My lessons from Ebola hospital

On a cold July day earlier this year, I left Kenya for Sierra Leone on a medical assignment. To get there, however, I had to go through Brussels, Belgium, where I spent two days at the Medicines Sans Frontières (Doctors Without Borders) staff health unit before taking a plane to Lungi, Sierra Leone.

This, though, was not the first time I had been to Sierra Leone; I had been there many other times on other medical assignments. I knew I had been sent here to help deal with the Ebola epidemic, yet somehow I wasn’t nervous about it. Come to think of it, I think I was more nervous regarding how I would get to Kailahun, a Sierra Leonean district that borders Guinea, than what I would find there.

On landing at Lungi, however, something curious hit me; I had to travel by boat to Freetown, and to do that I had to wear a life jacket. My first concern when a steward handed me a life jacket was “how many other people had worn this before me?”

You see, in a country devastated by the worst Ebola epidemic in the history of mankind, such minor things as whether or not to share life jackets become life-and-death matters.

LIFE JACKET

I looked around to see whether others were as hesitant as I was. They weren’t, and so, against my better judgment, I put on the life jacket and we set off on the 45-minute boat-ride to Freetown.

At six in the morning the following day, we left for Bo, the second largest city in Sierra Leone. On arrival, we were briefed on the situation in Kailahun, our home for the next month or so, and the dangers that lay ahead.

We were, I guess, all mentally prepared for the situation in Kailahun when we finally rolled into the small town and headed to the case management centre — in the medical world, we call such emergency health care units “case management centres” rather than “treatment centres” when dealing with diseases that have no cure yet, like Ebola, so the only thing medics do is try and make patients as comfortable as possible as they await their fate.

After watching news and reading newspaper and magazine articles and staring at gross images from epidemic zones, you tend to prepare yourself for the worst when going to such zones, but the huge difference between fact and hyperbole hit me when I saw, for the first time, a group of Ebola patients.

DEATH BECKONED

Where I had expected emaciated, grinning, bony figures lying on threadbare blankets as death beckoned, I found patients walking freely inside tents, talking to each other and basically looking forward to their healing. For a moment, I just stood there — immobile and emotionless — and stared.

I did not utter a word or make any movement. Like a blind man who had just regained his sight, my eyes darted around the compound, taking in everything they came across and trying to analyse it in minute detail.

Before me were tens of Ebola patients in various stages of infection, yet that ominous cloud we have come to associate with this deadly virus was not hovering over the facility as it has been in TV reports.

This, though, is not to rob the virus of its bite. No, not at all. Ebola still remains a devastating ailment, a disease that kills more than 70 per cent of its victims. Yet here, at a small facility in a small town called Kailahun in Ebola-hit Sierra Leone, patients were walking around, chatting with each other and trying to ignore the bug that had brought them here in the first place.

Our hosts took us through safety protocol that would determine whether we left Kailahun alive. Wash your hands not just with water, but chlorine, they advised us. Whatever you do, do not touch your face, or rub your eyes, or wipe your mouth.

NO HANDSHAKES

And get used to being sprayed, like a tick-infested cow, every time you enter or leave the patient tents. Oh, and, while we are at it, no handshakes, or hugs, or bonhomie slaps on the back.

And then it hit me; I may have been to Sierra Leone before, but on other less dangerous assignments. This... this... this was as dangerous as it could get. As much as it was my duty to take care of the ailing, I also had to take care of myself, otherwise they would quarantine me and place me in the same tents as those I had come to comfort.

During the two days I had spent in Brussels before heading to Sierra Leone, I had, courtesy of MSF, met with other doctors who had been to Kailahun. My interactions with them had, in a way, prepared me for the task.

And then MSF had introduced me to a psychologist, who had informed me and others on the mission that the risk of infection was real, and that, for us to do our duty, we had to be in the right frame of mind.

When, after a lot of counselling, they asked whether we were still willing to go ahead with the mission or we would rather bail out, we all answered in the affirmative.

The biggest precaution for every medic on the ground during any epidemic is not to get sick. Somehow, people tend to view these care givers as heroes and heroines, but in a real sense they are not. True, they work in the most dangerous and emotionally draining environments, but so do many other people in many other fields.

NO HERO

My supervisor hammered that fact into my head in Kailahun. Please, do not try to be a hero, he told me many times. Such words, told in the most caring way, tend to ring in your head for a long time. When dealing with a patient, you go through the motions knowing all too well that you are no hero or heroine, but a mere mortal who has the advantage of protective clothing.

In the medical world there are things that doctors do without the need to consult anyone; simple things like fixing an intravenous (IV) line. But not with Ebola. Whether or not to prick a patient’s skin for the IV line requires a whole discussion with your team; where safety, necessity and alternatives are explored.

If the patient can take orals instead, you avoid the hypodermic needle altogether, because a needle means sharp pain, which could translate to the patient reacting by touching you. And you know what that means in Ebola situations.

Our main focus at Kailahun was to prevent infections. Even inside the tents, we made sure people did not share cups, spoons or beds. But it was not easy; for example, there were mothers with little children, and you cannot just wake up one day and tell mothers not to hold their children.

Some bonds, Sierra Leone taught me, are just unbreakable, no matter the danger. And so many women risked their all to comfort their ailing children, even when they knew they were exposing themselves to great danger.

For the patients, we strove to maintain the delicate balance between preventing them from getting in contact with those who hadn’t been infected while at the same time giving them some form of dignity.

REHYDRATION SALTS

We provided buckets to each one of them to help contain infections through vomit, gave them rehydration salts, and talked to them on a daily basis.

When Ebola started in Guinea in the Guekedou Triangle, we had an MSF operation centre there but didn’t know what disease it was. Medics just saw people dying but no one was sure what it was.

They asked for help from our unit and a colleague who had worked on Ebola before went to assist them in setting up an isolation centre. They were starting from scratch; training medics, learning what this disease was all about and convincing a resistant community to come forward.

This is part of the reason the disease spiralled out of control. The other is that they had to look far and wide for people with experience and who were willing to lend a helping hand.

At the time I was attached to a maternal referral centre in Bo, Sierra Leone, and before I briefly left the country in May, we had the first case of Ebola confirmed in Sierra Leone.

Ebola is a type of disease that, because of its nature of transmission, you can easily predict where it is going to go next, so we embarked on sensitisation campaigns to explain the scenario to the public, warning it could get out of hand and telling them what they needed to do in case the worst came to pass.

VIRUS ON RAMPAGE

And then, just as we had predicted, the virus went on the rampage, killing hundreds within days. We decided to close the maternity unit because we felt we were not safe as we were dealing with blood and so many other body fluids.

MSF said they would open another case management centre in Bo, but I asked for time off. I was stressed and fatigued. Completely drained. I asked them to give me a few days off to go home and rest before rejoining them.

They obliged and sent me to Brussels, where I was counselled first before flying home. That is how, at the height of the epidemic, I was still in Kenya, planning my next trip to Ground Zero.

It is hard, really, to place a finger on what has gone wrong in our management of the situation in West Africa. I remember that, when I first left Sierra Leone as the disease was extending its tentacles, my seniors in Brussels asked me what we could do to improve our processes on the ground.

My opinion was that, even though we had a huge presence there, we were still not doing enough. We were concentrating too much energy on the case management centres at the expense of outreach programmes. We needed more people on the ground, but the numbers were limiting.

Dr Waithera spoke to Aggrey Mutambo ([email protected])