Ebola in DRC

We had no new patients today in the morning, so it was possible to really clean up and try and get everything in the right place. Every week we get half a day off so this afternoon seemed like a good time to take it. Fabulous. Just vegetating in a cool breeze under a palm tree.

The light in the late afternoon was amazing. Everything was very clear and bathed in a strong yellow light, with dark thunder-clouds in the background. I could hear the thunder but the storm seemed to pass in front of me.

In the evening we went to the “phone booth” because Barbara wanted to make a call. In fact it is just a stick under a tree marking the only point in Kampungu where there is mobile reception.

Tonight was Movie Night. We set up a four person cinema in the big white tent and then scrunched around the computer trying to hear the latest James Bond over the noise of the generator. Tomorrow I am going to lobby for the generator to be sandbagged to increase our viewing pleasure!

Early this morning the choir started practising in the church just on the other side of the fence. Lovely harmonies. They were accompanied by cock crows and the sounds of sweeping as every inch of our compound is brushed.

We went down to the isolation unit very early in an effort to keep ahead of everything for the day’s funeral. The first problem was that we had no car available until the afternoon. The second problem was that when the nurses went into the ward to see how the other two patients were, they found that one had died.

Then started really the most horrible tragi-comedy involving coffins, bodies and burial sites. We decided to bury in order of death. So last night’s death first.

The first mistake I made was talking to the wrong family and arranging the wrong coffin open in front of the isolation unit. It was made of wicket mat and was lined and covered with a kind of pink gingham and floral sheet. There was a lot of shouting between the family member that I was talking to and the family members from the second family, because of confusion over the coffins.

Then came the most unbelievable rain. I didn’t really know what to do as it was not going to be safe to try and carry the coffin and lower it into the grave as it would be too slippery. Amazingly, ten minutes later when we got to the cemetery the sky was blue and there was just a slight crackly noise as the last raindrops hit the dead grass stalks.

By the time I got back to the isolation unit, the third patient had died. He had been really very bad all day and his family had been outside crying and talking to him. His father had been in for a visit to say goodbye and they had cut two small pieces of string, one around his ankle and one around his wrist. Later in the morning they had asked Barbara to cut the last string which was round his tummy. It was awful to see: they were just waiting for him to die.

I went back to the cemetery and got two coffins into their graves before another torrential storm started with lightening that I could see streaking across the sky.

Today started very well. All our patients were well (or perhaps more accurately, alive). The morning was quite relaxing, which lulled me into a false sense of security. I pottered around trying to improve the water and sanitation situation. We started using our new disinfection area, which everyone was pleased with. Now we can all stand in the shade while we are waiting and then disinfect much more quickly.

At lunchtime I was told that a child had died in a neighbouring village. When we got there the child had already been covered with a piece of coloured cloth and was in the shade of the porch. He was very small, about four years old. When we had put on our protective clothing we laid the child size body bag out next to him and put him in. Then we picked up the bag and followed the family to the grave site. It started to rain on the way and we had to battle through undergrowth still holding the body bag. The rain was torrential during the burial: it was like standing under a shower. Water started to run down inside my goggles and fill them up. By the time we had all undressed I was soaked to the skin and my boots were filled with water.

On the way back there was lots of lightening, some of it very close, and the road was literally a river. A huge tree had fallen down in our path so we leapt out of the car and while Jean- Claude hacked at the branches, Faustin and I dragged them to the side of the road. We got through, but about a mile further on there was a fallen avocado tree. More branch hacking and a lot of wheel spinning and we were on the other side and heading home.

It was about five-thirty when we got back to the isolation unit. All the patients seemed comfortable so we decided to go home early. I went for a walk with Jan, another water and sanitation expert working for MSF. As we walked along the road some of the local isolation unit staff came out of a house and offered to show us around the village. We saw all the churches; breadfruit ( I think) trees planted by Belgians in the 60’s; the school; mandarin trees and our staff’s houses one after the other. They all came out and joined us, so the group got bigger and bigger as we made our way down the village along the ‘premiere avenue’. It really was a wonderful walk; the village was beautiful and everyone was so friendly. Best of all I was introduced to a man called Zoe!!!!

Unfortunately, when we got back to the compound we heard that our newest patient had died. Barbara, Christian and I decided to go and put him in a body bag straightaway, as it would be easier than in the morning. It was dark by the time we got there but luckily the generator was working and so the inside of the ward was quite well lit. He was sitting on the floor leaning against the bed. We got him into a body bag and onto the bed, and managed to get him arranged nicely in case his wife wanted to see him. Then we left him for the night.

Photo : P. Zintzen, MSF | Our boots drying upside down.

It had looked ominous for the two patients in the isolation ward last night, so I was prepared for a rather horrible day. But in fact both of them were alive this morning and we let them go home, which was a big highlight.

The young boy and old lady had been in the isolation unit since before I arrived and were fed up with being there. I couldn’t honestly say that they were fit and on top form but they are now in the recovery phase and don’t pose any risk for their families.

