I found her curled up in the fetal position on the ground, under a piece of cardboard wet from the rain, breathing quietly. Dried blood all around her mouth. Naked. Most likely she had stumbled from her ward in the middle of the night, making it past the gates meant to separate the area where patients live from the triage area, where ambulances pull in — gates that frustratingly still won't close. She had done this the day before, wandering in a semiconscious state of confusion all the way out of the Ebola treatment unit to the street — terrorizing the Ebola survivors who we were in the process of sending home.
We dress hurriedly, donning our space suits. No long surgical gloves are available, so we tape our short gloves over our covered wrists and hope the tape holds. We find the stretcher we made from two wooden poles and a body bag a couple of weeks ago, and carefully move the little girl on it. She hardly flinches. She is 10 years old, and we had admitted her, her two sisters, and her aunt two days ago. Her mom was admitted yesterday. Another family decimated by Ebola.
We stop and think before we transport her to her ward. What do we need before we take her back to her mattress? I walk to triage and ask over the fence, which separates the "hot zone" from the normal world, for a lappa (the Krio word for a piece of cloth) that we can use as a sheet on her bed. I also request medication to help sedate her. Somehow, we will have to be creative and make some restraints so this doesn't happen again — should she miraculously stand up once more.
I need to get moving. It is already hot at 9 a.m. We carefully carry her over and transfer her to the chlorine-stained mattress we have put on the ground. It is clear she is in the advanced stages of the disease. But she has shown incredible resilience, struggling her way over to the outside world the day before as well as today. We had to give her a chance and keep trying to treat her. I run over to Triage again: an IV line, IV fluids, tape. And we jerry-rig an arm-board using a folded piece of cardboard to keep her arm straight so the fluids can get inside her body fast.
My colleagues in triage are awesome. They work fast. They know the girl is critically ill. They also desperately want to help her. Her severely dehydrated body doesn't make it easy for us to succeed, and our lack of adequate supplies makes it even harder. A latex glove as a tourniquet, an IV catheter impossibly long to use in someone her size. We work as safely and as efficiently as we can as our visors fog up. After numerous attempts, we have an IV going. I tear a piece of plastic from a disposable apron and hang the fluid bottle to the window. Our solution for restraints is to string together a bunch of disposable plastic aprons, slide this makeshift belt under the mattress, and tie it over her body. It's all we can do.
We sometimes run out of chlorine, an essential cleaning agent that kills the Ebola virus and allows us to work safely.
We're done. Out of there. It's been about an hour and a half, well past the time we can spend in the Hot Zone without overheating in our PPEs. But we can't leave. The other patient in the room is barely alive, but hanging on. The woman needs more IV fluids, too. Luckily, she already has an IV, so all we have to do is find IV fluids and get things going. Done. My partner and I look at each other approvingly — job well done. As well done as we ever could. Out. Now.
Our final job on our way out is to transfer a patient from the suspect to the confirmed ward. We traverse the courtyard and explain to the man that he has tested positive for Ebola and we need to take him to a different building. Frail but strong in spirit, he picks up the bucket he uses for bodily fluids and walks over with us to the confirmed ward. I have hopes for him. After all, he has been there for several days already and is stable. I remind him to drink a lot. "Pee the Ebola out," I tell him. I am not sure he's convinced.
Such is our daily fight against Ebola in a country that so far has seen 8,356 confirmed cases of Ebola – and 2,085 deaths.
It is also a daily battle to do our work in a place with a nonexistent health infrastructure and where the international response system has been woefully inadequate and inefficient.
Millions and millions of dollars of aid are reportedly waiting to be spent – yet little of it seems to make its way to where people need it most. Droves of WHO and CDC consultants have made their way to Ebola treatment units and community care centers, observing, dispensing wise recommendations, taking plenty of notes, writing reports. And that is all well and good, but the bottom line for us and our patients is that the basics are still not met. We're fighting to get supplies. We're told they're coming. They never arrive.
Patients who come through the triage area after a two-hour ambulance ride still wait, critically ill, under the blasting sun without a shaded area to rest under. Our enclosed compound has gaping holes in the fence through which confused Ebola patients sometimes escape to the streets. Our patients lack bed sheets and soap. We sometimes run out of chlorine, an essential cleaning agent that kills the Ebola virus and allows us to work safely. There are no functioning toilets for our patients. We are still missing the tools to place an IV safely. We don't have IV poles to hang our fluids. Our gloves are too short. Staff sometimes (and understandably) strike for lack of pay. The list goes on.
The decision by (PIH) to become involved in the fight against Ebola by partnering with the Sierra Leonean Ministry of Health's health care facilities is a noble one – and it is the right choice. It confirms a long-term commitment to improving and strengthening the country's health infrastructure and not to just "fix the Ebola problem and get out." But it means PIH has to collaborate within an existing structure where changes are often painfully slow to come. And slow is not an answer when faced with Ebola.
Sierra Leone won't win this fight until the essentials are in place.
Yes to vaccines, ICU care, and tablets to electronically record patient care - as some ETUs have. But this is luxury, and it must come only after the basics are well in place. Where is all that money the world has given? It could have made a difference for so many patients in our Ebola treatment unit. The ten-year-old girl died that night, alone. As did her entire family.
Karin Huster, RN, BSN, MPH, is Partners In Health's clinical lead at the Maforki Ebola treatment unit in the Port Loko district in Sierra Leone. Maforki is about 80 miles from the capital Freetown in the northwest.
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