Confronting Ebola every day

Medecins San Frontieres has described the situation as out of control, while the World Health Organisation said the outbreak was moving faster than efforts to control it.

A medical team gets ready before entering the high-risk area at the Médecins Sans Frontières Ebola Treatment Centre in Kailahun. Sierra Leone. Sylvain Cherkaoui/Cosmos for MSF

Dr Sheik Umar Khan dedicated his life to combating infectious diseases in his native Sierra Leone.

Hailed as a national hero this summer, he treated more than 100 patients in the current outbreak of Ebola in West Africa that is spreading at an unprecedented rate.

But last week the virologist lost his battle with the very virus that he had been working so hard to defeat.

His death, reported around the world, was a demonstration of how dangerous it is for those people on the front line in public health emergencies.

Infecting more than 1,300 and killing more than half of these, the current outbreak is the worst the world has seen since the Ebola virus first appeared in 1976.

Medecins Sans Frontieres (Doctors Without Borders) has described the situation as “out of control”, while the World Health Organisation said the outbreak was moving faster than efforts to control it.

Anja Wolz, an emergency coordinator with MSF, is in the Kailahun district of Sierra Leone working in a team of 28 international and 250 national staff.

“For us, the most important thing in MSF is really to protect yourself, and protect staff and protect your patients,” she said. “When we say protection, only people who are trained can go inside the casemanagement centre. We don’t let any person go inside without training.

“When I speak about training for our staff, I speak about the medical staff, but also about our hygienists, our worker sanitation specialists, our sprayers, because everybody is sprayed before they go inside.”

The staff can stay inside the high-risk tented areas for only about an hour because of the temperatures and difficulties of working in such intense conditions.

“It also depends on the day,” Ms Wolz said. “Today it’s a little bit cloudy and not that hot so we can stay a little bit longer inside. We are not forcing anybody. When somebody becomes uncomfortable they have to go out immediately.

“We also have a buddy system in place so nobody is going in alone. And everybody is aware and knows that if – thank God we haven’t had it – but if we had an exposure, what we need to do.”

Those allowed inside the case-management centres must be covered from head to toe by protective clothing to prevent any infected patient’s bodily fluids from coming into contact with their skin.

The uniforms include white rubber boots, yellow long-sleeved overalls, white aprons, long-sleeved gloves, a hoodlike covering for the head with a ventilated mouthpiece and large clear goggles to protect the eyes.

“Overall the whole body is really covered. You don’t have any open skin where you could get infected,” said Ms Wolz, who is from Germany. “One of the main dangers is also the hand-washing procedure because throughout [the day] you have to wash your hands and you have to be sprayed all the time. It means, again, it’s draining because you have to be sure of everything you are doing all the time. When you are inside the isolation case-management centre you get tired.”

The MSF Ebola clinic in Sierra Leone is in a rural area, up a long dirt track. There are several tent structures, erected using wooden posts and covered with either strips of corrugated iron or tent fabric.

Each tent serves a different purpose – such as a patient and family meeting area, staff changing rooms or patient showers and toilets – and the layout is designed to minimise the risk of any spread of infection.

Suspected Ebola patients are brought here by ambulance from two referral sites in Koindu and Beudi.

In the Khailahun area, where Ms Wolz is based, there are 470,000 people and many of them are difficult to reach. This made it problematic for outreach education and finding people who have come into contact with the patient, a process known as contact tracing.

Ms Wolz said that when she arrived eight and a half weeks ago, MSF ambulances were stoned and people were so suspicious that they ran when they saw the marked cars. While things were improving slightly, the logistical nightmares continue, she said.

“We have villages that you cannot get to by car or by motorbike, you have to walk, and a lot of villages are not connected, they don’t have the [phone] network to call,” she said. “Access is a problem but also the population, because they are still afraid of Ebola, they still don’t tell us the truth. Patients who are hiding themselves, with symptoms of Ebola, they are going to different villages and then they are spreading the disease.”

MSF works with the World Health Organisation (WHO), local ministries of health and other organisations, but remains at the forefront of diagnosis and treatment. It trained more than 200 community health workers to help to spread knowledge of the virus and to help with locating cases.

WHO has four surveillance teams who also try to identify possible cases and perform contact tracing.

Another essential part of the work is getting the local population to understand what they are dealing with and to avoid traditional burial practices, which expose people to affected bodies.

There is also the issue of fear and superstition. Opinions ranging from complete denial of the virus to it being linked to witchcraft have all been heard, Ms Wolz said.

“When one of the leaders or some traditional healer is saying Ebola doesn’t exist, then they believe it. In the beginning they were saying Ebola is coming by snakes, because there was one woman who died and a snake came out of the house.

“Last week we had an example where one village was really saying ‘Ebola doesn’t exist, Ebola isn’t true’. We spent the whole day in the village. The next day we called up there and it was really something, OK, [now] they understand, they know our work.”

But not every example of community reaction is so positive.

“One example: we trained one community health worker in one village on contact tracing. [Then] he himself got sick and he ran away.”

At present there is no licensed, specific treatment or vaccine for human beings or animals infected with Ebola and the mortality rate is about 90 per cent.

This current outbreak is the most deadly since the virus was found in 1976 in a village near the Ebola River, from where it got its name.

The first symptoms are usually fever, muscle weakness, headache and sore throat, followed by vomiting, diarrhoea, impaired kidney and sometimes external and internal bleeding.

It is transmitted from person to person through direct contact with bodily fluids, such as blood or secretions, and also indirect contact with environments contaminated by these fluids.

While the disease is currently confined to West Africa, there have been false alarms elsewhere, including a suspected case at a British immigration centre.

One American doctor was flown yesterday from Liberia to Atlanta in the United States, where he was receiving treatment in a specialist infectious-disease unit.

Family members, mourners who come into contact with patient’s bodies, and health workers were most at risk, according to the WHO.

As well as the much-publicised death of Khan, another 100 health workers have been affected, and half of those have died.

For staff such as Ms Wolz, working on the front line of such a medical crisis takes its toll.

“We have a great team, because it’s difficult, it’s really, really hard, when you see the people dying. We have to face this.

“Our team, we can speak about it because we are all in the same situation, and MSF also has psychologists, if we need it, we can always call.

“In the beginning, people were not staying long, maybe four to six weeks. We have a problem finding experienced staff, this is an emergency now. We need experienced staff. I’m still coping because we have a fantastic team but I know in 12 days or two weeks I think I will be at home.”

There are, however, rare glimmers of hope among all the misery, uncertainty and death.

“Only yesterday we had one discharge, one of our children, a 10-year-old girl. She was in our isolation [unit] for two weeks and she came out with a big smile and this, when I see her come out, gives me the power back.

“Also, a lot of people here are really appreciating our work. People are coming and giving us bananas or something, saying ‘thank you for the job you are doing’.”