Ebola in DRC

The man in the isolation unit at the moment comes from Kalombayi. This is a village which has had no road access, just a track for bicycles and motorbikes. Martin has had hundreds of people clearing a path so that cars can pass and so that patients can be collected if necessary. He has also had to make three bridges. Today the road was ready so a medical team and a “contact” tracing team went to Kalombayi and Tchitala where there is a woman who has been unwell for a few days. When they got there they decided that she was not a suspect case but then went on to follow up some other stories in the area.

A camera team from the World Health Organisation (WHO) has been making films of some of our work. Yesterday they passed the sprayers on the road to Luebo and stopped to film them. One of them was a bit too close and so when the slightly permeable door of the house was being spraying from the inside, the cameraman and his camera got a shower of chlorine solution!

The film crew also asked our male patient if they could film him on the veranda and he agreed in exchange for a photo. They took one of him sitting on the veranda with four nurses in protective clothing. He was so pleased. Everyone here loves photos.

Every night we have a meeting. Often it starts at around 9 pm, which means that I really struggle to stay awake by the end. The first bit of news today was that the test result for a woman patient was positive. It is probably going to be a really sad story: she is pregnant and is breastfeeding a child. When she started to feel unwell last week she gave the child to her sister to breastfeed.

Tomorrow, a team will go to set up what we call ‘home-based care’ for her. At the moment her brother is refusing to let her come into the isolation unit, so we have to set up various systems to make sure that she can be taken care of at home safely.

Today was a massive spraying day. We had to disinfect a really badly affected village where there were about forty houses to spray. We seemed to be disinfecting every other house as we walked along the road. One place, where five people had died, had been taken down completely. We moved systematically through the village with the car following us carrying water for our chlorine solutions.

This afternoon I had time to go to the market to buy some essentials for the team (loo paper, tomato paste) and some treats (fresh tomatoes, green oranges and some peanuts). It was a small market and obviously it wasn’t market day because most of the wooden stalls were empty and there wasn’t much for sale. On a couple of stalls there were a few tomatoes arranged in pairs, one balanced on top of the other. One pair cost 100 Congolese Francs (500 is about 1USD) so I bought two tables worth.

There were chillis of different colours, so I bought some pale peach-coloured ones. I got a strange fruit that looked a bit like a pomegranate, three large cupfuls of peanuts and a declaration of love from the man selling tomato paste. I managed to gather quite a crowd as I negotiated. They wanted to know what I was doing here – I could hear “Ebola” being whispered amongst them.

At the moment we have two patients in the isolation ward, a man and a woman. Their tests have come back positive so they have been moved from the two “suspect” rooms into the “confirmed” ward. The veranda in front is now functional and we have put two wicker chairs out there so it looks rather smart. The male patient is very determined and every morning gets up and goes and sits outside. Sometimes he makes a fire and sits by it. His brother comes to see him every day and talks over the fence. He has a lovely shiny yellow shirt and a black skullcap.

This morning I went back to see the wife of a man who died from Ebola to give her a ‘Discharge kit’. This is a collection of items that is supposed to replace things that are destroyed in the disinfection process. We give one to every patient’s family. The kit includes a blanket, a bed mat, cup and plate, a bucket, and a towel. We forgot to put in a pair of flip-flops, so they will have to be delivered another day.

Later, Barbara and I went to Luebo to train various people to run the new isolation unit that we have set up there. We have no cases there at the moment – it is just to be prepared. We had about eight nurses and two doctors to show around the isolation wards. I liked the way the training session had worked with the spray teams on Tuesday, so we did the same thing and divided into two groups with one person per group dressing up in the protective clothing.

It all went really well until it came to the disinfection and undressing part. The last person to go through had already seen three people undressing reasonably well, so she should have had some idea how to do it, but it was chaos. Everyone was roaring with laughter and shouting instructions. Her arms were wind-milling all over the place as she tried to get the protective clothing off. What really struck me was how un-human she looked, completely dressed up, making strange jerky movements and impossible to see her face. I saw, really for the first time, how we might be perceived by the patients.

Photo : P. Zintzen, MSF | MSF staff wear protective clothing during Ebola intervention in the DRC.

We had a barbeque in the evening since a few of our staff are leaving over the next couple of days. There had been a goat in the compound for a day or two and unfortunately it was dinner. There were fantastic double-pronged skewers made of bamboo and I had some rather charred aubergine as the veggie option. The drink was Pastis mixed with tinned pear juice. Very inventive of the party organiser and surprisingly tasty. We should have thought of an appropriate name and patented it.

