Africa

Ebola clinic: The one who is about to die

By Kathryn Stinson 13 October 2014

The Plague by Albert Camus reads: “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…” It’s apt in Sierra Leone. By KATHRYN STINSON for GROUNDUP.

(This story was first published by GroundUp.)

Can you tell us whom 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. He is middle aged and he lost his wife to Ebola three days ago. He cared for her while she was dying. He was brought in by ambulance to our treatment centre last night with a fever.

We are trying to probe very gently whether there was anyone else who may have been in contact with him when he became sick. This is so that the health promotion and surveillance teams can follow up with the contacts to ensure that that if they are in quarantine that they have sufficient food, drinking water, mattresses and soap for infection control, and to address the concerns of the community and sensitise them about Ebola.

The man doesn’t speak. Sitting on a chair, his arms have the muscular definition of a hard labourer, but his body is limp and shiny with perspiration. He remains silent, frowning slightly, trying to remember. “My niece.” His eyes are clouded over and he looks away. I think he is overcome. “Don’t push it,” I say to the health promoter and then after asking him if he needs anything, we thank him and walk away.

His story is most likely similar to the twelve others who were admitted as suspect cases last night. Some arrive in the ambulance after a four-hour journey, and are too traumatised to speak. It’s my job to enter each admission into the database, and look for links between them, as well as to monitor the location from where they come in order to identify potential new clusters of infection.

Every day, I follow the strict infection prevention and control procedures to enter the treatment site. The smell of chlorine is ubiquitous: as we enter, we stand and wobble one legged, as each shoe is sprayed, after washing our hands, both with chlorinated water of different concentrations. Scrubs and boots are handed over and changing into them is a challenge: nothing must touch the floor.

The treatment centre is divided into zones of risk, the low-risk area for the medical and clerical staff, where patient administrative work is carried out. This is where I encode my data, closely watching the patient and laboratory white boards for new admissions; the daily blood results and the changes in status of each patient.

In the high-risk zone, medical staff move carefully and slowly around patients in a dozen tents that have been pitched in two rows of six, delineating the path and eventually the fate of the patient, using the fancy epidemiological terms “suspect” and “probable” – based on clinical diagnostic criteria, and then confirmed cases (with a blood test), before leading either to convalescence or death.

For us, the priority is personal protection and safety. Continuous vigilance regarding this leads to obsessive hand washing and keeping space between ourselves in order to apply the “no touch” mission policy. Actions need to be carried out carefully and slowly in order to prevent mistakes, as a mistake has the potential to bring the whole team down.

He died today, three days after I spoke to him. I feel a short stab in my chest as I scan the death register and recognise his name. The medical staff tell me that he died doubled over in prayer, facing East. It was unexpected, and most likely instant. Little is known about the pathology of this virus; death seems to strike suddenly at times. DM

Photo: A ‘Save The Children’ community health team worker talks to locals on a door-to-door sensitisation about Ebola at the Hill Station community west of Freetown, Sierra Leone, 08 October 2014. Figures released from the United Nations World Health Organization (WHO) indicate the death toll from Ebola in Guinea, Liberia and Sierra Leone has exceeded 3,400. In Sierra Leone 121 deaths have been recorded from Ebola in one day according to government health statistics compiled by Sierra Leone’s Emergency Operations Centre showing the total number of deaths at 678 on 05 October 2014 up from 557 the day before. EPA/STR

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