Diary Day 22 – Friday – THE END

October 25th, 2007 by zoey

Yesterday was a finishing off day back in Kinshasa. We had some news through from Kampungu: a young boy’s test result was negative. It was a huge relief. But, to temper that, we heard that our last patient had died in the night. It is so frustrating because she had survived so long and we had hoped that she would be able to hold out long enough to win.

I finally got on the plane back home at Kinshasa airport. This morning they woke us up with an announcement to apologise for the lack of breakfast service. A woman had gone into labour in the night, had delivered a healthy baby girl over Mauritania. She was now lying asleep in the kitchen. New life and a happy ending to my mission.

Diary Day 21 – Wednesday

October 23rd, 2007 by zoey

Good news last night: the man and child in the isolation unit tested negative so they went home today. I was very pleased, since it is my last day on the project.

At our new airstrip we had to wait about an hour before the plane arrived. Someone turned up to sell us some woven raffia material that had been tie-dyed – it’s quite funny that at this tiny airport we can buy souvenirs! The plane was very, very tiny: only five seats plus the moustachioed pilot from before. It was slightly worrying because two other organisations also wanted to get people and cargo onto the plane. The Centre for Disease Control pointed out that they had been promised 160kgs on the flight and unloaded piles of trunks and boxes from their cars. Health Canada thought they would have three people on the flight. I was a bit worried that we were going to have a diplomatic incident as we were obviously not all going to fit in.

So for the next hour and fifteen minutes the pilot, Barbara, Isabel and I loaded and unloaded the plane trying to squeeze everything into smaller and smaller spaces. It was so hot that there was sweat dripping down the pilot’s nose. Finally all in: we folded ourselves into the plane. I didn’t think that we were going to be able to take off but we did.

The pilot flew over Kampungu so that we could see what it looked like from the air. It wasn’t as big a village as I had thought and I could easily see our compound and the isolation unit.

Diary Day 20 – Tuesday

October 22nd, 2007 by zoey

Today I went off to see the new baby Zoe. Her whole family was at home and everyone wanted to pose for photos. When I got back to the isolation unit the staff there were rather hurt that I hadn’t taken photos of them (I had, but not enough), so we had a photo session. When they posed they were all very serious, so I prodded them and bared my teeth in a manic smile to get them to smile back at me. I got some really good photos with their faces split wide open in big grins.

Isabel, Barbara, Henry, Jan and I went off to see some other springs to be improved. We had a fabulous walk past ponds where they are rearing Tilapia fish.

The first spring was very well organised. They had made a dam of sticks lined with big leaves and then filled with sand. The water came through in hollow bamboo pipes. The sand was wonderfully white and clean and the water was completely clear. If they dig they might be able to find some clay, which would make the dam a bit more resilient and need less maintenance.

The next spring is not going to be so easy to improve. There is nowhere to put a dam with pipes so that jerry cans can be filled up. At the moment it is a kind of sandy pond.

We watched another movie night tonight: “28 Days Later”. It’s all about a virus that is unleashed in the UK and results in everyone killing each other.

Well, firstly we knew that it should have been called “21 Days Later” if it was Ebola (the incubation time) but we let that go and settled down to watch. There were about 10 of us around one laptop. It was a very silly film and of course we shouted instructions at the screen about how to deal with projectile vomiting and blood everywhere and why weren’t they wearing goggles? Perhaps this could be a new job for me: advising on horror movies.

Diary Day 19 – Monday

October 21st, 2007 by zoey

I had a bit of a busy morning in the isolation unit considering that we are hoping that the epidemic is now over. The outreach team found a man who was not well. He had a high fever and apparently some symptoms but no history of contact. Meanwhile, a child had also come in with a fever and a history of contact. She was so sad sitting there bored and probably pretty scared with all of us wandering around in our suits.

Diary Day 18 – Sunday

October 19th, 2007 by zoey

All calm in the isolation unit. Our patient is still here and still stable. We all really have our fingers crossed for her since apparently no pregnant woman has ever survived Ebola or Marburg. Obviously we want her to be the exception to the rule.

This morning, Azaad and I decided to look into water use in the isolation unit. We have guidelines which help us to estimate the amount of water needed for a set up like this. It is supposed to be about 500 litres of water per patient per day. That takes into account all the washing of scrub suits and floors; changing disinfection solutions; and disinfection itself.

