ELWA3, the MSF Ebola Management Center (EMC) in Monrovia, has been featured in many news stories over the past months. It’s a huge facility with lots of staff focused on triage of those with Ebola symptoms and management of the suspected and confirmed cases. The good news is that with the decreased in cases of Ebola in Monrovia, the census has been low leaving many beds empty.
I had the opportunity to volunteer for the nightshift at ELWA3. My partner for the experience was an expat nurse working in the EMC full time. It was my first time getting into full Personal Protective Equipment (PPE) and entering the confirmed Ebola area.
I was very happy for the help I had getting into all of the layers of PPE. My “dresser” was right there, walking me through all of the steps. It was clear she had done this many times. She gave me all of the components of the attire, tucked things in and tied parts down, ensuring that I had no bare skin or gaps which would allow for exposure. It was a cool, rainy night but I could still feel myself getting warm as I struggled into the overalls and the various layers.
Our rounds consisted of checking all of the patients and talking to those who were awake. I hadn’t seen an Ebola patient before and I was struck by how confused the first two patients were. The first patient, a man in his 50’s, behaved like he was unable to see… his eyes were red and he focused his gaze off to the side, beyond us. He was unable to follow the simple direction we gave him to lie down. I learned later that his symptoms and cognition had worsened over the day. The second patient was an elderly woman who had lost her nine-year-old granddaughter to Ebola just two days before. The woman was unable to respond to our directions and she simply laid on her mattress staring at us.
Most of the other patients we saw were not as sick. Two women had been in ELWA3 for over a week and when I asked them how they were feeling, they just chatted away energetically. One of the challenges of being in the EMC (for patients who don’t feel horrible) is the boredom as there is little to do to pass the time (anything brought inside the confirmed or suspected area gets destroyed). Despite being positive, neither looked sick and I walked away with the distinct impression they would win their battle against Ebola.
I believe the most dangerous part of going into the EMC contaminated areas is undressing from the PPE. My colleague alerted my “undresser” that it was my first time and he was very helpful and patient as I wormed my way out of the layers. From across the line (about 1.5 meters away) in light PPE, he walked me through each step. It was the slow, methodical process that I learned during my training in Brussels. Getting sprayed down with chlorinated water felt great as it was a cool shower through my PPE… then it was off with a layer and wash your hands, off with a layer and wash your hands, until I was back to the scrubs and boots I started with. Not so bad really.
While ELWA3 can be a little overwhelming due to the size, the yards of orange fencing separating the clean and contaminated areas, the number of people in some level of PPE, and the knowledge of the seriousness of the work, there is a bright light for me. The long billboard onto which the Ebola survivors leave their handprint in a variety of happy colors and proudly sign their name.
The survivors wall in MSF's Ebola Management Centre ELWA3 in Liberia, November 2014 © Malin Lager
From my first visit to my last visit the board has become completely covered. We are able to help people. People can survive Ebola. This work is important.