SA doctor on Ebola front line

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

My best ally

In the days leading up to the start of my first Ebola mission I frantically wrack my brain for knowledge of the lethal illness. I recall snippets of a medical school lecture, Viral Haemorrhagic Fevers.

It is filed somewhere next to Haemochromatosis and Klippel-Feil syndrome, in a section of the brain labelled "Things you are unlikely to need again after the exams".

My go-to electronic medical reference states that "even a single case of Ebola or Marburg virus outside of Africa is a public health emergency".

A sense of unease develops as messages pour in from well-meaning friends saying: "Be careful" and: "Don't get sick".

My briefings at the Médecins Sans Frontières headquarters are reassuring.

With a disease that occurs as seldom as Ebola, there aren't many experts. I find comfort in the fact that a good handful of [the experts here] have the organisation's initials written on their business card.

Before my departure, one of the MSF people sits me down in her office and rolls out a map. From memory she recounts all significant happenings and dates around the current outbreak.

I remark on how widely dispersed the confirmed cases have been.

"Exactly," she says, "and that's the biggest problem."

Finally, I am handed a small red book that contains MSF's most up-to-date guidelines on running a field hospital during a haemorrhagic fever outbreak. I instantly recognise it as my dearest ally in the battle I am about to enter.

The world's biggest Ebola ward - in a ghost town

Kailahun district is currently in the eye of the Ebola storm in Sierra Leone. This sedate village with jungle-covered hills and dirt roads has until recently been bustling. Now it has largely been abandoned in panic.

On the outskirts of the village lies the biggest Ebola case management centre in the history of the world. It is manned by more than 200 local staff and a group of about 20 field workers assembled from around the world.

The 56-bed centre has been open for only a month but there is already machinery in motion to expand it. It is the only centre in the greater Kailahun district that is able to admit patients with suspected Ebola.

On arrival I meet the emergency coordinator for my field briefing. "Don't be afraid of the virus," she says, "but always respect it... always respect it."

Then we are off to work and the first order of business is hands-on training in the use of personal protective equipment - rubber boots, yellow plastic suits, hoods, masks and goggles. The result is a person covered from head to toe with no skin exposed anywhere.

It may sound like this would cause one to get hot - it doesn't, it makes you boil. Of course, it is necessary: the entire outfit can be sprayed down with a [disinfecting] chlorine solution when you exit the isolation area.

Taking off the personal protective equipment is the most critical step. There is a person dedicated to spraying and assisting in (without touching) the undressing. He will make sure that we all remove the clothing methodically and correctly so that no self-contamination occurs.

Entering the isolation zone

I enter the isolation unit for the first time. My first patient is a nurse from a nearby clinic. He has been seeing many patients, some suspected of having Ebola.

He has now fallen ill himself. We collect his blood sample for testing: this is quite a process.

The sample container is decontaminated with chlorine, placed in a plastic bag, which is also decontaminated, and on our exit from the unit the sample bag is placed in yet another bag and decontaminated again.

The laboratory will do a highly specialised polymerase chain reaction test and before lunch-time we will know his result. I pray it will be negative, but he looks quite poorly.

Part of the problem with defining the disease is that Lassa fever is endemic in this area. Many healthcare workers have substantial immunity against it because they have survived it. The symptoms of Lassa fever, Ebola and malaria are indistinguishable in the early stages.

I wonder how many unsuspecting nurses have treated what they thought were Lassa fever cases without realising it was Ebola.

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

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