Life in an Ebola treatment centre
From the staff perspectiveLife in a treatment centre is harsh for both local and international personnel. The standard rotation of international staff lasts for around 6 weeks,2 with some international and local staff being stationed at the treatment centres for months.One of the most visible experiences is the distinctive yellow and white personal protective equipment (PPE), discussed in a previous step. Even those not working in the high risk zones need to take precautions. A South African Médecins Sans Frontières epidemiologist working in a treatment centre in Sierra Leone reports:3
‘Every day, 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.’
‘Heat [from wearing the PPE] means that there is no time to really get to know patients, to sit with them and answer questions, listen to their fears and hopes, hear who they are as people. This distresses me. It is in my physician’s heart to know my patients, to weave in personal and emotional support for their healing. I regret this particularly when I am helping someone who is dying. My desire is to sit down and be present.’5
‘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.’3
’Despite fatigue, I can’t get myself to rest. My anger and frustration is too much. Ever present in my mind are the images of the day. Once more, we saw the sheer horror of a father, as we buried his 7-year-old daughter. Once more we brought five suspected Ebola-infected people from some remote villages to our Ebola management centre. Once more, we had to explain and justify to several dozen villagers why we disinfect their homes with chlorine. And once more, we had to watch, powerless, a pregnant woman bleeding internally to death before our eyes. And this is still nothing compared to what is happening in Monrovia. Time to sleep. Tomorrow, the cycle starts again.’7
‘For every one doctor and three nurses working at an ebola treatment unit there are approximately 26 water, sanitation and hygiene (WASH) staff. Most of the WASH staff are recruited locally. Some of the senior WASH staff are former teachers who lost their jobs when the schools closed. The remainder were hired with little or no previous related work experience…WASH staff are responsible for cleaning/disinfecting wards, cleaning spills (e.g. blood, vomit, excrement), emptying buckets of vomit/excrement, handling dead bodies, disinfecting ambulances, and waste management including the operation and maintenance of the incinerators….The WASH staff are at considerable risk in an Ebola treatment centre…. Many of them do not tell their families or friends that they are working at the units out of fear that they will be stigmatised. Many struggle to find a place to live, to find an accommodating landlord who will allow them to rent a room. Many will lose their jobs when ebola has been brought under control. The stigma and the secrecy may last some time longer.’
From the patient perspective
’They are afraid. We’ve had 89 deaths at the centre. People think that, because there is no treatment available, they will come here to die. There are a lot of rumours that we are cutting off heads. Or that we are taking organs and selling them. At the same time, some people are saying that Ebola does not exist.’8
The symptoms of Ebola are severe, as described in an earlier step: ‘the pain is too great. You have no appetite and nothing stays in your system. You vomit a lot, you are dehydrated – then comes the diarrhoea. It’s bad, terrible, devastating. It makes you want to give up on life.’11 Patients have to watch the suffering of others around them: ‘I was there for two weeks. In the same tent as me in the treatment centre, a two-month-old baby died from the disease. And I lay listening to a lady who cried until she died.’11 Many will also witness or hear news of the deaths of their family members.For patients who are fortunate enough to survive Ebola, being discharged from the treatment centre is a defining moment. Before patients leave the ward, they are presented with transport money to get home (about US$10), a clean set of clothes, and a certificate declaring that they are healthy and no longer have Ebola. They are photographed and congratulated by staff, and in humble way, celebrated for their resilience.12 The next part of their journey begins, and for some it will be very difficult. The reality of being an Ebola survivor is not an easy business in a climate so fraught with fear.‘We re-designed the Ebola management centre to maximise transparency with the local community about our work and address rumours about what was happening inside. This involved removing the high barrier fences and replacing them with lower, see-through fences so that the people outside were able to watch how the centre was run. Prior to this, there had been an air of suspicion about what was going on behind our walls. People went in but were rarely seen coming out again.’10
Ebola in Context: Understanding Transmission, Response and Control
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