When I begin each day I feel like I know what to expect. I have been in and out of West Africa since June and watched this sad story developing both as a direct witness on the inside and as an observer from a far when back home.
In the Ebola Treatment Centre where I work I always go to look at the large board of patients’ names at the start of my day. How many have died overnight and how many will be discharged to singing and clapping as “cured”?
I’m less upset by the deaths than I was before, they have become a regular part of the day. Much like breakfast or dinner. It is now the arrival of new ambulances and what they represent that challenges me. More patients, but only a snippet of what exists beyond the comfort of the treatment centre walls.
Those who are lucky enough to make it to the treatment centre emerge bleary eyed after the long, hot journey down pot-holed and bumpy roads. Led by strangers dressed in the now iconic yellow suits to a bed, given a blanket, toothbrush and some food. There is an unwritten observation amongst those of us who have been here a while: The patients who arrive and immediately lie down are usually the ones that don’t get back-up. Their stoic expression tells nothing about where they are coming from and what they have seen. Families and communities crumbling. Women watching helplessly as their husbands die only to succumb to the same illness. Knowing that if their children try to help them they simply become the next link in the chain, and so on.
Every admission is a symbol of a tragedy that is not being told.
On this particular day one of the ambulances arrived carrying four patients already confirmed to have Ebola. But when we opened the doors we found five. Amongst the patients were two young children who had already been sick for a week, their mother who was completely well had come thinking she could stay and care for them. An Ebola treatment centre is not just about supporting the sick, it is also about physically separating the infected from the healthy to try and curb the transmission.
I sat with the mother to try and understand if she might also have any sign of infection. She told a sober story of taking her children from clinic to clinic looking for help. Finally to be isolated with them, deprived of food and water. Once the result of their blood tests confirmed they had caught Ebola she continued to look after them as no-one else would. In the ambulance another patient was already bleeding. The risk of exposure to her is huge, but she remains completely well with no other complaint than those of a mother concerned for her children.
After giving her something to eat and drink, I explained the care we would provide and made sure she knew how to call us for updates. Ebola is a disease that does not care about circumstance or ethics. When I uttered the words “No Madame, you can not go with them”, it may also have been the last time she will see her children alive.
Most of our patients come from holding centres where they are first tested. It is hard to know the quality of care that is received there, I think it would be fair to say it is variable. The stories of what is happening out in the community are as worrying as ever. Villages in crisis, fields not being ploughed, children and women dying from preventable diseases and childbirth. What I see is just a slice of the true disaster that is unfolding in the green hills around me.
Our sickest patients remain inside the High Risk Area where full personal protection equipment must be worn. The key to working in High Risk is to keep it as simple and efficient as possible. I try to know exactly who, where and what I will be seeing before entering. Have all equipment for procedures ready and a good idea of what I want to achieve. I also make sure I know when I’m going in so I can time that I don’t stay there too long and risk getting overheated in the suffocating suit. The last thing I do is look at the sky; the weather makes an enormous difference to my level of tolerance in the personal protection.
It is a pleasure to see the daily discharges, despite all the layers of personal protection that separate healthcare workers from their patients you can become strangely close to them. Often recovering patients will take a couple of weeks before they are ready to be discharged, watching the metamorphosis from fatigued, aching and withered into energetic, smiling and eager beings is something short of magical. Children orphaned that you can finally pick-up into your arms and let them remember what it is to feel human touch. We, the workers, all carry our heads high with pride during discharges, but reality is we offer little to save lives here. Nutrition, hygiene and “supportive care” are the cornerstones of what we provide, and for a significant group it seems to work. With the development of newer treatments in the pipeline that might all change, but for today this is what we have.
The day does not really end, just the shift changes. The national staff work incredibly hard and whilst I will get to leave soon they will continue to be the ones who carry the greatest burden of this disease till the epidemic is finally stamped out. For them this is personal too; colleagues, friends and family have died, sometimes inside our own centre. Their previous lives of working in community clinics have disappeared and the work that they were doing before in securing a better future is now all on-hold. Schools have stopped, financial security is precarious and great concerns exist around personal health. Without their stamina to come back everyday and keep going there would be no hope of achieving anything in this battle.