SA doctor blogs from the heart of the Ebola crisis

Blogging from the Ebola front line in Sierra Leone, Dr Stefan Kruger paints a vivid picture of how the war against the dread disease is progressing, and of the battles fought every day.

Triage & funerals

The case management centre is a neatly constructed tented village with timber and tin roofed walkways. Orange fencing indicates the path to take. At the one end there is a triage tent where patients are received and divided into 'suspect' or 'probable' categories, based on their history and apparent risk.

There are 'suspect' and 'probable' tents where patients wait for their blood test and from there another walkway leads to the 'confirmed' area. This is where the majority of patients spend their days either convalescing or gradually deteriorating. A little further along, in the distance, there is a makeshift mortuary. 

The handling of deceased patients' bodies is a crucial step in the operation. It appears that patients become more infectious the further their illness progresses. For this reason we take great care when handling bodies, especially when there has been bleeding or diarrhoea.

From epidemiological data, it seems the biggest risk factor for contracting Ebola in Sierra Leone is attending the funeral of someone who has succumbed to the disease.

Within the Kissi tribes there are elaborate burial rituals, which entail the body being exposed and touched. Often funeral goers will even the kiss the lifeless body. It is, in fact, difficult to imagine a more ideal setting for a virus like Ebola to proliferate.

Getting worse before getting better

In the days that follow we continue to receive terribly ill patients. My nurse patient withers away as time passes. His body finally gives in when the normal immune system simply ceases to function.

 We get into a routine of admitting between ten and twenty new patients per day. We become accustomed to families being broken up because of discordant blood test results and entire households being erased from their family trees one by one. The logisticians continue work on the expansion and finally an eighty bed treatment centre stands, as a monument to a collective failure in stopping the outbreak.

Of course not all patients exit the centre through the mortuary. Many suspected cases are discharged when their admission blood tests are negative.

There is also a cure rate of approximately twenty percent. The truth is that we don't know whether we truly cured them - perhaps we only provided the final straw their immune systems needed to break the Ebola camel's back. A small service we are more than happy to provide.

The magic of reaching cure

It is a magical occurrence when a cured patient is discharged. First they go through a decontamination area where their old clothes are removed and they wash themselves in a disinfectant. They are then given a new set of clothes and emerge from the isolation area clean and disease free.

In a moment of unadulterated euphoria staff members abandon their work. There is singing and dancing and everyone joins in, welcoming the convalescent patient back into the world. Even the patients who remain behind will often clap hands from behind the orange fencing.

Discharged patients are given a copy of their laboratory results as well as a certificate stating that they are disease free. Still the stigmatisation they often face when returning to their villages is immense.

There is a pervasive misunderstanding of the disease in many villages and also a deep mistrust of health structures. Our outreach teams are working hard to do contact tracing and mapping of the epidemic. They also focus strongly on health promotion and the dissemination of accurate information.

However, we still know of sick patients being hidden in their villages, out of fear and stigma. We also know of unsafe burial practices continuing in many villages. Sadly, this utter lack of insight is not limited to West Africa.

Looking at the outside view, from inside the epidemic

Social media is awash with hoax pictures and articles about alleged Ebola all over the world as well as conspiracy theories around bioterrorism. A quick glance at international media reveals abundant ignorance in the reporting of the outbreak.

Under the guise of true interest or even activism, most people are simply trying to ascertain what the risks are of their own comfortable lifestyles being affected by a disease, rampant on the other side of the world.

Ebola is not merely an impressive epidemiological phenomenon, it is not simply a matter for academic discussion, and let's forget about bioterrorism for the time being. Ebola is about entire communities decimated and children orphaned. It is about slow agonising deaths while health care workers can do nothing but provide palliation. MSF is doing what it can, but we are being stretched to our limits.

Every day that the world watches in morbid fascination, but apathetically, the epidemic spins a bit further out of control. Perhaps the time has come to stop hypothesising about theoretical outbreaks where Ebola ISN'T and start focussing on supporting ongoing efforts to fight Ebola where it IS.

“Doctors without Borders (MSF) is currently working in Sierra Leone, Guinea and Liberia to combat the spread of Ebola across the region.

To support this work, go to http://msf.org.za/donate or SMS “JOIN” to 42110 to donate R30.”