How an Ebola clinic works

Can you tell us who you were living with before you came here? The health promoter shouts across the fence.

Feeling uncomfortably self-conscious for drawing this patient to the feeding area to talk to him, I stand about seven metres away, in the blazing sun, shading my eyes to try to read the emotion in his face. He is middle aged and he lost his wife to Ebola three days ago. He cared for her while she was dying. He was brought in by ambulance to our treatment centre last night with a fever.

We are trying to probe very gently whether there was anyone else who may have been in contact with him when he became sick. This is so that the health promotion and surveillance teams can follow up with the contacts to ensure that that if they are in quarantine that they have sufficient food, drinking water, mattresses and soap for infection control, and to address the concerns of the community and sensitize them about Ebola.

The man doesn’t speak. Sitting on a chair, his arms have the muscular definition of a hard labourer, but his body is limp and shiny with perspiration. He remains silent, frowning slightly, trying to remember. “My niece.” His eyes are clouded over and he looks away. I think he is overcome. “Don’t push it” I say to the health promoter and then after asking him if he needs anything, we thank him and walk away.

His story is most likely similar to the twelve others who were admitted as suspect cases last night. Some arrive in the ambulance after a four hour journey, and are too traumatised to speak. It’s my job to enter each admission into the database, and look for links between them, as well as to monitor the location from where they come in order to identify potential new clusters of infection.

Everyday, I follow the strict infection prevention and control procedures to enter the treatment site. The smell of chlorine is ubiquitous: as we enter, we stand and wobble one legged, as each shoe is sprayed, after washing our hands, both with chlorinated water of different concentrations. Scrubs and boots are handed over and changing into them is a challenge: nothing must touch the floor.

Boots are sprayed before they are used. Photo and copyright: Fathema Murtaza/MSF.

The treatment centre is divided into zones of risk, the low risk area for the medical and clerical staff, where patient administrative work is carried out. This is where I encode my data, closely watching the patient and laboratory white boards for new admissions; the daily blood results and the changes in status of each patient.

In the high risk zone, medical staff move carefully and slowly around patients in a dozen tents that have been pitched in two rows of six, delineating the path and eventually the fate of the patient, using the fancy epidemiological terms “suspect” and “probable” – based on clinical diagnostic criteria, and then confirmed cases (with a blood test), before leading either to convalescence or death.

For us, the priority is personal protection and safety. Continuous vigilance regarding this leads to obsessive hand washing and keeping space between ourselves in order to apply the “no touch” mission policy. Actions need to be carried out carefully and slowly in order to prevent mistakes, as a mistake has the potential to bring the whole team down.

He died today, three days after I spoke to him. I feel a short stab in my chest as I scan the death register and recognise his name. The medical staff tell me that he died doubled over in prayer, facing East. It was unexpected, and most likely instant. Little is known about the pathology of this virus, death seems to strike suddenly at times.

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. She is volunteering in Sierra Leone for an NGO and writes in her personal capacity.

See Kathryn’s previous two articles on Ebola:

• Why I am going to Sierra Leone to fight Ebola

• Ebola: Where are the sick and dying?