The little boy was first to be released. The child has been in the isolation for over a week and had been amazingly accepting and serene. His mother came to visit him every day, but even she had to wear a gown, gloves and a mask. We gave him some notebooks and pens and he had been writing stories and drawing pictures. He was so delighted to have them.

As we released the patients, it was my role to wait on the other side of the fence acting as the “greeter” to take them outside and to show that they were safe to touch. After being given a shower by the nurse, Barbara, the little boy trustingly took my hand and I led him out and gave him back to his mother.

The old lady was next. She had lost three of her children to the disease and had been been in for over a week. She had her wash and was then wrapped up in a new brightly patterned piece of cloth. When I held out my hand her eyes widened and her face lit up and she gave me her hand. I led her out and handed her to her sister.

Aside from the good news, we also had new arrival in the ward today. We put him in the suspect ward which is where we put patients that don’t quite fill all the criteria for the doctor to be sure that it is Ebola. Apparently he hadn’t been in contact with any patients even though he lived in a village that had been quite badly hit by the disease.

Things were better today. No burials. The isolation compound is coming along very well: Martin, our logistician, has been doing the most amazing job and there are washing slabs, changing rooms and latrines popping up like mushrooms.

Tomorrow we will be ready to move into our new and expanded quarters. I spent the morning employing more people to help us. We now have guards who will stand by the front gate ensuring that everyone washes their hands when they go out and spraying their feet with chlorine. We also have some disinfectors who stand by the gate from the high risk area to the low risk area and disinfect people coming out. The new cleaning lady was amazingly calm and collected when I took her in to the ward to wash the floor. She wasn’t worried at all and didn’t make any mistakes.

Bit by bit the whole thing is looking more professional and becoming easier to manage. Tomorrow I will be increasing the number of water points in the high risk area to make them more accessible. Martin has been making stands for the water containers and they are now ready.

We’ve got two patients who were looking pretty awful this evening when we left so I have my fingers crossed for them.

Today didn’t go quite as planned. This morning a nurse from the outreach team came to tell us about a patient in a neighbouring village. She had been preparing to bring the girl to the isolation centre, but when she went for a last check on her she had just died.

I collected up the team and all the equipment that we might need. Extra jerry cans of water, chlorine powder, lots of sets of protective clothing, bin bags, and a body bag.

When we got to the village we found the house and the dead girl’s uncle. He was quite calm and told us where her body was and what had happened.

Apparently both her parents had died recently from the disease and she had been staying with him for the past few days. Her body was lying behind the house on a low bed, covered with some plastic sheeting. Some family members went to dig a grave while we disinfected the house. We sprayed everything in the house with a chlorine solution and disinfected the latrine because a patient’s faeces are very contaminated.

Then I dressed in protective clothing along with one other member of the team and we went to put the body in the body bag. The problem was that she was very stiff and was lying on her side. I couldn’t get her straightened out at all. I was worried about this not being respectful but was assured that it didn’t matter. So we wrapped her up in the plastic and got her into the body bag.

The burial pit was just by the side of the road on the way out of the village, not in a cemetery. It hadn’t been dug deep enough so two of the team had to make it deeper. Then we shovelled the earth back in using our hands. By the time we finished it was dark. Next time I am going to take a shovel.

When I got back into the MSF office last week after a holiday everyone was talking about a mystery disease in the Congo.

Apparently there had been lots of deaths, but it wasn’t at all clear what it was.

There were different theories in the office, and we had to wait for the results of tests on samples that were sent to three different labs for analysis.

In the meantime, we sent our DRC emergency team to Kampungu, one of the affected areas, to set up the temporary isolation ward.

The first result that came through was a positive for Shigella. Then, late last Monday, the results came through from the Centre for Disease Control in Atlanta: some of the samples had tested positive for Ebola.

Everything changed straight away.

MSF’s Emergency Unit coordinated a meeting with our water and sanitation experts, epidemiologists, public health specialists and HR people to decide what equipment and staff to send.

I boarded a plane to Kinshasa, the capital of DRC, two days later.

The seven of us travelled from Kinshasa to Kampungu on a 10-seater plane with a pilot who had a huge handlebar moustache.

The scenery was lovely: mile after mile of jungly forest which looked like tightly packed broccoli with the odd dead white tree reaching up above the canopy.

I didn’t see the airstrip until the pilot lined the plane up: it just looked like a footpath on a bumpy field. It was quite an exciting landing.

As we got out of the plane crowds of children and interested adults pushed forward to see us and then followed us shouting, “Comment ça vas? Comment tu t’appelles? Comment ça vas?”… on and on.

The din was amazing, piercing.

Photo : MSF | Zoe Young training local staff on the safety measures in order to work in the isolation ward, during the 2005 Marburg fever outbreak in Angola.

Then an hour’s drive to Kampungu on roads that forced the car to tip right over on its side.

So, my job. Ebola is transmitted by contact with bodily fluids so patients have to be treated very carefully and kept very separate from the community.

