I was sitting in my tent in a small northern Liberian town called
Zorzor when the fever hit.
My cheeks
felt hot like fresh sunburn though it was still a mountainous morning cool in
this town near the borders of both Guinea and Sierra Leone. I’d felt tired and cranky for the previous
two days, but attributed it to sleeping on too many floors and too much hard
travel through Liberia in the past month.
I’d only taken one day off in the
past thirty. We were moving through the
country opening up new Ebola Treatment Units (called ETU’s) and training
hundreds of Liberians to run and staff them.
I put my phone camera in selfie mode to look at my face. My cheeks and nose were bright red and the
whites of my eye were sick and glassy. I
looked as old and tired as I felt. Wow, I
thought as calmly as possible: this is
really happening.
I called my friend “Sumo” who’d been hired as the camp
manager for the Zorzor Ebola Unit. I’ve known Sumo for nearly ten years as a
trusted friend and a skilled paramedic. I asked him to grab one of the
thermometers packed in the storage containers and bring it to me. I suppose he heard the concern in my voice
and asked what’s up. Just bring it to my
tent I said. He came by five minutes
later. He opened the zipper to the door
of my tent and started to step inside.
“Stop. Just wait at
the door, dude. Don’t come in. Did anyone see you bringing this?”
“No. What’s wrong?”
he said
“Just toss me the thermometer.”
Don't shoot! |
I ripped the box open and took out the Thermoscan. These are the gun-like thermometers used
outside every establishment in Liberia, Sierra Leone and Guinea to check the
body temperature without having to touch another person. Medically these are not the most reliable
devices to check a temperature as they sometimes under-read the actual
temperature. They are certainly the safest though during an Ebola
epidemic. I fumbled with the batteries,
checked the calibration and pointed the gun to my forehead. I pulled the trigger and held it
down. One beep says no fever - you are
clear to enter. A string of beeps says
you have a fever and you risk quarantine
in an Ebola Treatment Unit. I got the
menacing string of beeps. I looked at the screen on the back of the device. It read 39 degrees Celsius (102.5 degrees Fahrenheit).
“Dude, I have a fever.
I’ve been working in Ebola Units and I have a fever. I gotta figure this out.”
“Take it easy,” Sumo said, “don’t let your imagination run
away with you.”
“It wasn’t until you said that.”
Critical glove check |
I’d been providing medical care and training in over twenty
countries in Africa and Asia and Europe for the last fifteen years. I’ve worked through all kind of epidemics
including big hitters like HIV, Hepatitis, Tuberculosis and dysentery. There’s been fears and issues along the way,
but never like this. I had to calm down
and work through this logically. The ripple effect if I had Ebola was going to
be huge. My first concern was for the
people I’d interacted with in our makeshift tent city camp during the last
twenty-four hours. We lived elbow
to elbow. The number would be in the
hundreds. I was going to be the Typhoid/Ebola Mary of camp Zorzor - trigger immediate pangs of guilt. Ebola can only be spread when an infected person shows symptoms. I figured, at the latest, my symptoms really
started two days before. Next I would have to sort out my evacuation
options. We’d flown to Northern Liberia
on a Russian M8 transport helicopter—a veritable city bus of a helicopter that
can carry twenty people and tons of supplies.
To evacuate me from Zorzor to the Monrovia Medical Unit—an Ebola Unit
designed specifically for health workers who’ve caught Ebola on the job—would
require a monster effort of personal protection, decontamination and would take
this vital helicopter out of service for a long time during a lengthy
decontamination process. Last, but
certainly not least, would be a difficult conversation with my wife whom I
convinced at great length that there was nothing to worry about when I took
this job. I’d told her it was relatively
safe and as one of the directors of the project I’d barely have patient contact--which
wasn’t exactly true.
I was still calm.
Ebola, while horribly lethal and easily spread, follows certain
rules. I’ve been teaching these rules to
nearly five hundred international health workers over the last month all over
Liberia. To catch Ebola there has to be
an exposure beyond the constraints of one’s Personal Protective Equipment or
PPE—the biohazard suits, boots, multiple masks, gloves and aprons and goggles
that have defined the media’s symbolism of the Ebola worker.
I’d had one such episode.
