholera and shigellosis in many developing countries, the contents of this online program provide an outstanding introduction to the management of diarrhea in challenging circumstances.

The COTS Program is available for download at

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.