When you enter the “high risk zone” in Personal Protective Equipment (PPE), you always go with a partner, never alone. The partner is responsible to you, as you are to him or her, to ensure that your barrier equipment has not torn, pulled loose or otherwise compromised your protection, to ensure that you are not becoming faint from the heat, and to help keep track of time, for, no matter the task, we are advised to stay “inside” for no more than 60 minutes at a time. Even that long is a challenge for many of us (like me).
If your gloves are a little big, I have found the fingertips end up soft and bulbous slightly distended by fluid collection. All the boots are poorly fitting anyway; footsteps quickly feel soft and squishy and just a tad slippery, adding to the adventures of ambulation. If I have to read inside, I mustwear my glasses inside the goggles. All the fog-preventing lens cleaner in the world is no help after 30 minutes or so and I just have to peek out the bottom of the goggles hopefully. Ah - for some contact lenses!
The discharge job entails entering the “confirmed” wards with a list of lucky survivors. Each patient must be identified by numbered wrist band. A pre-prepared package of discharge items, all supplied by MSF - clothing, shoes, towel, and, soap - is brought across the clean/dirty barrier.
The patient is guided to a tiny, plastic sheeted room by a fenced wall and given a bucket of dilute 0.05 % chlorinated water with which to bathe, followed by a bucket of plain rinse water. After days to weeks of desperate fever and illness, often plagued by the miseries and filth of nausea, vomiting and diarrhea, it is hard to imagine the pleasure that must be experienced by these patients in their final, cleansing bath, no matter how simple and dark the enclosure, no matter the dirt floor.
The personal clothing and any personal possessions, plus bedding, plastic bottles and anything else handled and/or used by the patient are all piled, sprayed with stronger 0.5 % chlorine solution and left to be later removed for incineration by WATSANs (water and sanitation specialists) using special procedures and PPE.
“Personal possessions” means everything - radios, written materials, religious and spiritual talismans. Even the modern talisman of a cell phone is supposed to be left behind without mercy, although I understand that sometimes the cell phones are taken apart, sprayed with the stronger chlorine solution, and the patient is allowed to take their chances on possible electronic survival. After all, they themselves have beaten the odds. Why not the phone too?!
Once a patient has dressed in the simple discharge outfit, s/he is guided through the adjacent orange plastic net gate, through another controlled area where feet and hands are again disinfected. The patient emerges onto the main causeway of the “low risk” area, a dirt (or mud depending on how recently it has rained) track lined by a series of tents dedicated to various functions - the nursing tent, the medical tent, the WATSAN tent, the store (pharmacy and supplies), the changing tent, the lab tents, the laundry shelter. As patients emerge, always individually, for the preparations are done always one at a time and with laborious care, s/he is greeted by cheering, clapping and enthusiastic congratulations from all the staff in the area.
It is little enough that we are able to do for our patients. They face a future of complete uncertainty. Although each survivor is him or herself thought to be completely immune now for an as yet undetermined duration to Ebola Zaire, the strain that is currently epidemic in Sierra Leone, other family members may have succumbed either before or during their illness, in many cases as a result of their contact with this very survivor.
It takes weeks to recover, both in the treatment center and afterward. Their livelihoods are a shambles. They are given an official, stamped certificate of cure to present to potentially skeptical village chiefs and other authorities, but they may nonetheless face intense suspicion or fearfulness among their remaining family, friends and community members.
Yet each and every survival is a triumph of individual will, determination and sheer biological stamina; each and every survival deserves our respect and heartfelt celebration. We do our best to surround our survivors with that sense as they leave us, cured.
Patricia wrote this post on 23rd September 2013 in Kailahun, Sierra Leone. For more information about MSF's work on the Ebola outbreak in West Africa please visit msf.org.uk/ebola