At the moment, women bring water in twenty litre jerry cans to the isolation unit. Initially some of the water was horribly murky with peaty bits in it, so we had to quickly get the quality under control. Now Philippe and Franqui – our water managers – check the turbidity of the water in each jerry can before they pour it into the water containers around the isolation unit.

In the afternoon, when it was a bit cooler, we went to visit a local spring to see if it could be rehabilitated. We cut through the village and then followed the path down into a valley. The trees got denser and the temperature dropped as though we had walked into the chilled section of a supermarket. Absolutely amazing. Very jungly with long hanging tendrils and trees with huge leaves. Wonderfully green and full of noise of chirping and rasping. We had to go down and down, and we found a path which over the years has been worn deep into the earth so that I walked along some bits with the jungle floor level with my head.

The area around the spring had been recently rather over-cleared which is a shame since soil can now wash down into the small stream. Two of my colleagues, Elisabetta and Henry, have made a small dam and used bamboos to pipe water to a collection point. The idea is to set up a point with three outlets so that the people can collect water as it pours straight into their jerry cans rather than fishing it out of the pond. A little lower down we will set up a couple of half drums as basins so that people can do their washing and soak cassava.

As we walked back up through the village we came across some village chiefs. One of them had his “spiritual bodyguard” with him. He had a long metal cowbell which he shook vigorously as he came running towards us. His face was blackened with paint and on his head two feathers stuck forward from his hat. On closer inspection his hat turned out to be some kind of hawk (dead) lying on his head with its wings hanging down towards the man’s shoulders. Ugh.

Diary Day 17 – Saturday

October 17th, 2007 by zoey

Yesterday Alain, an anthropologist from the World Health Organisation [WHO] came to our compound. I asked him what he thought of the isolation unit. He was very positive about it, especially about the fact that it is quite open so it is possible to see what is going on inside.

The only bad thing he mentioned was the rather untamed grass growing in-between the buildings. I had thought that this greenery was rather nice and soothing for the patients. But according to Alain, we need to put more of a stamp on the area to show that we are in control of the environment. So today I organised a bit of a tidy up and now the whole area has received a rather haphazard haircut.

Meanwhile the contact tracing teams have been out checking the last remaining contacts. The chains of possible infection have been getting fewer and fewer as one family after another passes through the twenty-one days with no illness (the incubation period for Ebola can be up to three weeks). Now we are down to four main chains.

At the moment the team are having problems with the family of our current patient – they are refusing to have their temperatures taken. They are all smiles and say that they are healthy, but when the thermometer is produced the atmosphere changes.

In the evening meeting, Armand, our specialised doctor, said that our current patient might be our last one. It could all be over!

Diary Day 16 – Friday

October 16th, 2007 by zoey

Wow, today was almost a day off! Everything went brilliantly in the isolation unit. We had a rousing meeting yesterday in which I complained a lot and so today everyone has been doing exactly what they should be! The medical staff were full of compliments rather than complaints which was very satisfying.

I also spent some time setting up the water filtration system. The previous filters were too small and poor quality, but today we got five new ones and Jan and I spent a happy couple of hours putting them together and running water through them. The water now tastes much better, if a little medicinal.

We also have a “fridge” – a box that Jan constructed out of bricks and then filled with beer and covered with a towel with its ends hanging in buckets of water. It works quite well and although the beers are not exactly cold they are definitely chilled!

Diary Day 15 – Thursday

October 15th, 2007 by zoey

Barbara and I set off early for Luebo North. A team from the Centres for Disease Control (CDC) are running an Ebola testing service at the hospital there. They are checking out rumours in the local area and identifying possible suspect patients. One of the nurses in the hospital has been unwell and just tested positive for Ebola. While we were doing the training session it was obvious that the other nurses were scared.

Back in Kampungu, I had to bury another patient. She had been with us for quite a long time but she died early this morning. The team at the centre put the body bag in the coffin and then on the pickup. We tied it securely because the road to the village is very rough. Some policemen ran after the car asking for a lift. I have never seen anyone change their mind so completely when told what was under the plastic sheet.

