The Ebola prayer that goes unanswered Doctors and nurses face the constant risk of infection in a desperate attempt to halt the diseases spread across Liberia By Hoa Co Dailin Freeman, in Monrovia, video and pictures by Will Wintercross11:53AM BST 21 Sep 2014 In time-honoured hospital tradition, the mid-morning ward round at Liberias JFK Ebola clinic begins with doctors and nurses gathered in a neat semi-circle. The purpose of the huddle, however, is not to compare medical notes but to sing a loud chorus of prayer - firstly for their patients, and then for themselves. Treating Ebola patients is very risky as we can become infected ourselves, said Thelma Kane, 36, the ward hygienist, standing alongside her colleagues in protective uniform of boiler suit, masks, and gloves. So before we go into the ward, we sing a prayer to ask the Lord to follow us in our work. Right now, though, the prayers of JFKs medical choir seem to go unanswered. Not only do nearly half their patients die, they are also completely overwhelmed by the number of cases, which has far outstripped the capacity of Liberias war-ravaged health service. We cannot cope, the demand is huge, said Dr J Soka Moses, 34, the hospitals clinical director, who opened the facility just a month ago in what used to be a cholera treatment centre. He points through a gauze-covered window to the clinics high risk treatment area, where feverish, vomiting patients can be seen occupying not just the beds, but most of the floor space in between. Related Articles Ebola: Sierra Leone begins three-day shutdown 19 Sep 2014 We cannot cope. The demand is huge: Liberias doctors warnings on Ebola 20 Sep 2014 Briton is first to try Ebola vaccine 17 Sep 2014 Black market in blood of Ebola survivors to treat victims, doctors report 15 Sep 2014 UN to deploy Ebola mission as death toll continues to rise 19 Sep 2014 Sierra Leone Ebola burial team attacked despite lockdown 21 Sep 2014 Moscow scientist claims turning point in Ebola battle RBTH This place was constructed for 35 beds, but right now I have 69 patients, so half of them are on the floor, he said. There isnt even adequate corridor space for us to walk between them. But if we turn them back into the community, they will infect other people. Nonetheless, on busy days, that still happens - just as it does at the handful of other Ebola treatment clinics across Liberia, which has had 40 per cent of the 2,200 Ebola deaths across West Africa so far. At the Medicins Sans Frontier clinic, on the other side of the capital, Monrovia, staff were last week turning away between 20 and 30 people a day. Doing so seldom goes down well, as Dr Moses has seen for himself. Last weekend, relatives of a man who died while waiting for treatment outside JFK hurled rocks at staff when they came out to spray disinfectant on his corpse. It is scenes like this, on top of aid agency warnings that up to 20,000 West Africans could have the virus by the end of the year, that prompted last Tuesdays announcement by Washington that 3,000 US troops will be heading to Liberia in coming weeks to boost the medical effort. It is the biggest US ground operation in Africa since the ill-fated Black Hawk Down mission to Somalia in 1993, when US troops sent to deal with a famine ended up tangling with local warlords. And while Liberias own notorious strongmen are now long gone - ex-president Charles Taylor is serving a 50-year war crimes sentence in a British jail - some fear similar trouble should US troops become a lightning rod for public anger over the lack of help so far. Last week, in neighbouring Guinea, that frustration turned deadly for the first time, when eight Ebola health education workers were murdered by a club-wielding mob in a remote village. Feelings had been running high in the area after rumours that other medical workers had contaminated people with the virus. The risk for medical workers, however, is not just from angry mobs. Last Wednesday, a French volunteer working at MSFs clinic in Monrovia tested positive for Ebola, the first time any international staff member in the agency has caught the virus. It is proof that that even the most stringent precautions can never eliminate the risk. And it is that exact scenario that goes through the minds of Dr Moses and his team as they don their protective gear, which consists of multiple layers of boiler suits, aprons and overtrousers, with four separate pairs of gloves alone. Simply robing up takes around 20 minutes. But the Russian doll-style layering makes it safer when undressing again, when a doctor is most likely to be accidentally contaminated by touching clothes smeared with bodily fluids from the ward. So far none our staff have been infected, although we have occasionally had patients develop neurological symptoms and become combative, requiring sedation, said Dr Moses, whose fondness for medical terminology does not perhaps convey quite how frightening such incidents must be. It is very dangerous, it is scary, he conceded. But if I dont do it, who else will? While Dr Moses work has had a certain personal cost - as a high risk worker, he is not allowed to cuddle his two children when he comes home - he is proud of his wards track record so far. Its 43 per cent mortality sounds grim by normal clinic standards, but is considerably better than the 70-90 per cent rates reported at the start of the outbreak. While treatment is simply a matter of keeping patients fed and hydrated in the hope that they fight the virus off, survival rates have improved because more people are coming forward in the early stages of symptoms. Nonetheless, by the time Dr Moses mid-morning rounds are over, another five patients and their families are waiting in the pouring monsoon rain outside the clinics green metal gates. Among them is 15-year-old Faje Kan, who lies convulsing on the muddy ground, mucus streaming down her face. Her elder brother, Kiwai, holds her head and shoulders upright, wearing two carrier bags as makeshift plastic gloves. She was very sick overnight so we brought her here this morning, he says. We got her two hours ago but we could not get in because the place was packed. Another man, Lee Sac, whose pregnant wife is lying semi-conscious, complains angrily that The Liberian health system has failed us. When Dr Moses comes out to try to help, an ugly mood turns uglier. I know you are angry but we are doing the best we possibly can, he says through his mask, as the crowd gather round. I have created five extra beds, please be patient. The five sick people, including a silent ten-year-old boy, are then carried in, the hospital medics spraying them first with disinfectant. But for one woman outside, Dr Moses appearance brings only bad news. A shriek of grief goes up as she learns that her husband, Vani Wana, brought into the clinic two days before, has died. And no amount of bereavement training can help Dr Moses for what he has to say next. Which is to remind Mrs Wana, gently but firmly, that she too must now consider herself at risk of being infected. I am sorry for your loss, he says. Get tested now, then go to your house and keep away from other people. If you start feeling sick, come back here.
Posted on: Sun, 21 Sep 2014 12:27:31 +0000
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