Via The Telegraph in the UK, Dr. Naomi Platt vividly describes her experience working in a small rural hospital in Sierra Leone: 'It couldn’t be Ebola, could it?’ Excerpt:
I’m not sure what I had expected from my work experience at Masanga, a hospital part-funded by a British, Danish, Dutch and Norwegian alliance. In January, I had taken a three-month diploma in infectious diseases at the London School of Hygiene and Tropical Medicine, and had been due to follow it with three months of work in Sierra Leone in April.
Early reports of an Ebola outbreak delayed the sabbatical by a month, while safety was assessed, but in May I went out with my fellow doctor-in-training, Aatish Patel.
I’ve travelled in Africa before, as my parents had lived in Zimbabwe, and I have carried out a short research project in Burkina Faso, so there was no great feeling of culture shock when I arrived in Sierra Leone. However, the facilities at the hospital – which is surrounded by jungle – were more basic than I had anticipated.
The infrastructure had been damaged during a civil war that ended in 2002. There was no running water and a generator provided power for two hours a day and during operations. There was no isolation unit and many common drugs were not available.
If someone came in with a non-specific set of symptoms, such as fever, abdominal pain or diarrhoea – which are also signs of Ebola – we would treat them with antibiotics for sepsis or typhoid, antimalarials, paracetamol for fever, and fluids or oral rehydration salts for diarrhoea.
We could send blood for testing to Kenema, Sierra Leone’s main treatment centre, but samples sometimes went astray, as happened with those from one of our suspected Ebola patients. Waiting for the results could mean delaying alternative, potentially life-saving treatments.
We mostly saw malaria, diarrhoea and non-specific fevers on our ward rounds, but in the back of our minds was Ebola. I always imagined I would recognise the disease the minute a patient arrived with it at the hospital.
However, most sufferers at an early stage have the same symptoms as the majority of other patients; and only half of them experience telltale bleeding. With Ebola, there is also a long incubation period of up to 21 days, so if you see a patient with a fever that is unresponsive to standard treatment, you wonder: could this be it?
As rumours reached us that the disease was spreading towards our region, we began to feel very vulnerable. We’d talk about it at night, and senior doctors kept us updated with the latest information from the Sierra Leone government, but it was obvious that the hospital needed to prepare for infection control.
We asked for additional gowns, aprons and masks. I had visions of head-to-toe boiler suits, thick gloves and full-face masks, with not a glimpse of bare skin. The reality was thin gowns, latex gloves, hairnets and goggles like those worn in science lessons at school. Better equipment was being sent from Europe, but shipments invariably took weeks to arrive.
To control properly any infection, you need chlorinated running water; for the entire isolation unit and decontamination area that we rapidly set up, we had only nine buckets of it.
Perhaps our biggest problem, however, was the refusal of locals to believe in the existence of Ebola. I met some who simply dismissed the disease, and even learnt of one health officer who would not take precautions. Sadly, he contracted the disease in June and died.
We had a problem with the first patient to use our isolation unit. He and his family accepted that Ebola was real, but they could not grasp how easily it is transmitted. On the ward round one morning, he was found naked on a bed stripped clean of sheets.
He had passed his clothes and bedding to his mother through a window, which she had then taken away to hand-wash in a communal laundry area. They thought they were doing the right thing for the hospital, but had he been found to be suffering from Ebola, he could have inadvertently spread the virus to his mother and the wider community.
The most upsetting cases I saw were when a 26-year-old woman and two children arrived within the space of 48 hours, with fevers and diarrhoea. We gave them what help we could, but soon after admission, they died without us knowing why.
After trying desperately to resuscitate one of the children, I realised I had done so without gloves. In the heat of a desperate moment, I had not protected myself against Ebola.
Dr. Platt was lucky; she came home with only malaria.