When we got to the village everyone came running out of the houses wailing and following the car. There was an enormous amount of noise. We went along slowly so that everyone could follow us, even though there were some men telling people not to come close.

After the funeral I went back to the isolation unit to find that the female patient we had been looking after in her home had had a miscarriage. Her brother had brought her into the unit to be taken care of.

I went with a disinfection team to spray the house where she had been living and take down the latrine and fencing. There was a lot of blood under the bed on the earth floor. The team poured a very strong chlorine solution over it and it turned black. I shovelled it up and put it on the fire, and then put the shovel in the fire to clean it.

There was a rather surprising end to the day. One of the more recent employees’ wife had a baby this afternoon and they called her Zoë! So now there are three Zoë’s in Kampungu.

Diary Day 14 – Wednesday

October 9th, 2007 by zoey

Today was rather long and tiring. Barbara and I went to Luebo to continue training the staff in the isolation unit there. The first thing was to show them how to put someone in a body bag. Then we trained them on disinfection procedures.

I thought that this had been well and truly understood: there are two main solutions, one for washing gloved hands and the other for washing patients, soaking clothes and washing un-gloved hands. The latter solution is about ten times weaker than the former. Unfortunately, after the training I walked into the laundry area and found the staff about to dip all their scrub suits into the strong disinfection solution. That would have resulted in white, not green, scrub suits! This clearly required more clarification before we were finished.

After the training session, the car didn’t come and get us. We had been forgotten. I had visions of no one noticing until the evening meeting and us having to sleep on one of our nice new mattresses in the isolation unit. We tried phoning the team mobile but that didn’t work and it wasn’t possible to get the satellite phone either. In the end we had to phone the headquarters and ask them to Kampungu for us!

The road to Kampungu is much better since Martin worked on it. Before it was almost a motorbike track but now it is much smoother. Along the road there are lots of ‘buyanda’ (porters) pushing bicycles loaded with sacks of maize. They often have two 50 kg sacks, one over the cross bar and one stuffed through, above the pedals. They have any number of other things – chairs, chickens, goats – all tied on top.

They are only going in one direction – from Mweka to Koni. It takes them seven days to make the journey, struggling through the sand all the way and pushing the bikes up impossible hills. They are taking maize from the area where it is grown to the more densely populated diamond mining area. Here they can get seven times the price for the crop as they can at home.

When Barbara and I got back to Kampungu, we had to take yesterday’s patient for burial. There was no coffin so we put the patient in her body bag in the back of the pickup and headed north to Baka Tombi. It took about an hour to get there.

All the family were there outside their houses and when the car approached they started wailing. The coffin was the biggest I have ever seen, but luckily it was made of matting and bamboo so it was light enough for the family to carry to the grave yard.

The grave had probably taken all afternoon to dig. It seemed like half the village were standing around while we waiting for the grave to be finished. Lots of them had their t-shirts tied over their noses to protect them from the disease.

When we finished, we passed by the family to say goodbye and to give the husband a bucket filled with the blanket, mosquito net, soap and other items. It was very sad. He said to Hilde, the doctor with me, “What about me? Now I am a contact.”

Protective clothing
Photo : P. Zintzen, MSF | Googles and protective gear during Ebola intervention in the DRC.

Diary Day 13 – Tuesday

October 7th, 2007 by zoey

A suicidal goat threw itself under our wheels today. They tie goats by a front leg to lead them or tether them. This means that the poor goats have only three legs to walk on. This one threw itself in front of the car, rolled, and appeared again on the other side of the bonnet before sitting up and looking at us. It gave us all a bit of a fright!

When I got back to Kampungu this afternoon the nurse on duty, Isabel, was dressed up and in the high risk area. A patient had just died. She had only been brought in a few hours before. Isabel had been going to give her some medicine and had found her dead.

I went to talk to the husband and to see if he would like to come in and see her. Isabel made sure that she was looking peaceful before we brought him in. Then we put her in a body bag along with her clothes and left her for the night. She will be buried tomorrow.

By the time we had finished it was completely dark and it was possible to see all the stars and the Milky Way. It is interesting looking at things with no light. There was a fantastic tree that looked like an umbrella blown inside out. I will have to have a closer look at it tomorrow morning.