How a “simple” intervention helped save millions of lives

Dr. Richard Cash, who played a key role in testing and implementing a cheap and easy treatment for cholera and other diarrheal diseases that saved tens of millions of lives, died at home in Cambridge, Mass., of brain cancer this week . , his wife by his side. He was 83 years old.

His greatest achievement—oral rehydration therapy for diarrhea—is something so simple that people can be trained to do it at home. Even so, an editorial in The Lancet in 1978, called ORT “the most significant medical advance of the century.”

Cash’s role in developing ORT came after he graduated from New York University School of Medicine and completed an internship in New York City. In the late 1960s, he headed to Dhaka – in what was then East Pakistan and is now Bangladesh – to address the tragic toll of cholera.

Cholera patients suffer from diarrhea, which causes them to lose both salts and water. The disease could turn you “from a grape to a raisin” in a matter of hours, he observed.

At the time, it was well known that simply drinking water did not help. Cash and his colleagues asked people to drink water with carefully chosen salts and sugar and found that the formula allowed for successful rehydration. As long as people were aware and could drink oral rehydration salts, they would survive.

Working with others at the Cholera Research Laboratory, Cash conducted field studies demonstrating that oral rehydration therapy was effective; a study conducted years later showed an estimated 93% effectiveness rate.

Eearlier this year Harvard Magazine wrote a story about his work. Cash told the reporter that ORT is an example of the simplest solution to a problem being the best. Fancy technology is not always necessary for difficult problems. “Simple does not mean second class,” he said.

Lessons in humility

In 1977, Cash began teaching at the Harvard School of Public Health and remained a senior lecturer there until the end of his life, making frequent visits back to Bangladesh as well as other Asian and African nations to teach and work on projects of public health.

On one such visit to Bangladesh in 1979, Cash went on a trip with Mushtaque Chowdhurywho worked for BRAC, a large development organization that aims to help poor people by promoting physical and economic health and education. They were checking out a child survival program. It proved to be a learning experience for Chowdhury, who eventually became vice-president of BRAC.

“The first thing I learned was how to be humble,” Chowdhury told NPR in a phone interview. Cash always approached the villagers with great respect, he recalled: “People who come from the Western world don’t always respect the local culture and people. I found it to be the exact opposite.”

Working on a project to teach people how to make their own rehydration solution, Chowdhury and Cash visited a home where people were so poor that there were no chairs. The owners hurried about, trying to find something for their eminent visitor to sit on. The money immediately fell to the floor with everyone else.

The ethics of global health policies has become a passion. He has taught and written about the need to focus on affordable and affordable solutions to difficult global health problems such as COVID. In a paper in The Lancet Months into the pandemic, he lamented the emphasis on rich country approaches such as lockdowns and sophisticated hospital treatment that would not be feasible in poor countries.

Cash was one of the driving forces behind the school of public health founded by BRAC in 2004 and has been a lifelong faculty member.

Teaching was another passion – and his students were impressed by his commitment. About eight years ago Dr. Junaid Nabia senior fellow at the Aspen Institute, took a course from Cash at Harvard on global health innovations. Nabi knew about Cash’s landmark work in oral rehydration therapy. What struck him most was that someone so eminent was always available.

“He would instantly find time,” Nabi said. “Whether it was a student trying to work on a paper, whether it was someone trying to create a new intervention for another global health issue, whether it was a group of students trying to create an advocacy group, he was always happy to help. He saw potential in every endeavor. With him, it seemed like anything was possible.”

“What he was trying to teach us was that you can make an impact in the real world,” Nabi said. “You can drive an innovation in a way that helps people in real time, rather than publishing articles about it when nothing is really happening on the ground.”

Cash remained single until he was 60, when he married writer, businesswoman and yoga instructor Stella Dupuis, whom he met at an Ayurvedic spa in Kerala, India. They traveled extensively to places like Namibia’s Skeleton Coast, the Mongolian steppes and China’s Silk Road, stopping along the way to make friends and, according to an obituary written by his friends, to photograph toilets from ancient sites, sparked by his interest in water, sanitation and cultural beliefs – much to his wife’s amusement.

In 2006, Cash shared the prestigious Thai Royal Family Prince Mahidol Award for Outstanding Achievement in Public Health and Medicine with David Nalin and Dilip Mahalanabis for their work in establishing the use of oral rehydration for people with diarrhea. Others who have worked alongside Cash include Bangladeshi researchers Rafiqul Islam and Majid Molla.

Ron Waldmanprofessor emeritus of global health at George Washington University, became good friends with Cash when both lived and worked in Delhi. He wrote in an email to NPR that Cash was remarkably open and caring: “kind, generous, smart, modest (or, at least, modest), sharing (but usually fair), anti-establishment ( unless the establishment was heading in the right direction).”

The obituary written by friends of Cash said that he lived his last months as he lived his 83 years: “with grace, gentleness and humor; making those who came to visit and say goodbye feel special and loved.”

Joanne Silberner is a freelance journalist and former health policy correspondent for NPR. More than 30 years ago, she was a student in a global health course co-taught by Dr. Cash.

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