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).
Today I am writing from Monrovia, Liberia. Yup, Monrovia… the center of the Ebola crisis in Liberia. I know, I know… be careful and wash my hands. Don’t worry, my new perfume is chlorine.
I’m here with MSF’s Paris Operational Center and our mission is focused on mass distribution of malaria treatment to the families in the Monrovia area (50,000 families give or take). The goal is that of public health, if we treat people for malaria (which is endemic here) we will keep malaria patients out of the Ebola Management Centers (EMCs).
The line between genuine fear and real paranoia is so fine that it already threatens to blur. "The aftermath," I was warned, is perhaps even more challenging than the assignment. I can only agree. I have been back for a week in the middle European bubble. I am at day seven of the 21-day incubation period I have to wait through to be sure that I have not been infected with Ebola. A waiting game…
We receive our patients in several ways: sometimes they walk or ride in cars to us individually, but seldom. We are in a rural setting, the roads are bad and it is a distance from town. More often our patients arrive stuffed into ambulances from “isolation centers” and sometimes from hospitals, frequently located many hours distant from us. They may be relatively okay, delirious with fever, obtunded by weakness, and sometimes they die along the way.
When I meet Alexander he is standing in the visitors’ area for confirmed Ebola patients, anxiously waiting for his son to come out from the tent so he can see him. ‘I thought we’d find you here’, says Henrike, MSF’s psychologist smiling at him. ‘How are you feeling this morning?’
The driver puts his fist on the hooter insistently, indicating to oncoming vehicles, people and animals to move out of our path, which is obscured by lush forest at every corner.
We twist and turn on the dirt road, the tyres kicking up clods of mud. It has rained intermittently the whole afternoon and the road becomes increasingly difficult to negotiate, requiring the full 4-wheel drive.
This week has been mainly a good week for me, but even with the good, devastating sadness is hard to escape. I've concentrated on the 'good' stories – the survivor who's now working at the centre, the awesome work of the psychosocial support team, and how the different teams work together to do the best job they can in ridiculously constrained circumstances.
The people are dying - in ambulances on their way to us, quietly in corners of our treatment center, under the beds, sometimes crazily stumbling from place to place. The final stages of this disease must be agonizing, for even in the extremes of their final weakness our patients contort themselves into impossible positions in pools of their own body fluids, their faces struck dumb in strident grimaces.
I am sorry to tell you this, but it is the face to face reality that the media and the numbers cannot describe.