Ebola: highs and lows

10 December 2014

It is moments like this that I fear most. A woman with Ebola is wandering around naked and screaming. A confused and potentially aggressive patient with a highly infectious and deadly disease – and all that separates us is my yellow protective bodysuit. I heard the commotion while I was working my way through the patients in the High Risk zone – the area of the centre reserved for the confirmed cases of Ebola. The screaming woman had left High Risk area and was heading for the Low Risk zone where MSF staff do our paper work.

When I came outside, the woman lay down on the concrete floor under the glare of the scorching sun. She rolled around moaning – not aggressive, just distressed.

Together with a Sierra Leonean staff member, I protected her head from the hard floor and carried her to bed - hot work in our sweat-proof suits. I asked if she is in pain and she pointed to her chest: “My father died, my mother died, my sister died, children died”.

I have nothing that can cure a broken heart or a crushed soul - just a gentle hand on the arm, a blanket and a sedative.

Each medical round is a catalogue of such sad stories and practical challenges. With so many sick patients it is easy to lose track of time. There is no end to the work one can do: helping one patient to drink, providing an intravenous line, comforting words or pain relief for another. If we discover a patient who has died, we stop to straighten the body out before rigour mortis sets in. Patients often die with contracted limbs making it difficult to place them into the body-bag.

Each day that I enter the centre, I take a look over the whiteboards filled with patient’s names. Five weeks ago there were three boards, now there are seven. With more than 60 patients and high turn around due to admissions, discharges and deaths, it is difficult to keep track of everyone so we have devised a colour code to rank them in severity. In recent days, the red marker pen, for severe, has been getting a lot of use.

I try to organise the medical team early in the shift so we can get as much done before the sun is high. Entering the High Risk area requires heavy Personal Protective Equipment and to work in the West African heat wearing this is incredibly hard. The treatment centre is set up to minimise risk of infection. In the High Risk area, we work through a one-way system, starting with patients awaiting test results and ending with those confirmed to have Ebola. That way we don’t risk infecting someone who has another disease with similar symptoms, like malaria.

With a Sierra Leonean colleague, I go to see the patients inside the first part of High Risk, the “suspect” area. The girl inside today is another colleague’s daughter. Ebola is not just something that happens to other people here, it has struck staff, family and friends too.

Inside the next area, for patients who are highly probable of having Ebola, these patients are visibly sicker, amongst them a two year old girl. Their test results are still awaited, but they have enough signs and contact history for us to make a calculated judgment. The two year old is lying on the bed working hard to breathe. I gently wake her, sit her up and with the help of my colleague help her to take a few sips of water. With so many patients I cannot spend long with her so I make a note for insertion of an intravenous line and move on.

The final area is for patients confirmed to have Ebola. It is made of three large, long white tents. Most patients are well enough to walk outside to talk with an MSF colleague who sits across the plastic orange fence that separates High Risk from Low Risk. I am only seeing those who cannot get out of bed, and today there seems to be many.

Once my shift is over, I head to the fence and call out all the details of patients I have seen and activities I’ve performed. It must be written by someone on the other side of the fence, nothing I use in High Risk can come out. I then proceed to decontamination, a structured system of undressing under direct observation, with intermittent chlorine washing.

Once I am out I hear that three more patients have died since I began the round, including the two year old girl. It is only 10am.

The rest of the day comes with highs and lows. Every day we have a group of survivors to be discharged. This happens to the banging of drums and blowing of horns, and reminds us this is also a place of life and resilience. Each survivor receives counselling and support to help prepare them for re-entry to the world outside the centre’s fences.

The arrival of more ambulances from across the country quickly fills the spaces emptied by death or discharge. Despite repeated calls for more treatment centres, Sierra Leone still remains woefully under resourced. Until we can break the chain of transmission, days like this will continue everyday.

MSF began its Ebola intervention in West Africa in March 2014 and is now operating in Guinea, Liberia, Sierra Leone and Mali. The organisation runs six Ebola case management centres with a total capacity of more than 600 beds. Since March, MSF has admitted more than 6,700 people, of whom approximately 4,000 tested positive for Ebola and nearly 1,900 have recovered. MSF currently has some 300 international staff working in the region and employs 3,100 locally hired staff.

For more information on MSF’s Ebola response, please visit http://www.msf.org.uk/ebola.