Since the end of January, local physician Patty Ruze has been stationed in Port Loko, Sierra Leone, treating patients at the Maforki Ebola Treatment Unit. Dr. Ruze is volunteering with Partners In Health, a Boston-based organization responding to the Ebola outbreak in West Africa. These are her notes from the field, which have been edited.
Last week Dr. Ruze described her arrival in Sierra Leone, the training she received in protecting herself from contracting and transmitting Ebola, and the impact of the epidemic on helping professions. This week she shares firsthand experiences with patients.
Port Loko, January 31, 2015
Today is my first day in “the hot zone.” Yes, we actually do call it that; it’s not just for action movies. I have been assigned to the Maforki Ebola Treatment Unit (ETU) in Port Loko. This eastern city was a major hot spot during the epidemic. In November, Maforki’s 160-bed unit was packed and chaotic. Thankfully the epidemic has slowed, and today there are 25 patients on our census. We are very busy, with high patient turnover, so I can only imagine how overwhelming November must have been.
The ETU is a rough structure made of blue tarps and two-by-fours, erected hastily to isolate and treat the numerous patients here. Partners In Health now manages this early ETU. Inside, we call the most infectious areas the red zone, where all confirmed and suspected Ebola patients stay. The green zone is where we prepare meds, put on our personal protective equipment (PPE), and eat lunch. Full PPE is always worn in the red zone. In the green zone, regular surgical scrubs are fine.
We must always enter and exit the red zone with a partner, never alone. I am assigned a “buddy” who is an experienced staff worker. It turns out “experienced” means working with Ebola for about two weeks. My buddy checks my PPE, making sure my equipment is safe and in place. As we enter the unit, sweat pours into my gloves, my face shield fogs, and my mask soaks up perspiration. I think of scuba diving in the dark: everything closing in around your body, the regulator in your mouth, the loudness of each breath. Like your first deep-water dive, there is a panicky sense that your equipment might fail, you might run out of oxygen, or the dive boat might abandon you at sea.
We are able to see only four patients during this trip inside the red zone. The first patient is a chubby, 11-month-old baby boy with huge brown eyes and long lashes. We made him a “crib” by stacking metal bed frames on their sides to form a square. He stood clinging to the railing, crying and crying. He and his mother were together in the suspect ward for several days until his mother’s Ebola test came back positive. Although she was still nursing the child, she had to be moved to the confirmed ward. The baby’s test was negative, so he was being kept alone in this unit. We held him the best we could with our awkward, alien costumes. We changed his diaper and tried to get him to eat and drink. When we left 10 minutes later, he was standing, holding the rail of his crib and sobbing, very alone.
Doctors are regularly confronted with our inability to provide a cure. At times, we are unsuccessful in alleviating physical and mental discomfort. However, we hope that by partnering with patients we can provide them the comfort and healing that comes from our shared efforts to conquer disease. In the hot zone even this last hope is scant. Our time there is limited by our tolerance to the heat and humidity. Our physical connection to patients is dramatically reduced by PPE. This is a new level of helplessness.
Port Loko, February 12, 2015
Port Loko Government Hospital is typical of government hospitals in developing countries. The compound is composed of a series of low, white, stucco buildings with tin roofing. There is electricity but no running water. The facility is in the center of town, which is also the district center. If I choose, I can take a break and stroll to the market stands outside the entrance for peanuts, beer, flip-flops, African fabrics, plastic plates, oranges, and handmade knives. The children in the stalls shout out, “apoto, apoto,” a friendly greeting for a white person. This is my new office.
My assignment here is to assist with rebuilding and strengthening the hospital system. Ebola hit Port Loko General Hospital hard. Last fall, the inpatient wards were full. There was no virus protection: 14 nurses at this hospital were sickened by the virus and 10 died. An Ebola unit was established, which currently functions as an Ebola “holding unit.” When patients have symptoms that suggest Ebola, we immediately don our spacesuits and transfer them to the holding unit, where they are tested for the disease. When test results are available, patients are either discharged back to the regular wards or sent to a formal Ebola Treatment Unit.
Most of my job now involves inpatient patient care. We are diagnosing AIDS, TB, malnutrition, cancers, and advanced liver disease, to name a few cases. There are many more diagnoses, but with the limited diagnostic services available, there is significant guesswork.
Although more than 3,000 people have died from Ebola in Sierra Leone, more lives have been lost because of Ebola’s impact on the hospital system. This week I cared for a woman with a ruptured ectopic pregnancy. This is an obstetric emergency, fully treatable with prompt surgery. But here, no surgeries are performed without a prior negative Ebola test. Test results are not available for at least 36 hours, which delays life-saving surgery. Young, otherwise healthy women are dying for lack of a test result.
Patient-care needs here are immense. I am able to impact some treatable problems, but most diagnoses are incurable with the treatments available. I am a believer, however, that kindness and a smile can go a long way.
