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Ebola: Pregnancy and the deadly virus
She was pregnant. Around the time that the World Health Organization (WHO) finally woke up and declared the Ebola epidemic in West Africa an international public health emergency, 18-year-old Adama Kargbo conceived.
This is the first day of her new life.
MSF nurse Marisa Litster gets ready to enter the high-risk area, where the patients are. Her mission is to get Adama out of there – the results of the latest test show that she has overcome the haemorrhagic fever which has killed more than 8,600 people in West Africa.
This is Kissy, a suburb of the Sierra Leonean capital, Freetown, where Médecins Sans Frontières/Doctors Without Borders (MSF) has built its newest Ebola treatment centre in the country with the highest number of cases of the disease.
“Adama is a special case. She was our first patient and she will be discharged today,” says the nurse as she puts on the yellow personal protective equipment. Adama was admitted on 8th January, on the day the centre opened its doors.
Loneliness is common among Ebola patients, but Adama may have felt lonelier than most, because when she was admitted, she was the centre’s only patient.
Now there are around 10 patients, and Adama has made a full recovery.
No longer infectious
“I’m excited for her, but also a little bit nervous, because I can see that there is lot of fear,” says Marisa.
“This is just one part of the journey, but a big step will be going home and dealing with the aftermath of everything that comes with Ebola.”
After the ritual of preparing to enter the high-risk area (adjust the protective glasses; make sure there are no gaps for the virus to sneak in), the medical staff go inside.
Adama is sitting on a plastic chair, waiting. She gets up and walks towards the chlorine disinfectant shower.
She is no longer infectious, but her clothes and personal items might be contaminated and all traces of the virus need to be liquidated.
Ebola vs Adama
When Adama crosses the gap in the wooden fence that signals the separation of patients and the outside world, there is timid applause.
On the other side of the fence, two people wait for her: MSF health promotion manager Roberto Wright Reis, who has been providing Adama with psychosocial support for the past two weeks; and Javiera Puentes, the medical team leader.
Now they are free to do so, they immediately embrace her, hold her hand, put their arms around her.
As the group walk along the aisle to the exit, between two orange fences, louder applause breaks out from the Sierra Leonean logisticians.
Adama smiles and greets them. Roberto raises her hand in the air in a gesture of victory. In Ebola versus Adama, Adama is the clear winner.
The next emotional moment takes place when the 18-year-old leaves a handprint on the ‘survivors’ wall’, as has become a tradition in Ebola treatment centres.
The wall is a blank rectangle, touched by a single person – Adama’s handprint is the first blue stain on it.
Ebola and pregnant women
Outside her home of the past two weeks, Adama sits down with Javiera, the medical team leader, to receive some medical advice.
“Ebola gets into you and sucks all your energy, all your vitamins,” says Javiera. “Now that the virus is gone, you will feel weak for one or two months. This is normal. Don’t think that you are not better – all Ebola survivors feel weak for weeks.”
Javiera advises Adama not to have sexual relationships without protection for three months, because the virus remains active for a while in vaginal and seminal fluids.
“Do not get pregnant now, you are very weak,” says Javiera. “A new chapter of your life is opening in which you will need to take care of yourself. Sleep and eat well.”
The death rate for pregnant women infected with the virus is a matter for discussion.
A study in Democratic Republic of Congo showed that 95 percent died, but the sample was too small to draw conclusions from.
While it is clear that the chances for the mother’s survival are lower than in other cases, the prognosis for the foetus is much worse. The virus appears to concentrate itself in the foetus.
Medical staff in the newly opened MSF maternity unit cannot do routine procedures because of the risk of high exposure to body fluids.
However, they do use intravenous therapy, oral medication and, most importantly, they try to minimise the mother’s bleeding while in labour and after the delivery to prevent the risk of her haemorrhaging and dying from blood loss.
Leaving the Ebola centre
After Javiera has finished giving Adama medical advice, staff crowd around, keen to find out how Adama feels. She’s a bit overwhelmed.
She thanks everyone and says: “I’m feeling fine. I’m happy because I’m discharged, so I pray to God for the others to be discharged.”
During her stay, the team has put a lot of effort into making her as comfortable as possible.
They brought Adama her favourite pepper soup, even though it was not on the regular menu.
“I don’t know yet what food I will prepare now,” she says. Over the two weeks she was here, MSF staff chatted with her for hours from the low-risk area, which is separated from the high-risk area by an orange plastic fence.
“I like being outside to take fresh air,” Adama whispers.
Adama is wearing a green T-shirt and skirt, the clothes she was given on discharge.
She combs her hair and says that she prefers red to green, then gets ready to leave for home.
How will your new life be? “I imagine it to be good,” she says. “When I get better, I want to go to university, study accounting and work in a bank.”
Life after Ebola
But Adama won’t be able to go home yet, because it is still under quarantine, surrounded by tape.
Most of her family came down with Ebola. Her mother, sister and brother are currently in a holding centre.
Her brother Abu Bakar, who didn’t get the virus, was the only person to visit her while she was battling the disease.
A decision is made that she will go to stay with one of her aunts in Waterloo, half an hour’s drive from the treatment centre. Stigma will be the first hurdle that Adama will need to face.
Accompanying Adama to her aunt’s house is someone very special: Hawa Turay, one of her former teachers.
Fate saw them meet again in the Ebola treatment centre, where Hawa works as a health promotion officer.
“When I met Adama in the centre, I couldn’t believe she was the one, with a pregnancy of several months,” says Hawa, as the MSF car negotiates the potholed roads of Sierra Leone. “I didn’t think she was going to survive, so I was very sad when I saw her. The time she got here she was weak, unable to talk.
“Now she is the first pregnant woman to survive in our centre. She looks good, she’s happy, but she has lost many things.”
When they arrive in Waterloo, the neighbours look on, unfazed. The MSF staff members hug Adama to demonstrate to the community that she is not longer infectious, but nobody pays much attention.
Soon Adama’s brother, Abu Bakar, arrives on a motorbike. In the coming days, he hopes she can come and stay with him. “I’m happy for my sister. As of now she’s going to stay here,” he says.
While everyone discusses her future, Adama sits down on a plastic chair outside the house.
Chickens and goats roam around clothes drying on lines. She sits, just as she did for hours outside the tent for Ebola-confirmed patients in the centre; just as she did as she regained her energy after losing her baby; just as she did when she gazed at the landscape while the other patients chatted away next to her.
She sits, just as she did when she was beating Ebola in silence, stealing minutes, hours and days away from the virus. She sits, just as she did when she was seeking peace in the fresh air – the fresh air that she likes so much.