And then I found myself…

This post was written on 10th September 2014

This post was written on 10th September 2014

. . . in Brussels, preparing to go to Sierra Leone to work in Doctors Without Borders’ (MSF’s) Ebola project in Kailahun. This has been a week of training - some of the science of pathophysiology and treatment, lots of emphasis on caution and use of PPE/personal protective equipment, epidemiology, case tracing and health promotion - and constant conversation about Ebola. It turns out that, as an organization, MSF has more experience in managing/treating hemorrhagic fevers than almost anyone else on earth. The Centre for Disease Control (CDC) perhaps is more immersed in the science and research of hemorrhagic fevers, but none has done more active intervention.

I am trying to wrap my mind around this series of stark facts from our training: in the midst of an outbreak of untoward proportions, there is only one functioning Ebola treatment center in Sierra Leone. It is in Kailahun and is run by MSF. There do exist in other places “isolation wards”, where people thought to be infected with Ebola are housed, removed from the general population, and hopefully roofed and fed. These are run mostly by local Ministry of Health (MOH) “Health Posts” or “Health Centers”. MSF is racing to open a treatment center in Bo, site of a long term MSF general hospital and maternity project, midway between Freetown and Kailahun and action central for our outlying treatment center in Kailahun.

MSF experts provide in-house training in Brussels to MSF staff volunteering for Guinea, Sierra Leone and Liberia. © Ikram N'gadi...

MSF experts provide in-house training in Brussels to MSF staff volunteering for Guinea, Sierra Leone and Liberia. 

Our treatment center in Kailahun has limited bed space (around 70), although the epidemic continues to swell out of control. Some patients are coming from as far as Freetown, across the country, where the urban population is dense and we are hearing of an extension of this terrible outbreak with confirmed cases and deaths from Ebola infection. Patients are coming also from Bo, until the new facility can get up and running. In fact, I and my fellow travelers are carrying with us from Brussels pieces of one of the structures intended to form part of that treatment center. Therefore, many patients all over the country are waiting to be admitted but cannot be because the Kailahun treatment center is already full.

In Malawi, during malaria season, our pediatric unit was often so full we had three or four or even five children to a bed. Adults slept on the floor between or under the beds. In the malnutrition unit in our hospital in South Sudan, we sometimes had to pick our way gingerly, squeezing amongst the bodies of our patients and their caregiving family members sharing beds and sprawled on floors when it was busy. This is simply the way it is when providing a scarce resource to a needy population in desperate straits. Our constraint though here in “Ebola-land”, is our own safety - ourselves, our staff, and those patients who come because they are ill but not from Ebola: we simply cannot risk overcrowding our treatment center in such a manner that non-infected patients and  caregivers are placed at risk of unintentional accident and/or unprotected contact with infected patients. It is truly a dilemma I have never faced.

The other thing I have never faced is care for a patient population of whom we can expect more than 60% to die while under our care, even a higher percent if they do not reach our care. It is not really possible to imagine this in our developed world - I just don’t have a reference point for such a condition.

MSF creates a “field” setting in the midst of Brussels

MSF creates a “field” setting in the midst of Brussels

The trainers and “brief”-ers, the people responsible for trying to help us understand the situation and undertake our work, tell us it is actually preferable for these deaths to occur at our treatment center, even if the patients never make it inside. Their bodies can then be managed by our own teams in their protective gear, disinfected, bagged in impermeable plastic bags and buried without creating more risk of contagion in their homes and among their family and community. Talk about a harsh reality.

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