We have set up a small isolation unit which is made up of a low risk part where we can change into protective clothing and then a high risk part which is where the patients are.

The building was part of the health centre before and has been surrounded by a low fence made of orange netting to keep people out (and to stop patients wandering off accidentally).

Four of us work in the isolation unit: a logistics expert who is responsible for building any new structures, beds, tables, fencing etc that we need; a nurse; a doctor and me, responsible for water and sanitation.

We are slowly improving the wards for the patients, but everything takes ages since we have to dress up in full protective clothing before we can go in.

We have head covers, enormous white overalls with elasticated wrists and ankles so that they puff out making us look like little marshmallows.

Photo : Peter Kimarx, CDC | The isolation ward set up by MSF for the current Ebola outbreak in West Kasai province, Democratic Republic of the Congo.

Two pairs of latex gloves, ski-type goggles, a duck beak mask and an apron. The overall effect on the outside is rather like a spacesuit.

On the inside it’s like a sauna. Pouring with sweat takes on a new meaning.

The tiniest activity, like moving a patient or carrying a bed, causes sweat to cascade down my face.

Of course, I can’t wipe it off as I am all covered and have no access to my skin until I disinfect and leave the high-risk part of the centre.

We have some nursing staff that have been trained to work in the high-risk area and some Red Cross volunteers who disinfect and help move patients around.

We are slowly increasing the numbers of staff but it takes time because we first have to find people who want to work with us and then we have to train them very carefully to make sure that they are safe inside the high-risk area and don’t make mistakes that would put others in danger.

One of the patients died today.

He had been a nurse in the health centre. He was an inpatient for a few days and was very brave and determined to get better. Every morning he sat on a wicker chair on the balcony to see what was happening and once or twice did a runner to go home.

That was OK.

When he came back we went back to disinfect the hut that he had been in.

Anyway, today he died and so I went into his ward with two of the disinfectors to tidy him up and put him in a body bag.

This is important because it is possible to get infected even when people have died.

Photo : Peter Kimarx, CDC | The isolation ward set up by MSF for the current Ebola outbreak in West Kasai province, Democratic Republic of the Congo.

I was trying out a new kind of very waterproof body bag so I had a few teething problems trying to put him in but soon it was done and I left him on a bed while we waited for a coffin to be brought (I could see it being made through the window).

I could hear his family wailing and crying: they live in a house about 200m from the centre. I could see them from the window of the ward.

When the coffin was ready we brought out the patient and the intensity of the wailing increased.

We put the body bag into the coffin and then we put it on the back of the pick-up truck, which set off for the cemetery accompanied by the burial team.

I disinfected myself rapidly and ran to catch them up at the graveyard.

There was a big patch of cleared ground with sticks lying on it. They told me that this was where all the other recent corpses had been put.

But there were no markers.

The grave was ready but there was no path alongside so that the coffin carriers couldn’t get the coffin next to the grave without falling in.

I shovelled along the grave to make it easier and then they inched forward.

The coffin started to fall so I wedged the shovel under it to hold it while they organised themselves and then they carefully lowered the coffin in.

I looked around expectantly for someone to shovel the earth back in.

Nobody around.

So, digging with our hands like badgers and with the single shovel, we backfilled the grave. Very hot work.

Some improvements to the burial procedures are definitely needed, I think, not least reassuring family members that it is perfectly safe once the person is in the coffin.

We are living in a large field that has been divided up with a campsite at one corner.

Five of us are sleeping in one big tent on inch-thick mattresses, under mosquito nets suspended from strings stretched from one side of the tent to another.

I seem to have a small hill under my bed which is not disguised by my rather thin mattress so I sleep curled around it like a snake.

Every night we have a meeting after dinner, which is how I find out what is going on outside the isolation unit.

The teams are working out where there might be more patients and visiting neighbouring health centres, talking to the communities and authorities and gathering information.

It is becoming clearer where cases have come from in the past few months and they are trying to work out what is going to happen next.

Some samples have also tested positive for typhoid, so we now have three epidemics at the same time.

Tomorrow I need to make changes in the wards to try and get more water in there.

I need to train a new cleaning lady and some more Red Cross volunteers.

I need to disinfect the deceased person’s house.

I might try cementing up some holes in the ward floors to make cleaning better.

Hmmmm – long list!

Related News:

12 September 2007 – “DR Congo: Ebola virus confirmed in Kasai”

14 September 2007 – “Ebola: no antidote, no cure, all emphasis on isolating the infected”

BIO : Zoe Young grew up and was educated in London, and has
worked both in the UK and abroad for a number of humanitarian
organisations including Oxfam, Interact, and Médecins Sans Frontières
(MSF). She is a Water & Sanitation expert with significant field
experience in Rwanda, Kenya, the Democratic Republic of Congo (DRC), Sudan
and Angola. In 2005, Zoe worked in Uige, Angola following an outbreak
of deadly Marburg disease – a haemorrhagic fever similar to
Ebola. She is currently stationed in the DRC working on the outbreak of Ebola in West Kasai province.