Every day the outreach team go out to check the “contacts”. These are people who have lived in the same house or touched an Ebola patient during their illness or after death; touched the bodily fluids of a sick person; or handled a sick person’s clothing. We check up on these people for three weeks after their last contact (the incubation period for Ebola is 21 days).

When I went out this morning with the team one of the first houses we visited belonged to one of the patients that we buried last week. His wife was sitting there, looking extremely desolate. I asked how she was and she said, “not sick”. Of course, I hadn’t meant that. What was very difficult was that it wasn’t really possible to touch her arm or take her hand to show a bit of empathy. She is a contact and has to be monitored.

We disinfected her house as well as about seven others. Then we had had a long and loud meeting with a few of the village leaders (and all the children in the village as bystanders) to see which houses really needed to be sprayed.

Most of the houses are very small and simple. They are made of sticks with mud caked in between. People really have hardly any possessions, at least not in the houses that we disinfected.

We concentrated on disinfecting the sleeping mats, beds and any old clothes lying about. We binned the clothes, but sprayed everything else with chlorine and then put them out in the sun to dry. We only covered eight houses in total, but by the end of the morning I was completely exhausted. I have to do it all over again tomorrow, to train the second half of the team.

On the way home we had a photo opportunity with some of our favourite children. They always have cars made of old plastic bottles with lids as wheels but today we saw cars made of balsa wood with radio antenna. They had made our MSF cars!! The moon is full tonight and rose up as a red orb in the mist. Almost like a sunrise. Beautiful.

First thing this morning I did a refresher course for the team in the isolation unit. There have been quite a few new recruits over the last few weeks and I wanted to make sure that everyone knows exactly what we are doing. It was a good session: there were questions about whether or not there is an Ebola vaccine, what can be done for the patients, and could the guards please have some new boots.

At the end of the session I gave everyone a malaria prophylaxis. We are implementing this as a policy for all staff to prevent them from getting malaria. We are worried about people getting malaria and their symptoms being confused with those of Ebola (fever is a symptom of both diseases). Taking a malaria prophylaxis is compulsory for all of the international staff as well.

In the afternoon, I started to train a group of 12 people on how to disinfect houses. Now that we have a few more cars available, we will be able to send spray teams out to disinfect houses, village by village. We probably need to cover about 200 houses in total, which is rather daunting.

After explaining to them about Ebola, I got one of them to dress up in the protective clothing. Then I divided the group into two teams, each of which had to dress up one person. It was very effective – there was a bit of rivalry and they did it very well. They will start work tomorrow in a village not far from here.

This morning, Barbara, Martin and I set off for Luebo. The road is much better than it used to be. Martin has had hundreds of people levelling the road from Kampungu to Luebo, so now it is a mainly flat sandy track. It’s not nearly as exciting as it was!

Our objective was to find out if we could create an isolation unit in each of the hospitals in Luebo. Luebo is split into two areas divided by the river – north and south – and apparently there is not much love lost between the two.

We started at the district hospital in the south. They have had a couple of patients in their isolation unit, the last of which died on Saturday. We had a look around to see if we could turn a corridor into a changing area and a couple of small rooms into isolation wards. It shouldn’t be too difficult with a lot of drums of chlorinated water at strategic points and some dressing and disinfection areas.

Just outside one of the wards was a pile of syringes and other waste that had obviously just been thrown out of the window. One of our other tasks will to be to safely dispose of this and set up a waste management system for the isolation unit.

Then we drove back across the river to the Protestant hospital in the northern area. The first thing I saw was a large clock tower with the remains of a clock. Rather surprising. I wonder when that last chimed.

The hospital buildings are made of brick and have wrap-around verandas and corrugated iron roofs. Unfortunately most of them are in a sad state of repair and have had their windows blocked up. The Centre for Diseases Control (from Atlanta) are trying to set up a laboratory in the hospital in order to be able test samples for Ebola on site. It is going to be a very high level facility and when we visited they were putting duct tape around the doorframes so that they could make a completely sealed room.

The room that we are considering turning into an isolation unit is not very inspiring. It is black inside – perhaps they have had had fires in there. It would be quite some work to set something up. We have to decide what to do.