It’s been a month since I applied and now it’s a matter of days until I go. I head to Europe for briefing before landing in Freetown, Sierra Leone next Tuesday.
It is not known how a two-year-old boy from Guinea became the index case. He wouldn’t have been slaughtering bats or bush meat, and maybe not even consuming bat soup, a local delicacy. Yet this is where Ebola began in December 2013 –according to our current information– before spreading to neighbouring Liberia, and Sierra Leone.
In May, 2014 a woman from Kenema, Sierra Leone developed symptoms after contact with a sick traditional healer in Guinea. She was lucky to receive early treatment and survived, while the traditional healer, who had treated Ebola patients, died and was subsequently linked to more than 360 further cases of Ebola.
The number of confirmed cases of Ebola in Sierra Leone is heading towards 2,000, with about 600 deaths to date. Taking advantage of an existing weak health system, the epidemic has grown exponentially over the past months, amidst both calls from the ground for assistance and criticisms that the global response has been too little too late.
Now in October, I will be going as an epidemiologist to assist. I’ll be a tiny cog in a wheel grinding away at an epidemic that has grown out of control, and I’ll be spewing out statistics and charting an epidemic curve.
Stories from the field suggest a cloud of denial: that during the lock down this week, only a few new cases were found, that things were more under control again. Conflicting stories of 20 deaths a day circulate on blogs and Facebook pages. It’s hard to know what to believe and what I will find.
“Wear black – as if it’s a wake”, I snap back in a Whatsapp. I’ve been invited out for dinner tomorrow night. Somewhere special, this is no ordinary meal. My friends want to see me before I go. They don’t say it, but I know that they are anxious that I won’t come back the person I am now, or at all.
“I don’t want your children to be without a mother,” a plaintive plea on another Whatsapp message earlier today. “Do you have to collate the stats from there? In this day and age, can’t they email them to you?”, or “I’d never go!” and the dreaded existential “Are you sure you should be doing this?”
Yellow Fever, tick. Meningitis still valid. Need Hep A and B checked. No time for rabies boosters before I go. My doctor warns me to stay away from wild animals, and I should be okay – and don’t forget the malaria prophylaxis. Training in biohazard security is mandatory, and today I practiced the dressing and undressing in personal protective equipment (PPE) – those hazmat suits that are becoming commonplace on page 1, 2 or 3 in the newspapers.
One hears about the stifling feeling of the mask and the goggles, and it’s true … you want to run away from yourself when you are in that suit. This is why some recommend not more than two hours of work in them. But there are two contagions at play here, continues our instructor: The Viral Haemorrhagic Fever (VHF) and the “Oh Shit Syndrome”.
The former belongs to the patient and the latter is a panicked malaise of health care workers exposed to VHF – and possibly anyone who is slightly ‘germaphobic’ and reads the local news. Just remember it’s body fluids we are talking about, he continues, only body fluids: you can’t get it from a toilet seat unless you are sitting on top of the Ebola patient.
The virus survives only a short time if treated with chlorine and sunlight. A swimming pool on a summer’s day comes to mind as a lifesaver. Powerpoint slides of patients progressing with the illness from Day five to Day nine (usually death) are unnerving. Bleeding from all orifices and needle puncture sites makes it increasingly difficult to manage a patient.
Someone in the training asks, “What do they do with the bodies?” The instructor laughs, “This question always comes up!”, he remarks. Three body bags, decontamination procedures go with each bag, including the injection of formaldehyde in between each bag. Cremation is preferred and the preparation for a burial is terribly complex – with all sorts of permissions required. But the luxury of choice may only apply to these parts.
Stories from West Africa suggest mass graves, with bodies carried by burial teams in torn hazmat suits and no triple protection body bags. I go up to the instructor afterwards to ask for a copy of the slides. My colleague lets slip. “She leaves for Sierra Leone on the weekend”. I cringe. Every time the words of my departure are uttered, I get the usual, “Gosh, erm … you’re crazy/brave/admirable, but – Should you be doing this?” I suppose anyone reading this article asks the same question.
Perhaps I am crazy, but I have the tools of the trade and I need to help. I think back to when I first learned about Ebola though a written assignment on an infectious disease epidemiology course. It sounded so exotic. Something that happens to other people, preferably far away (we’re only famous for HIV/AIDS and TB, remember). The assignment made Ebola seem manageable on paper: the epidemic curve petered out, with only a handful of deaths, due to infection control in the hospital and the rural context, where contact tracing was effective.
In contrast, the current epidemic is no hypothetical outbreak, neatly fitting onto a five-page assignment; it is one of extraordinary proportion. Hospitals have been forced to shut due to health care provider deaths and desertions and lack of infrastructure. Ebola-stricken patients are turned away from the remaining hospitals due to no capacity to take in more.
They are sent home to die and to infect those around them. We are sharing a continent with others who are bearing the consequence of a foundering health system that is in turn, betraying its own people. While fully understanding the risks, it’s time to put my money where my mouth is. I need to plot that epidemic curve for real.
Hence the question isn’t about whether I should be doing this, but rather how can I not do this?
Main Gif: Created from MSF video
Ebola treatment interactive guides: Courtesy of Medecins Sans Frontieres
Kathryn Stinson has a PhD in Public Health and she works as an epidemiologist at the University of Cape Town. She has three children, two Great Danes and one very supportive husband. Kathryn writes in her personal capacity.