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    Battling Ebola: A View From the Front Line, Part 1

    iso unit board

    By Jeri Sumitani
    Special to WebMD Health News

    Editor’s note: Jeri Sumitani is a U.S.-trained physician assistant who volunteered to help with the Ebola outbreak in West Africa. She will be chronicling her experiences during her six-week stay.

    When the Ebola outbreak reached a critical point during the summer of 2014, I started submitting requests to volunteer in West Africa. I am a U.S.-trained physician assistant working in HIV medicine for the past two years in South Africa. I don’t have any experience managing viral hemorrhagic fevers, and would never describe myself as an infectious disease “specialist.” I have never been to West Africa, and don’t understand the cultural context under which this disease has exploded.

    What I do know is that having worked and lived in Africa and other resource-limited settings, I understand what the challenges are and perhaps more importantly, my own limitations. I know what I cannot change and when I have reached my physical and psychological limits. Besides that, the only reason I qualified for this position is because I am willing to do whatever is asked. I am no martyr and no hero. I have no intentions of saving the world from Ebola. I volunteered simply because I can.

    The journey to Sierra Leone from my residence in South Africa took 48 hours, a four-country touchdown (Germany, Belgium, Senegal, and Guinea), and finally a boat ride from the airport to reach the country’s capital, Freetown. In essence, I had to leave Africa to return to Africa. Previously, this trip would not have required me to leave the African continent, but due to the grounding of several flight routes since the Ebola outbreak, it now takes an epic journey of this sort to reach the land of the “Lion Mountains.”

    I arrived in Freetown close to midnight on November 19. This marked the beginning of my six weeks in Sierra Leone.

    Day 1

    Although any job begins with some kind of orientation process, this orientation carried with it an acute sense of gravity. Not paying attention to what was being said or demonstrated could literally mean life or death. I was introduced to the team working for the UK-based King’s Sierra Leone Partnership (KSLP). Many on the team have been in Freetown since before the first Ebola case was identified in Sierra Leone, despite requests from headquarters to pull out of Freetown. They support Connaught Hospital, the sole facility in Freetown to keep its doors open to Ebola and non-Ebola patients. All other facilities in the city were forced to shut down as they either lacked capacity or staff to support the volume of patients flowing through their doors. Many health care workers contracted Ebola and died, leaving a health care work force that was already stretched too thin even thinner.

    Freetown

    Freetown, Sierra Leone

    Connaught operates a 16-bed Ebola isolation unit, essentially holding units for Ebola suspect patients awaiting results. Patients stay in the isolation unit until results are available; if they are found to be positive, they are then transferred to an Ebola Treatment Unit (ETU) for further management. Negative patients are given a certificate of negative results as proof, assessed for other causes of illness, and referred to the outpatient department for care and treatment if necessary. Isolation units seek to minimize exposure to others without Ebola.

    My primary role was to help staff the isolation unit. I would be working next to UK-based volunteer healthcare workers as well as local nurses, cleaning staff, and district case managers who staff the unit 24 hours, seven days a week. On my first day, I practiced donning and doffing my personal protective equipment (PPE) for several hours with my mentor, a volunteer doctor from the UK who had been working in the unit for a month.

    One of the most important aspects of this process is to move slowly, deliberately, and thoughtfully. Think through each step – which surfaces are contaminated? Which are clean? Should I touch that surface? That patient? With the support and advice of my mentor, I slowly perfected each technique. Having worked in respiratory and contact isolation settings previously, I figured this process would come relatively naturally. Perhaps it was the adrenaline, but I would routinely find my mind going completely blank. It was actually most foolproof to blindly follow the illustrated, step-by-step checklist posted on the wall of the decontamination room of our isolation unit. I wouldn’t ever want to rely solely on my memory to save me from potential exposure.

    Jeri

    Jeri Sumitani

    As the final PPE training step, my mentor took me on a walk-through of the isolation unit before I would start providing patient care the next day. I was given strict instructions not to touch anything to minimize my risk of exposure. I felt surprisingly calm and safe in my PPE, like I was walking through an alternate universe in a bubble. I imagined this is how astronauts must feel when space-walking. The only difference is that this universe is a horrible reality full of suffering and anguish. It is bleak and it is grimy.

    I returned to the guest house feeling relatively calm. And then the paranoia started.

    I felt like everything was covered with Ebola. Every square inch of my skin, my clothing, my backpack, all were virus-infested. I quickly shed all my clothes, and made a pile of “contaminated” clothes in the farthest corner of the room. I attempted to take a shower, which was more like water torture — literally cold water dripping from the shower head. I tried to scrub the smell of chlorine off (and with it, hopefully the virtual virus crawling all over me) but it was futile. In the end, I went to bed convinced that I was starting to experience Ebola symptoms. I did not sleep very well that night.

    Day 2

    The next morning, I went into work ashamed of my amateurish, panic-laden evening. The lead clinician, a Spanish doctor who was recruited by the organization to oversee the Ebola response, was in the office. Perhaps having sensed my slight sleep deprivation and noticing my anxious expression, she asked me how things went. I mustered the courage to divulge my evening to her. She simply smiled an all-knowing smile. “Did you also suddenly develop a headache? Or feel feverish?” she asked. “And your stomach started churning? It’s all part of the process, we all felt like that for the first several months of being here. Welcome to Sierra Leone!”

    That afternoon was my first true shift in the isolation unit. I was more nervous that morning than I had ever been since deciding to join the response. I repeated the mantra that my long-time mentor told me just before I left: “When you see your first patient, remember your training. Remember that the virus has to obey certain rules, and remember those rules.”

    Even over the relatively short amount of time I spent in the isolation unit, I began to recognize Ebola patients. They exhibit a certain look that health care professionals refer to as the “Ebola stare” – a kind of empty, haunting expression of someone battling a devastating disease. I have never seen anything quite like it. Many also appear to develop a loss of coordination. Not only are they weak, but also they can no longer perform routine movements and ultimately are unable to eat and drink despite assistance. Some will ooze blood from their eyes, gums or rectum.

    The young lady in bed 8 was one such patient. She was starting to show signs of altered mental status and confusion. Although the day before we had caught her aimlessly wandering the hallways of the unit, this day she was completely bedridden. During rounds that afternoon, we noted bleeding from her gums. I sat her up and tried to get her to take some fluids to help with her dehydration, but she could barely hold herself upright and lacked the coordination to swallow. As the solution dribbled down her face and onto her chest, I started to lose a little hope.

    And then, as if she sensed my despair, she looked right at me in a brief moment of lucidity and said, “I like you.”

    She died that evening.

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