Via MSF, a powerful blog post by Dr. Benjamin Black: Individuals in an Epidemic. Excerpt:
The emergency response teams working at the Ebola project in Kailahun are very busy. Resources are limited, and the need is great. I soon became involved in assisting the medical team with their daily tasks.
Medicine in an Ebola outbreak is not rocket science. Management is kept as low-tech as possible to avoid unnecessary procedures that could expose health workers to risk of infection, for example inserting intravenous lines using a needle. As there is no current curative treatment for Ebola the focus is on “supportive treatment” only (see last post).
I would like to introduce you to a few of the isolated patients, to see what I saw and to understand some of the challenges. Whilst the cases are real, all names and identifying details are changed for the maintenance of patient confidentiality and dignity.
Once the cumbersome personal protective equipment (PPE) is applied, I have a colleague check me to make sure I have not left any small patch unprotected. Satisfied, I enter the isolation unit with the nurse, who is to be my “buddy” whilst inside.
We first enter the “Suspect” case area, here are mostly patients admitted in the last 24 hours, waiting for blood test results which will determine if they move through the one way system to “Confirmed” or get discharged if not infected.
Most of the patients in "Suspect" look well, there is just one man who is lying on his bed inside the hot and humid tent. I saw him on admission the day before, when he walked to the unit himself to declare his concerning symptoms. He has begun to have bouts of watery diarrhoea and his appetite has almost gone completely. He’s still alert and able to hold a coherent conversation. We talk a bit about basic care when suffering diarrhoea, a quick assessment shows he is not clinically dehydrated so I encourage him on oral intake and make a note “not for IV”.
Some patients arrive to the unit in small convoys, whole families or chunks of a single village where there has been the tell-tale stories of mysterious deaths and traditional funerals. In the tent next door are the "Probable" cases, still waiting for test confirmation but with a solid contact and symptom history.
The day before six members of one family came from a village known to have an uncontrolled outbreak, they all tested positive and moved along the conveyer to the "Confirmed" area, filling the beds of recently deceased or discharged patients.
The patients in the "Probable" tent look to be in significantly worse condition than those from "Suspect". Most are lying in fetal position, one hand resting on their stomachs (a common symptom of Ebola is stomach ache), they look weak and apathetic.
There is one small boy quietly curled up on his bed. He arrived late in yesterday’s shift, reportedly he is nine years old, he is visibly malnourished and could easily pass for much younger. He was brought by the same ambulance as his mother. The roads around Kailahun are in appalling condition, the rainy season does not help either. I can only imagine being thrown around in the back of the ambulance as it navigates each muddy bump and pot-hole, when already feeling sick and frightened on ones way to a strange unit.
When the ambulance doors were opened the mother was found to have already died during transit, her child lying next to her. To be a rural Sierra Leonian, nine years old, sick and away from home, recently bereaved and alone. Now faced with strangers in fully covering bright yellow suits. Terrifying.
He was lying in a pool of watery diarrhoea, and though awake, not able to show any sign of recognition or eye contact. He was literally frozen with fear. We take the small blood test (a swab as his veins were too challenging), and make a note for him to be cleaned and fed.