Fieldset
A Cruel Disease

Sitting in the epicentre of the largest ever recorded Ebola epidemic, is a strange place to be. Family and friends ask everyday, “When are you coming home?”.

In all honesty, I ask myself the same question too. It can be frightening to be here.

Sitting in the epicentre of the largest ever recorded Ebola epidemic, is a strange place to be. Family and friends ask everyday, “When are you coming home?”.

In all honesty, I ask myself the same question too. It can be frightening to be here.

As a doctor I have been in tricky situations before, as I’m sure most healthcare workers all over the world can relate to. I’ve had confused patients shout at me, I’ve seen relatives get aggressive, and I’ve worked in situations where there is an infection risk. What makes being here unique is that I am inside the infection zone all the time. Granted there is high risk (inside the treatment centre) areas, and low risk areas, but the fact remains: Ebola is here.

We have our strict protocols of protective equipment, chlorine washing and no touching. They give us some reassurance. Though for it to really work there needs to be a consensus and trust between me and every other person I work or interact with, national and international. That’s a big ask in one of the world’s poorest countries. Everyone here is literally entrusting their life in everybody else.

The second question, which should probably be the first, why am I here? Why would anyone choose to be here?

I read the same news as my family. The international paranoia from thousands of miles away. The shortsighted decisions to close borders without any good evidence that it will be of benefit to anyone, but certainly make an adequate response ever more challenging. The statements about experimental drugs and vaccinations.

There is more news on this sad story everyday, and amongst the hysteria where is the compassion?

Yes, we are all very worried; it is a worrying time. Behind the headlines though there are over two thousand stories of personal tragedy, loss of life and loss of community. I’m not staying here because I’m a doctor, the medical side of this disaster is pretty basic, I’m here because I’m a human. And when I leave, it will also be because I’m a human; and like everyone else I too have my limits.

Earlier in my mission I met an expert in Ebola and he said to me some very true words, “Ebola is a cruel disease, it kills those who love you the most, the people closest to you and who look after you when you are sick”. His words could not have been more accurate. I often hear them when families are admitted into the treatment centre, all infected from having cared for a sick relative or attended the funeral.

Initially I arrived in Sierra Leone for an obstetric project, but now my focus is Ebola. I returned to Kailahun treatment centre a week ago, a pregnant woman had been admitted and I was helping in her management. The treatment centre is set-up as a system of tents (our wards); everyday I try to see the same patients to review their progress and offer some continuity in their care. So I took to seeing all the patients in her tent, with all the palaver of putting on the protective clothing it is sensible to make the most use of time whilst inside. I took an instant liking to Jeneba (not her real name), she had the same name as the baby we delivered in “United We Stand” which made me smile.

She was about six months pregnant with her fifth child. Jeneba’s village has been badly affected by the epidemic, she is one of 11 members from the same family to be infected, most of whom had now died including her youngest child. She was sharing a tent with some of her relatives. Two young brothers, nine-years and eight-years-old, lay on the beds opposite hers.

It was clear from our first meeting that the foetus had died, Jeneba hadn’t felt it move for days. In herself she seemed quite well, no pain and no bleeding. Some fever and a bit of diarrhoea, but she was walking around, talking and managing to eat.

The boys looked less promising. The younger of the two was lying in his bed, weak and lethargic. He managed to sit-up and drink some oral rehydration, but really he just wanted to sleep. His brother was comatose, and bleeding from his mouth and nose. The boy’s parents had already both died, they were here alone except for the care and attention afforded to them by the staff of the unit. There is a point where you know that you can not do anymore except make sure there is no pain, and provide comfort, cleanliness and dignity. A human touch, to say that you are not forgotten and you are not alone. I do not think it is possible to ever become accustomed to watching a child die.

The young brothers died within 24 hours of one another.

Jeneba was improving though, the second day I saw her she managed to come and sit outside. We talked over the isolation fence, I asked if she knew why the baby wasn’t moving. “Because it has died and I’d like it to come out now”. I explained how that could be done, but also that with Ebola I had reservations as she could bleed very heavily. Together we made a plan, keep improving, get stronger and build-up with vitamins and nutrition then we’ll do it. “When you’re better”, I said it because I believed it.

The same day that the second brother died, I found Jeneba having rapidly deteriorated. Already struggling to breathe and gagging with vomit and nausea. We cleaned her, and gave medication to help with the sickness. She died a few minutes after.

I probably should not be shocked that people with Ebola die, but I am.

I am taking up a new approach in trying to understand this disease, it goes back to the expert’s words. The patients inside the treatment centre are who we see, some live and some do not. What I am focusing on is the people who will live because their relatives are in the treatment centre.

Ebola is a disease of contact, remove the contact and you remove the risk. Appropriate isolation, protective clothing and safe burials are saving lives. It might not have the same sex appeal as seeing someone “cured” and discharged, but it is vital to stopping this epidemic. This is the mantra I now keep in mind, it gives another sense of purpose to the work. Knowing that we can ease the pain of those inside, and protect the lives of those outside.