It happened on my first day in a busy Monrovia Ebola Unit with my first Ebola
patient ever. I’d donned my protective
gear and entered the “Suspect Ward” where new cases waited for confirmatory
blood tests. It was a hot mid-day in
Monrovia, sweltering in the Ebola treatment tent and ten degrees hotter still
inside my biohazard suit. I was drenched
in sweat, my goggles fogged over completely. My N-95 face mask pushed painfully into my
nose to the point where I could only breathe through my mouth. My first Ebola patient ever sat on the side
of his bare green army cot. I leaned
down to speak to him and had to yell through the thick mask for him to hear me
and understand my American accent. I
asked how he was doing. He said he felt
well. He was having no more fevers and
was not having any diarrhea or vomiting – the hallmark sings of a new Ebola
infection. I examined him as best as possible
in the clunky biohazard suit, wrote in his chart and moved to wash my hands before
the next patient.
Suddenly, THUD! I
turn back and he was having a full blown seizure. He thrashed violently on the
small unstable cot. He’d bitten through
his tongue and bloody saliva flowed from the side of his mouth. He’d also pulled out his intravenous line and
blood ran from the hole in the back of his hand and dripped and splattered on
the floor. I called the doctor working
with me to help and we struggled to turn his head to the side. He was in danger of choking on his bloody tongue
or drowning in his own secretions. All this
time we had to be careful not to rip our suits or gloves and risk exposure to
the surely contaminated fluids now filling his bed. The nurse went to the nurse’s station to find
an injection of Diazepam (Valium). Hopefully
that would break the seizure. We charged
the experienced nurse to give the
injection. Now there were more fears. I worried when this big man felt a sharp
needle pierce his skin, he was going to react and grab one of us or start swinging. I positioned the team out of his reach and
told the nurse to proceed with the injection, but to do it quickly. He jabbed the needle into the man’s right
shoulder, injected in one move and we all backed away. The seizure eventually stopped and the man looked
at me disoriented from the seizure and the Valium. I looked briefly into his eyes through the
fog in my goggles and saw a look of desperation that I’d never seen even in the
Tuberculosis and AIDS dying wards throughout Africa in the late 1990’s. If there’s a devil, I thought, this is his disease.
Uptown Zorzor |
My apron and gloves were covered with infected blood. Protocol says to clean them with 0.5%
Chlorine solution which kills the Ebola virus.
I sprayed down my contaminated suit, washed the blood from my outer
second pair of gloves and then decided to throw them away and get a new
pair. I carefully removed the gloves to avoid any
fluid splashing and dropped them gently in the waste container. Only one box of gloves was left on the nurses
table, but they were too small. They
would have to do. As I struggled to put
them on, POP. My hand poked through my
only remaining glove. There it sat
unprotected, exposed to the air on my first day ever in an Ebola unit with the
most deadly infectious patient I’d ever seen in a long career of deadly
infections. I called out as calmly as
possible, “BREACH!” The nurse instructed
me to clean my hand as thoroughly as possible with chlorine and to put on two
fresh pairs of gloves. As I ran the
stream of chlorine water over my bare hand all I thought was: I have two small
children and a wife. What the hell am I
doing here? After a good five minute
wash I left the unit, decontaminated the rest of my suit and threw it away to
be burned. I moved into the “Green”
uninfected zone of the Unit. I tried not
to show it, but I was shaken.
Tent City, Downtown Zorzor |
So there I sat febrile in my tent in Zorzor replaying every moment
as vividly as if it happened yesterday.
But it did NOT happened yesterday and here is where the rules of Ebola brought
reason to my fear. Ninety-nine percent of Ebola infections occur within twenty-one days
after exposure to the virus. In my
head I counted backward to that day in the Monrovian Ebola Unit. Twenty-five, twenty-six,
twenty-seven…twenty-eight days! Time was
on my side. I wasn’t showing any of the
other signs of Ebola that define the infection…not yet anyway. I told Sumo that this had to be Malaria. I was convincing myself as much as him. I’d been taking Malaria prevention tablets,
but it is never one hundred percent effective.
I’d had this before. This
definitely felt like Malaria.
“Sumo, can you grab me a pack of Coartem?” I asked. Coartem is our effective three day Malaria cure.
“Sure. Why don’t you
just rest and chill out though.”
I took the cure and
my fever resolved later that day. I watched closely
for any other symptoms, but none came. That was 4 days
ago. I’m starting to feel better. I’m
fatigued, but I can still work and teach. I'm
trying to rest a bit more,and put back lost weight. I'm still working. There's too much to be done.
Ebola has changed so
many of the ways we in the medical field think about things. Never in my life did I imagine I would think
this: Thank God I have Malaria.
Goooooood Morrrrrrrning West Africa! |