Another week has come and gone here in West Africa. As remnants of the rainy season disappear, the heat and humidity seem to be climbing rapidly. Of course, this means there are now more insects, more scorpions, more snakes and more difficult working conditions. Despite those challenges, we are more determined than ever to contain the virus, provide good care and convey to our patients the depth of our commitment.
Wearing full PPE is a challenge for many reasons. In addition to the physical limits, it makes it difficult to recognize individual staff members and masks all of our emotions. Not a day goes by that I don’t wish I could pull that mask off so that my patients know I care, so they can see that I am laughing, smiling or even crying with them. The kids, especially, are terrified and uncomforted by our alien appearance. Christine — the sister of Rancy and cousin of Solomon — was one of those kids.
Christine was one patient that we didn’t expect to survive. There were nights when she was close enough to touch death, but somehow held on. She has finally turned the corner and is a whole new person: sassy, demanding and snooty. She has never been fond of the PPE-encumbered medical staff and — even in better health — remains unconvinced. Yesterday, I went into her room to see how she was doing. As I started walking out, she stood up on her bed, started crying and yelling at me not to leave. I went back and sat at the end of her bed and started talking to her. She didn’t respond, but instead, crawled onto my lap and put her arms around my waist. My heart melted all the way down into my boots and stayed there pooling with my electrolytes and fluid volume. I put my arms around her and rocked her for awhile. Christine left for home a few days later- I found a part of myself wishing that she didn’t have to leave.
For some of our patient’s — like Christine — there is a happy ending. Many, like Ester and her son Saah, see a very different outcome. Ester’s husband was the first of the family to die of Ebola, leaving her with four children. Saah, the oldest, is ten years old, but shoulders responsibility like a grown man. He spent hours at his mother’s bedside trying to assist her in any way possible, despite being sick himself. Though Ester seemed to be getting better for a few days, her frail body was unable to fight the virus for long. Saah took the loss of his mother hard; he became especially quiet and withdrawn. A few days after Ester died, Saah’s six-year-old brother, named Godpower, arrived to the ETU. Saah immediately went from a grieving child to a loving father. Just as he did with his mother, Saah looked after Godpower’s every need. He changed him, bathed him, fed him and — as Godpower became more weak and incoherent — simply stayed close to his bedside. Two days ago, Saah’s blood test came back negative and he was able to go home. When asked if he was ready to leave, Saah replied, “I have seen hell and I want to go home”. A few days after Saah left, Godpower passed away. Unlike many children who have lost both parents and end up in orphanages, Saah’s extended family was able to each take one of the surviving children to raise as their own. Though we all take comfort in the fact that Saah and his siblings will be with family and in the same village- Ebola has only just arrived to that village and they are all far from safe.
As the Ebola cases in many of the larger cities seem to stabilize, cases from the remote regions are on the rise. Unlike the individual cases that arrive from cities, entire families are arriving to the ETU from these outlying towns and forest villages. One of those villages is called Gbarpolu. To get to Gbarpolu, one must drive four hours, take a canoe across a river and then hike another four hours along paths through the forest. Saah and his family are from Gbarpolu, along with two other families in the ETU so far. Yesterday, instead of a day off and in an effort to gage the current impact of the illness and stem its capacity for destruction, myself and a small team were taken to Gbarpolu by helicopter. The goal was to draw blood from as many suspected and high-risk cases as possible. We were greeted with cheers and applause and a constant audience ensued as we dressed in full PPE and began drawing blood in the village center. It was heart wrenching to see their excitement, knowing that most of them will become ill in the following weeks and at least half of that number will succumb to the virus. Until an effective and safe method of transporting infected people out of the forest is devised, all those suspected of having the virus or who have had a high-risk exposure are being encouraged to start heading for the county Ebola holding center. Those that are already too weak to walk are painfully beyond our reach.
Liberia is teaching my heart to stretch and grow. It is stripping me of my normal methods of demonstrating compassion and care due to full PPE and limited patient contact. It is requiring me to participate in some of the most excruciatingly painful situations I have ever seen human beings experience. Just this morning we delivered a 26-week-old baby in the confirmed ward; he died twelve hours later. I am learning what it means to love, and how to communicate that love more deeply and in ways I didn’t even know were possible. I am learning that I have placed too much value on external demonstrations of compassion when what really matters is what is happening internally. A heart that truly loves has no trouble conveying love and compassion — no matter the circumstances — because that type of love and compassion resonates from the very deepest corners of the soul and becomes an almost physically compelling force experienced by all those around.
While I miss everyone, I can’t imagine being anywhere else in this world. Please continue to keep all of us — patients and staff — in your continued thoughts and prayers!