April 25, 2024
medical practice

On the front lines of the war on Ebola

Michael Cook

A field worker describes her day-to-day work.

Three thousand US military and healthcare workers are being sent to West Africa to fight the Ebola outbreak there in an operation which could cost US$500 million. The Americans will train local healthcare workers, build clinics and distribute supplies. 

“Faced with this outbreak, the world is looking to the United States and it is a responsibility we are prepared to embrace. We are prepared to take leadership on this,” said President Barack Obama. “This is an epidemic that is not just a threat to regional security, it’s a potential threat to global security if these countries break down, if their economies break down and people panic.”

The head of the World Health Organization, Dr Margaret Chan, is describing the epidemic in frightening terms: “None of us experienced in containing outbreaks has ever seen, in our lifetimes, an emergency on this scale, with this degree of suffering and with this magnitude of cascading consequences.”

She says that reports that 5,500 people have been infected more than 2,500 killed by it are “vast underestimates”.

It takes courage to stand in the front lines. Cokie van der Velde, a British sanitation specialist with Medecins Sans Frontieres/Doctors Without Borders, comes from Yorkshire. She spoke with the BBC about her responsibilities in Sierra Leone. The work is not only dangerous; it is exhausting and often repugnant.

In the centre, people groan and cry out – the smell of blood, diarrhoea and vomit is awful – unfortunately there is also a very pervading smell of dead bodies.

I can only leave it to your imagination to understand what a pile of bodies smells like after a week in very hot, moist surroundings – it makes you feel sick quite a lot of the time.

Nobody else has been near them for days. They must feel very lonely and very frightened.

I am responsible for infection control which means that my first job is to ensure the safety of the people I work with and of myself. We have to wear our scrubs, then two or three pairs of gloves, a completely waterproof suit and a head covering, a mask, goggles and a big apron over the top.

It’s incredibly hot and humid – when you undress back to the scrubs afterwards it looks like someone has just poured a bucket of water over you.

I try to go round the patients and help where I can and give them some water. I’ll change and wash patients and just try and give some physical contact to each person because nobody else will touch them, nobody else has been near them for days. They must feel very lonely and very frightened.

I don’t know how much comfort I am bringing to people when I’m dressed in a mask and goggles and completely covered from head to foot. If we have children at the treatment centre, which we quite often do, I’ll try to bring them some toys and have a little game with them if I can …

There is always an element of risk when I work for MSF – I could be caught in crossfire, I could always pick up a nasty disease and there’s the small chance of kidnap. And normally I would put that risk at about one in 1,000. So it’s not that high. But I must admit, when I sat down and thought about it, I would say the risk for me now is about one in 10 …

I go partly because of my belief that there should be social justice in the world – that there should be some sort of equality. The people I’m helping are part of the human race, part of humanity – in that respect, all people for me are the same. I feel I have as much obligation to help a stranger as I do to help someone I know.

That last time I was in Liberia I must have moved hundreds of bodies but only three people survived during the month that I was there. I don’t think you can see that many bodies without viewing death in a different way.

I try to always make sure that the team I’m working with stops for a moment to say goodbye to the person before we put them in the body bag. We still try to keep a reverence for the dead. Even though I’m not religious, I hope I can bring some sort of spirituality to that moment and some respect to the grieving of the relatives.  

The disease is not the only danger. One team of eight Ebola educators, including three journalists, in a remote part of southeastern Guinea has been killed, presumably because people feared that they were actually spreading the disease. Their bodies were dumped in a village latrine. 

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