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Ebola: An afternoon in isolation
Dr Luis Encinas is a Médecins Sans Frontières/Doctors Without Borders (MSF) emergency coordinator and was working with our team in Macenta, southeastern Guinea, during the Ebola outbreak. Here, he describes an afternoon spent in the isolation ward set up by MSF.
Today, I’d like to start my story at 4:30 pm. I am meeting Macenta hospital’s managers and doctors with my colleague Kathleen, who will replace me tomorrow. I have asked to go back to the isolation unit so that I can see the patients again. We head toward the old paediatric unit, located alone and isolated at the other end of the hospital compound. The climb is gentle, but the hot and humid climate means we are soon covered in sweat. We arrive and speak to the other members of the team, just ahead of the entrance.
"The silence is like lead"
Every time I approach the isolation unit I realise what an immense amount of work we have done. In just the time it takes to climb the remainder of the little hill to reach the entrance of the building I am filled with a sense of satisfaction. After forcing ourselves to drink half a litre of water, we put on our boots, green blouses and trousers. We follow the strict protocol for protection clothing: hospital gloves, number one mask, full overalls, a hood to be tied in three places with simple knots, neither too tight nor too loose, just so, after carefully making an opening to let the face mask pass through.
We feel the body thermometer, which measures tenths of degrees. A second pair of gloves, this time surgical. Then we close the overalls with two pieces of Scotch tape and put on the pair of glasses, referred to as 'ski goggles', because they are so large. We proceed to check the air tightness of our garments. After a final adjustment we are ready to enter the isolation unit, taking with us medications, food and water.
We go into the long corridor to reach the first room. It’s a large, dark room with ten beds where this afternoon there are two of our three patients - a couple admitted nearly a week ago. I remember them very well. I had met them before when I went to their home to help them to wash the body of the last of their surviving children.
Emotions are heavy, the silence is like lead. I try to concentrate on the current moment. I look at the husband, stretched out on the bed. He seems to be smiling at me. I imagine he has recognised me and I smile back at him. Suddenly, I realise that he can only see the shape of my eyes and I fear that in the semi-darkness he can hardly recognise me.
"I have lost everything"
I speak to him slowly and he answers me in barely comprehensible French, saying that he is well. He sits down unaided but has difficulty remaining seated. We give him medication, fresh water and bring him his meal. I would have liked to sit down and speak with him, listen to him, calm him down. “I have no more strength. I have lost everything,” he says. He eats his meal and keeps looking at his wife. Time is passing ... tick, tock, tick, tock. I have no concept of time, but I estimate that a dozen minutes have already passed.
We go to his wife, who I had seen looking so dignified, so strong on the first day that she arrived. She had guaranteed me that nothing would happen to her, and it took us so much time to convince her that, clinically, her condition was worrying. She had come to accompany her husband, to feed him. “I am coming in so as not to leave him alone,” she told me that day. Today, she has no strength, and has trouble raising her arm so that we can take her temperature with a thermometer. Her body is heavy. We try to seat her on the bed.
Kathleen talks to her all the time and checks her drip. We change her infusion line because blood has coagulated there. She does not stay still for a single minute. She is feverish, weak and perspiring. We get towels and soap and begin to wash her. Her husband stares at us, powerless, a few metres away. He speaks to her in Toma, but she does not answer. And time does not stop - those clock hands seem to me to speed up, to go crazy. I place a sponge towel on her head.
"Powerlessness and frustration"
We organise the room a bit, try to give it a more human look. The hanging electric lights, hurriedly installed so as to allow access to patients at night, were definitely not set up with me in mind. I have to be a contortionist to pass from one side of the patient to the other.
She murmurs something to us, but we have trouble understanding, as does her husband. Her condition has deteriorated so much that in less than 48 hours I have difficulty recognising her. I try one last time to make contact with her husband. I have the impression that he will survive. I hope so.
Suddenly, I tell myself that I may be mistaken, that he is old, that, although he has lost and already buried five members of his family, he may just have a backache, a little fever, common diarrhoea. My head suddenly becomes a Chinese puzzle and I lose my train of thought. I re-focus. In any case, this evening we will finally have the laboratory results.
My colleague tells me that she is slowly beginning to feel hot. I look at her. Her goggles are filling with condensation and beads of perspiration are forming on her mask. We step up the pace. I close the door with a sympathetic glance. I try to give them all my strength. I cannot stop thinking about them.
The heat outside becomes unbearable. I feel as if I have the Loffa, a river in Guinea-Liberia, running down my back, and my face feels the same, except that it is tears, not sweat that are running down it. They are tears that express my powerlessness and my frustration.
"The breeze revives us"
We head toward the last room, the second having been vacated by the patient yesterday. We reach a young man. As soon as we enter the room he rises proudly to the height of his 22 years. He smiles at us and speaks in understandable French. He asks us lots of questions. I have the impression that his fortune has turned around. He has no temperature and seems to be in good shape. We tell him that we are awaiting the lab results at 6:30 pm. He arms himself with patience.
It’s time to leave. We walk in single file. The 'controller and sprayer' arrives and we start getting undressed, the adrenaline and the concentration are at their peak. I let Kathleen go first. Finally we leave. The breeze and direct contact with the outside world revive us. Our blouses and trousers are soaked and stick to our skin. One detail, finally. My thoughts are still inside, in room number one, with the husband and wife. The husband’s smile and his wife’s determination to try to get up are imprinted on my memory.
We return to the main entrance, where the hospital manager joins us. “I have the lab results.” Silence once again. We are thrust back into reality. Three positives and one negative among the last four patients. Suddenly, we understand…