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.

We had no new patients today in the morning, so it was possible to really clean up and try and get everything in the right place. Every week we get half a day off so this afternoon seemed like a good time to take it. Fabulous. Just vegetating in a cool breeze under a palm tree.

The light in the late afternoon was amazing. Everything was very clear and bathed in a strong yellow light, with dark thunder-clouds in the background. I could hear the thunder but the storm seemed to pass in front of me.

In the evening we went to the “phone booth” because Barbara wanted to make a call. In fact it is just a stick under a tree marking the only point in Kampungu where there is mobile reception.

Tonight was Movie Night. We set up a four person cinema in the big white tent and then scrunched around the computer trying to hear the latest James Bond over the noise of the generator. Tomorrow I am going to lobby for the generator to be sandbagged to increase our viewing pleasure!

Early this morning the choir started practising in the church just on the other side of the fence. Lovely harmonies. They were accompanied by cock crows and the sounds of sweeping as every inch of our compound is brushed.

We went down to the isolation unit very early in an effort to keep ahead of everything for the day’s funeral. The first problem was that we had no car available until the afternoon. The second problem was that when the nurses went into the ward to see how the other two patients were, they found that one had died.

Then started really the most horrible tragi-comedy involving coffins, bodies and burial sites. We decided to bury in order of death. So last night’s death first.

The first mistake I made was talking to the wrong family and arranging the wrong coffin open in front of the isolation unit. It was made of wicket mat and was lined and covered with a kind of pink gingham and floral sheet. There was a lot of shouting between the family member that I was talking to and the family members from the second family, because of confusion over the coffins.

Then came the most unbelievable rain. I didn’t really know what to do as it was not going to be safe to try and carry the coffin and lower it into the grave as it would be too slippery. Amazingly, ten minutes later when we got to the cemetery the sky was blue and there was just a slight crackly noise as the last raindrops hit the dead grass stalks.

By the time I got back to the isolation unit, the third patient had died. He had been really very bad all day and his family had been outside crying and talking to him. His father had been in for a visit to say goodbye and they had cut two small pieces of string, one around his ankle and one around his wrist. Later in the morning they had asked Barbara to cut the last string which was round his tummy. It was awful to see: they were just waiting for him to die.

I went back to the cemetery and got two coffins into their graves before another torrential storm started with lightening that I could see streaking across the sky.

Today started very well. All our patients were well (or perhaps more accurately, alive). The morning was quite relaxing, which lulled me into a false sense of security. I pottered around trying to improve the water and sanitation situation. We started using our new disinfection area, which everyone was pleased with. Now we can all stand in the shade while we are waiting and then disinfect much more quickly.

At lunchtime I was told that a child had died in a neighbouring village. When we got there the child had already been covered with a piece of coloured cloth and was in the shade of the porch. He was very small, about four years old. When we had put on our protective clothing we laid the child size body bag out next to him and put him in. Then we picked up the bag and followed the family to the grave site. It started to rain on the way and we had to battle through undergrowth still holding the body bag. The rain was torrential during the burial: it was like standing under a shower. Water started to run down inside my goggles and fill them up. By the time we had all undressed I was soaked to the skin and my boots were filled with water.

On the way back there was lots of lightening, some of it very close, and the road was literally a river. A huge tree had fallen down in our path so we leapt out of the car and while Jean- Claude hacked at the branches, Faustin and I dragged them to the side of the road. We got through, but about a mile further on there was a fallen avocado tree. More branch hacking and a lot of wheel spinning and we were on the other side and heading home.

It was about five-thirty when we got back to the isolation unit. All the patients seemed comfortable so we decided to go home early. I went for a walk with Jan, another water and sanitation expert working for MSF. As we walked along the road some of the local isolation unit staff came out of a house and offered to show us around the village. We saw all the churches; breadfruit ( I think) trees planted by Belgians in the 60’s; the school; mandarin trees and our staff’s houses one after the other. They all came out and joined us, so the group got bigger and bigger as we made our way down the village along the ‘premiere avenue’. It really was a wonderful walk; the village was beautiful and everyone was so friendly. Best of all I was introduced to a man called Zoe!!!!

Unfortunately, when we got back to the compound we heard that our newest patient had died. Barbara, Christian and I decided to go and put him in a body bag straightaway, as it would be easier than in the morning. It was dark by the time we got there but luckily the generator was working and so the inside of the ward was quite well lit. He was sitting on the floor leaning against the bed. We got him into a body bag and onto the bed, and managed to get him arranged nicely in case his wife wanted to see him. Then we left him for the night.

Photo : P. Zintzen, MSF | Our boots drying upside down.

It had looked ominous for the two patients in the isolation ward last night, so I was prepared for a rather horrible day. But in fact both of them were alive this morning and we let them go home, which was a big highlight.

The young boy and old lady had been in the isolation unit since before I arrived and were fed up with being there. I couldn’t honestly say that they were fit and on top form but they are now in the recovery phase and don’t pose any risk for their families.

The little boy was first to be released. The child has been in the isolation for over a week and had been amazingly accepting and serene. His mother came to visit him every day, but even she had to wear a gown, gloves and a mask. We gave him some notebooks and pens and he had been writing stories and drawing pictures. He was so delighted to have them.

As we released the patients, it was my role to wait on the other side of the fence acting as the “greeter” to take them outside and to show that they were safe to touch. After being given a shower by the nurse, Barbara, the little boy trustingly took my hand and I led him out and gave him back to his mother.

The old lady was next. She had lost three of her children to the disease and had been been in for over a week. She had her wash and was then wrapped up in a new brightly patterned piece of cloth. When I held out my hand her eyes widened and her face lit up and she gave me her hand. I led her out and handed her to her sister.

Aside from the good news, we also had new arrival in the ward today. We put him in the suspect ward which is where we put patients that don’t quite fill all the criteria for the doctor to be sure that it is Ebola. Apparently he hadn’t been in contact with any patients even though he lived in a village that had been quite badly hit by the disease.