“No One Knows When It Will End”: A Doctor on the Ebola Emergency

“After that, we put on a hood, and then an apron. We are checked for any leaks of air, and they write our names on a piece of tape on the apron. This way we know each other when we are inside, and the patient knows whom he is talking to. They write, also, the time when we finish putting on the full P.P.E. If I finish before my buddy, my time is written first. We monitor who reaches a maximum of one hour inside the P.P.E. so that the buddy can tell him to go out.

“Most of the time, when doctors enter, the nurses go through the vital signs, but for critical patients we have to take vitals again and do a quick A.B.C.D. (airway, breathing, circulation, disability) assessment. If there are not many critical patients, we can see up to six patients in one hour. But when there are more critical patients we sometimes see only two. We go out, refresh, and then go back after one or two hours of rest.

“Before we leave the red zone, we write the status of the patient. In Bunia, we have a Plexiglas divider where we hang what we’ve written. The clinician on the other side can quickly copy the notes before we discard them in the red zone. (In Beni, we go to a designated area within the E.T.C. where we can talk to clinicians who are on the other side—the green side. We dictate to them each patient’s instructions.) Once we finish that, we doff our P.P.E. under supervision. Someone receives us with a bottle of water and biscuits. And then we go sit down, recover for a few minutes, and we start discussing each patient again.

“The first obvious thing you feel in P.P.E. is the heat. It’s really hot. You are putting everything on top of the scrubs that you are wearing. I come out of the red zone and I’m totally wet with sweat. I’ve seen in past outbreaks, like in Liberia, colleagues falling inside P.P.E. The second thing is breathing. When you have everything on, there is a barrier for airflow. Often, if the supervisor did not pay attention, we have to say, ‘O.K., let’s go out, because your goggles are fogging.’ If you don’t see well, you can easily stumble on something and fall.

“In the red zone, I know I’m going to see patients who are confirmed to have Ebola. If I make any mistake, I will also be in quarantine for twenty-one days—or I will also be infected. So we enter with that anxiety, knowing that this is a risk that I’m taking. I know that everybody has that level of fear. But I have to go. Because I’ve been in many other outbreaks, I trust that, if I respect the protocols, there is nothing that will happen to me. And that has helped me a lot in gaining confidence. I always tell my colleagues that, if we continue to respect the protocol, none of us will be affected.

“People need to be trained well to avoid being in a panic when they are removing the P.P.E., because that’s the critical moment. We have entered the red zone. We have touched patients. Our colleagues sometimes have to mop the blood of confirmed patients, or body fluids. I myself was taking care of a patient, and he sneezed and everything went on my apron. We have a mirror so that you can see what you are doing. We have, also, a huge banner showing each step. And then there is a person in the green zone, in light P.P.E., who is also giving instructions: ‘O.K., now you can wash your hands.’ And then we have a sprayer who is spraying us with disinfectant. If there is visible soiling on our P.P.E., he cannot spray, because he will spread those things. So he will just tell us what to do, like removing it carefully and dropping it in chlorine very quickly before we wash hands.

“Recently, a man in his forties was brought in. He had spent two weeks with symptoms. He had a light fever first, with vomiting and muscle pain, but it was mild enough for him to stay in the community. And then when symptoms started to worsen—especially when he started having profuse diarrhea and vomiting, ten days later—he was brought to us. He was already very weak. He was no longer fully conscious and was not able to listen. And he was still passing a lot of diarrhea. Because of vomiting, we put in a nasogastric tube. A moment later, he started bleeding everywhere.