While leaving Freetown for the airport by hydrofoil, I reflected on how I felt when undertaking this route at the start of my journey. It was night and there was no electricity. We were disorientated by sensory overload: while trying to become accustomed to the darkness and warm, humid air, we were also contemplating getting used to frequent hand washing and keeping distance between ourselves, not touching each other and objects (where possible).
I know how much Ebola has been in the media lately and one of the questions I’m asked by friends and family is how do I protect myself from Ebola…?
My first priority was to understand the activities of the mission; their timing, and what stock had arrived in Monrovia to support the activities. Despite this mission just getting underway, parts of the emergency orders from MSF Logistique in Bordeaux had already been shipped. How much anti-malarial medication, central to the distribution activities of the mission, is here? What other medical supplies are here? Have they been organized in any fashion? When is distribution starting? What is required from pharmacy? Is there a pharmacy?
MSF's Belgium operational centre (MSFB) has been working in “Ebola” settings for many years… almost 20… so they have an enormous amount of knowledge to on safe behavior, infection control and patient management. They recently developed a training course “to ensure staff has a sufficient knowledge of the disease and its transmission routes and are able to adapt a safe behavior and work efficiently in a well-designed Ebola Management Center (EMC).”
On September 13th, Ibrahim came to us in the arms of his mother, his older brother Lamin walking at her side. He was a little more than a year old on arrival. We couldn’t be sure of his age exactly and his mother did not know. His mother told us her husband, Ibrahim’s father, had died less than a month ago.
‘When will we be free of this Ebola?’ It’s a question I’m hearing more and more. People are tired. They’re tired of the fear, of the loss, of the interruptions, and yes, they’re getting a bit tired of seeing us, too. ‘Every day we see the ambulance passing on the way to the cemetery. It is not nice. When will this thing end?’
We realize that one of the crucial steps in intervening in any infectious disease outbreak, but perhaps most especially this one, is contact tracing, sort of an unholy amalgam of social work, epidemiology and divine intervention. MSF has some people who are incredibly expert at developing systems and networks for such activities under circumstances most of us in the “first” world would find utterly impenetrable.
“So just think of the one who is about to die, trapped behind hundreds of walls sizzling with heat, while at the same time, there are all those people, on the telephone or in cafes …” The Plague, by Albert Camus.
"Can you tell us who you were living with before you came here?" The health promoter shouts across the fence. Feeling uncomfortably self-conscious for drawing this patient to the feeding area to talk to him, I stand about seven metres away, in the blazing sun, shading my eyes to try to read the emotion in his face.