The frustration tent

On Sunday I meet Margareta, a journalist who works for a Swedish public radio, who asked to visit our Ebola treatment centre.

On Sunday I meet Margareta, a journalist who works for a Swedish public radio, who asked to visit our Ebola treatment centre. She had arrived on Friday and the following day, looking as if she had not had much sleep, and fearful like everyone else who arrives in Monrovia, she passes by our office to meet us.

When we first meet journalists we explain to them what they will see when we enter the treatment centre. On the one hand, we want them to understand the general way an Ebola centre works, but we also want to know the specific angle they want for their work. These preliminaries enable us to save time the following day and to find the right people for the journalists to speak to.

But the most important thing is that they leave the office having a clearer idea of what they can and can’t do, out of respect for the privacy of our patients, but also for their own safety.

After our meeting, we decide that we should visit the centre on two different days: the first visit will take place the next day and then she will interview Amie Subah, one of the 15 survivors that have joined the Médecins Sans Frontières (MSF) team after having overcome the disease. Having endured the same situation as the patients and now protected  from contracting the disease again, plus her professional skills, make people like Amie the ideal candidate to offer psychosocial support to the patients and their families. This is exactly the approach Margarita is seeking.

The following day we meet by the Elwa-3 entrance. Margareta arrives completely wet, sweating from the heat and humidity, and I guess also due to nerves and the fact that she needs to get used to the place. It happened to me when I first arrived. I go out to welcome her and ask her to come with me to the place where Amie and the rest of the team are working. She seems hesitant for a moment.

"Would you prefer to do the rounds first before going and meeting Amie?” I suggest.

“I’d rather do that …. If you don’t mind” she replies.

“No, of course not. Let’s go.”

Going into an Ebola treatment centre is not like going shopping at a supermarket where you can start by perusing your favourite aisle and do as many rounds as you like until you end up at the till. To be honest, this is something I should have realised. We change our route and go and visit our health workers first: Samuel, Jaycee and the rest of them.  

Health workers are the ones who have the first contact with the patients and their families, performing the first screening to know whether those arriving are candidates for the triage area, the place where the nurses decide if a person fulfils the requirements to be tested for Ebola or not. And they are the ones in charge of a very important task such as distributing to family members the self-protection kits and teaching them how to use them. These kits contain several pairs of thin and thick gloves, chlorine at 0.5 to disinfect the houses and at 0.005 to wash their hands, masks, a basic protective outfit and soap; it can be used when someone starts vomiting or has diarrhoea.

The protection kits contain chlorine, soap, gloves, gowns, plastic bags, a spray bottle, goggles and masks. © Agus Morales/MSF

Ebola protection kits © Agus Morales/MSF

The next stop in our round is the mental health area. Here is where several Liberian colleagues offer information and psychological support to the family members and where appointments between the patients and their families are made, respecting the safety distance provided by the orange plastic fences and only when patients are well enough to see them.

Then we pass a tent that after four months still has no official name. It symbolises a sort of failure in the system and it illustrates one of the most important problems affecting Liberia (as well as Sierra Leone and Guinea) right now: the lack of hospitals, resources and professionals to cater to the medical needs and diseases directly related to the virus.

Of course, we know that people are dying of Ebola. But malaria is out there too, and we know that, if not treated, it can also be fatal. Complicated births are still an issue, but without gynaecologists or midwives to assist them, mothers and their babies will keep dying. People living with HIV/AIDS need antiretroviral medication to live and those with chronic diseases need doctors that can monitor them and prescribe them the medicines they need.

However, most of the hospitals are closed, and the ones that have managed to reopen refuse to admit patients suspected of having the evil virus, and the health staff are afraid of going back to their workplace; because they have lost many colleagues in the past few months and they know that Ebola has not gone away. This means many of them are not willing to keep exposing themselves and risking their lives.

I discretely peer into the tent that I have been calling the ‘Frustration Tent’ since that day, and less than two metres away I see a patient in a rather bad condition. “We cannot go in Margareta. There is someone inside and I think he is not well,” I tell her. I am suddenly consumed by doubt. I stop to think for a moment and I half-open the door again to check whether I am right or not. It can’t be, but it is, the same man as the other day! But, why is he here again?

“Rose, is the patient inside…?" I ask.

“Yes, he is. He was brought here again yesterday, we have tested him twice and he is still negative.” the nurse tells me before I even finish my sentence.

“But he looks awful.” I insist.

“Yes, I know. And what is even worse, he will most likely die. But he does not have Ebola. There is nothing we can do for him here.”

“So? He dies and that’s it?” I say, unable to comprehend what she’s just told me.

“When he arrived here for the first time we decided to run a few tests, because in spite of having had no other contact with any Ebola cases, he had fever, vomiting and other symptoms that made him a susceptible virus-carrier. Once admitted to the area for suspected cases (where they have to wait 24 hours together with other patients under the same circumstances for the results of their tests), we removed his T-shirt to dress him with clean clothes and saw he had lacerations all over his body, open wounds and signs of having been tortured. 

"According to another patient who’d spoken that night with him, he had apparently been arrested, accused of robbery and been badly beaten up while he was tied to a chair. This is the reason for the vomiting and the fever. When his results were negative we removed him from the suspected patient area, where you last saw him, and brought him here. And after dressing his wounds and disinfecting them, we sent him to JFK hospital hoping he’d be treated there. 

"You know, as we do with everyone: we refer them to a hospital hoping they’ll receive the care they need and pay their bills. This is all we can do: this is an Ebola centre and MSF is focusing all its resources on this emergency. This is why we are insistently urging other organisations to help reopen the hospitals. We have also started doing it”.

“I know Rose, but why is he back if he has no Ebola? And most important of all, why have you said he is going to die?”

“He is going to die because most probably he needs surgery and to date there are no medical centres with a surgeon able to operate on him. And because he needs someone to change his bandages and clean his wounds every day. And there is no medical staff to do so either”.

“And why was he sent back to us?”

“Because he started vomiting again and there, at the JFK hospital, they are still convinced that he has Ebola, so we have run new tests in case he has developed the disease in the past days. But you can see for yourselves: if he is in this tent it is because he has tested negative again. If we go on like this, after insisting so much, he will end up being infected. In the condition he is in, and being in the same place as patients that probably have Ebola, mean that in the end he will get it. But right now Ebola is the least of his problems”.

“And what are you going to do with him now?”

“We are going to refer him to the SOS hospital. And the same thing that happened at the JFK will happen again. He will not receive the care he needs and eventually he will die. And worst of it: he has not even turned 18.”

We leave Rose behind, whose mood has sunk to a new low, and continue our visit in silence until we reach the place where Amie Subah is waiting for us. Amie is an exceptional woman who is very proud of being able to help other people in very difficult situations move on with their lives.

“We often see children as old as my little one, who gradually begin losing the battle, and who we are just unable to help. Yet when I come here and manage to help some of them get up, eat or walk a little, I know that that day, my work, has been worthwhile. And besides, it’s not all bad news! On Saturday we discharged five people in the same afternoon. And if I am not mistaken, and I am almost sure I am not, more than 450 of us have managed to shake the virus off in this centre.” Amie tells Margareta.  

And I could not agree more with Amie: Elwa3 is a place that always manages to churn up mixed emotions in me. Here complete happiness is a rarity but the success stories you come across every day, together with the huge dedication of these people to their work, make us all feel in MSF that this is the place where we should  be right now.

Fernando G. Calero is a press officer working for Médecins Sans Frontières. He wrote this post from Elwa 3, the MSF centre for Ebola patients in Monrovia, Liberia on 15th November 2014.