At the end of the week in which we heard the news that the community
health officer and three nurses from a health centre in a village just a few
miles away from Segbwema had died from contracting the Ebola virus, we decided
to give up our game of chicken against the onward progression of the epidemic
of the dangerous virus that has now killed over 500 people in West Africa and return
to the UK slightly earlier than planned.
Although, in part due to the continued
expansion of the outbreak, more expertise and support now appears to be getting
to where it needs to, in those first few weeks when cases were rapidly appearing
in our district of Sierra Leone, the atmosphere felt very unsettled. In the
days before we departed I had been alone at the hospital, with limited personal
protective equipment (gloves and aprons) and my main source of information on
new cases and deaths was through my friend Victor who owns a small bar in the
village.
While news of the outbreak quite quickly made it onto the headlines
of the BBC world service with comments from the World Health Organization and
Medicine Sans Frontiers, the reality on the ground felt very remote from a
radio studio. At the time I had a patient (herself a healthcare worker) who worryingly had a fever that wasn’t resolving despite treatment for malaria and bacterial infections. However despite the increased media coverage, trying to get advice on how to ensure she was tested for haemorrhagic fevers including the Ebola virus was no simple task. After several unsuccessful attempts at contacting a surveillance officer I then had to personally find a motorcycle rider and pay them to take a blood sample to the laboratory in Kenema. The next day when I phoned the surveillance officer to chase up the result, I was a little concerned to say the least at his initial response of ‘what sample? I didn’t receive any sample...’ Thankfully several phone calls later I was able to establish the sample had been tested and was negative. Although undeniably our decision to leave was one based on self-preservation, and there is naturally a feeling of guilt about our friends and colleagues we left behind, at the time, flying blind against a virus with a mortality rate of up to 90%, with just a box of out of date latex gloves for protection, is something that instinctively felt like a bad idea.
Since being back in the UK although there have been on-going
difficulties with communities not wishing to engage with the health services to
prevent further spread of the disease (perhaps not unsurprising given that significant
number of people in rural areas do not trust western medicines but rely on
traditional healers), when I spoke to staff at the hospital a few days ago, I
was relieved to hear that they had now received appropriate quantities of
personal protective equipment and training and that all the staff members remained
safe.
In the midst of a difficult few weeks at the hospital (both
related to the outbreak and not) one joyful moment came when one of the
hospital’s long serving nurses gave birth to a healthy baby boy. Despite looking
ready to burst for some weeks she had continued working devoutly. On this
particular Tuesday morning she was looking even more exhausted than usual. When
she came to see me on the maternity ward after her shift had finished she
confessed to me that her waters had broken the previous night but she thought
she should come to work to do her morning shift first before seeing the midwife.
After assessing her with the midwife, she finally succumbed to the fact that the
time really had come when she needed to stop working. Thankfully she delivered
a healthy baby boy later that night. The next morning I could see a moment of
panic on her face before she realised I was joking when, after congratulating
her, I said that we could give her the afternoon off to recover but could she work
the night shift instead? It is a testament to her commitment as a nurse that
she continued to care for her patients up to just hours before she needed a
hospital bed herself.
Goodbyes were naturally difficult; perhaps most to my friend
and colleague Tamba Missa, the medical superintendent who has run the hospital
with or without support from the end of the civil war when he slept on the
clinic floor for several months. As in all professional and personal relationships
we have had our turbulent moments resulting from the frustrations or failure of
a given situation but our connection both as doctors and friends has grown
stronger over the months we worked and lived together. The physical cooperation in surgery naturally lends
itself to a sense of camaraderie and I will sorely miss those moments when
we were jointly delivering a baby during a caesarean at midnight, but I will also
greatly value the shared pleasure of seeing a complex unwell patient on the medical
ward pull through as a result of pooled knowledge and experience. For me perhaps
the defining moment when we became friends as well as colleagues was when he
came running into my house saying he needed to hide from repeated groups of school
children collecting funds for various projects who kept knocking on his door! Or
perhaps when he confessed to me that his technique for avoiding shaking hands
with some whose hygiene he wasn’t convinced by was to suddenly start pretending
to search for his phone in his pocket; something that I had seen him do
repeatedly and was always confused by!
I know that during our time at the hospital we have barely
scratched the surface in beginning to deal with some of the difficulties the
hospital and community faces in ensuring access to medical care; such problems
and inequalities will take decades, if not generations to solve. However, I
hope we have been able to leave some imprint with a few of the people we have
had the opportunity to live and work alongside, as they have left their
impression with us; the student inspired to pick up a book from the library
shelf and then beaming with their certificate as they win an essay competition,
the mother of a premature baby who brought her once tiny infant back to me in
clinic healthy and smiling after months of kangaroo care (where the baby is
held skin-to-skin almost
continually), the community on the TB ward whose faces lit up when we
brought a food package, the staff member who now knows how to deal with a woman
who bleeds during her delivery, the small boy who turned up at the door every
day from 7 ‘o’clock onwards to ask repeatedly if he could borrow one of the toy
cars with his gentle persistence of the phrase ‘I play with car?’, the simple pleasure of a shared Friday beer
with my friend Victor or the mutual celebration after hours of sitting next to
this laptop with the medical superintendent of him being able to send an email independently.
Thank you for reading and excusing (or highlighting) my
mistakes over the last year.
Update 20th August 2014: Very sadly over the last month 5 members of hospital staff including 4 nurses have lost their lives as result of the Ebola outbreak.
Update 20th August 2014: Very sadly over the last month 5 members of hospital staff including 4 nurses have lost their lives as result of the Ebola outbreak.