South African doctor on Ebola’s front lines
Medecines Sans Frontières (MSF) doctor South African Stefan Kruger recently touched down in the eye of the Ebola storm where entire households are being erased from their family trees by the disease.
MSF is currently working in Sierra Leone, Guinea and Liberia to combat the spread of Ebola and has launched an international funding appeal. Kruger takes us through his first days in country in Sierra Leone’s eastern Kailahun District.
In the days leading up to the start of my first Ebola mission, I frantically wrack my brain for any knowledge on the lethal illness. There are snippets from a medical school lecture entitled, “Viral Haemorrhagic Fevers”… in a section of the brain labelled, “things you are unlikely to need again after the exams.”
My go-to electronic medical reference has scanty information on clinical management but copious notes on the identification of Bioterrorism. It also states that “even a single case of Ebola or Marburg virus outside of Africa is a public health emergency,” which I find rather offensive.
My briefings at MSF headquarters are reassuring – with a disease that occurs as seldom as Ebola there aren’t many experts in the world. I find comfort in the fact that a good handful of them have the letters “MSF” written on their business cards. Before my departure, one of them sits me down in her office and rolls out a map and plots the current outbreak for me.
I remark on how widely dispersed the confirmed cases have been.
“Exactly and that’s the biggest problem,” she says.
I am handed a small red book that contains MSF’s most up-to-date guidelines on running a field hospital during a Haemorrhagic fever outbreak. I instantly recognise it as my dearest ally in the battle I am about to enter.
Eye of the storm
[quote float=”right”]”We become accustomed to families being broken up because of discordant blood test results and entire households are being erased from their family trees one by one”
Kailahun is currently in the eye of the Ebola storm and until recently, this jungle village with jungle hills and dirt roads has been bustling.
Now, it has largely been abandoned out of fear and panic.
On the outskirts of the village lies the biggest Ebola case management centre in MSF’s history manned by about 220 local and international staff. The 56-bed centre has only been open for a month and there are already plans to expand.
It is the only centre in the greater Kailahun district that is able to admit patients with suspected Ebola.
“Don’t be afraid of the virus, but always respect it,” says the MSF emergency coordinator who briefs me on arrival.
The first order of business is hands-on training in Personal Protective Equipment, which entails rubber boots, yellow plastic suits, hoods, masks and goggles. The end product? A person is covered head-to-toe with not a single area of skin exposed, which allows them to be sprayed down with chlorine solution exiting isolation areas. There is a dedicated person responsible for spraying and helping you remove all the gear – without touching you, of course.
It may sound like this would cause one to become quite hot. It doesn’t, it makes you boil.
In the isolation ward
[quote float=”right”]”Some data suggest that one of the biggest risk factors for contracting Ebola in Sierra Leone is attending the funeral of someone who’s died from it”
My first patient is a nurse from a nearby clinic. He has been seeing many patients, some suspected to have Ebola. He has now fallen ill himself. With safety precautions, even collecting blood samples for testing is a process. Once we’ve collected and repeatedly decontaminated the sample’s container, it will be tested with a specialised test. I should know his result before lunch.
I pray it will be negative, but he looks quite poorly.
Diagnosis can be difficult because Lassa fever is endemic in this area. With early Lassa fever symptoms nearly identical to those of Ebola or malaria, I wonder how many of these unsuspecting nurses, with the best intentions in the world, have treated suspected Lassa fever cases without realising that it was Ebola.
The case management centre is a neatly constructed tented village with timber and tin roofed walkways. A little further along, in the distance, there is a makeshift mortuary.
The handling of deceased patients’ bodies is a crucial step in the operation. It appears that patients become more infectious the further their illness progresses. For this reason, we take great care when handling bodies, especially when there has been bleeding or diarrhoea.
Some data suggest that one of the biggest risk factors for contracting Ebola in Sierra Leone is attending the funeral of someone who’s died from it.
Within the local Kissi tribes there are elaborate burial rituals that entail the body being exposed and touched. Often funeral goers will even the kiss the lifeless body. It is, in fact, difficult to imagine a more ideal setting for a virus like Ebola to proliferate.
In the days that follow we continue to receive terribly ill patients.
My nurse patient withers away as time passes. His body finally gives in when the normal immune system simply ceases to function. We get into a routine of admitting between 10 to and 20 new patients per day.
We become accustomed to families being broken up because of discordant blood test results and entire households are being erased from their family trees one by one.
[quote float=”right”]”There is singing and dancing and everyone joins in…even the patients who remain behind will often clap hands from behind the orange fencing”
Of course not all patients exit the centre through the mortuary and approximately 20 percent of patients are cured.
Discharging a patient is a magical occurrence. First, they go through a decontamination area where their old clothes are removed and they wash themselves in a disinfectant. They are then given a new set of clothes and emerge from the isolation area clean and disease free. In a moment of unadulterated euphoria staff members abandon their work. There is singing and dancing and everyone joins in, welcoming the convalescent patient back into the world.
Even the patients who remain behind will often clap hands from behind the orange fencing.
Discharged patients are given a copy of their laboratory results and a certificate stating that they are disease-free, but many often face immense stigma in their home villages.
There is a pervasive misunderstanding of the disease in many villages and also a deep mistrust of health structures.
Our outreach teams are working hard to map the epidemic, trace those that may have been exposed, and teach people more about the disease and how to protect themselves.
However, we still know of sick patients being hidden in their villages, out of fear and stigma.
MSF is doing what it can, but we are being stretched to our limits.
Every day that the world watches in morbid fascination, the epidemic spins a bit further out of control.
A University of Cape Town graduate, Stefan Kruger did his community service in rural Mpumalanga before joining MSF. A longer, unedited version post was originally written for MSF’s donor magazine. You can support MSF’s work by donating online or SMS’ing “JOIN” to 42110