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ONE WOMAN WALKED IN, AND THE EBOLA NIGHTMARE BEGAN

Adam Levine, Special to CNN
Updated 2:07 PM EDT, Wed September 24, 2014
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Ebola overwhelms new hospital in Liberia
02:34 - Source: CNN

Editor’s Note: Adam Levine is an assistant professor of emergency medicine and
director of the Global Emergency Medicine Fellowship at Brown University. He is
a member of the emergency response team for International Medical Corps. The
views expressed in this post are his.


STORY HIGHLIGHTS

Phebe Hospital in rural Liberia was abandoned after first Ebola patient infected
staff

All three hospitals and schools in Bong County shut down due to fear of Ebola

The first Ebola Treatment Unit opened in Bong County in mid-September

CNN  — 

A middle-aged woman walked into the emergency room of Phebe Hospital with a
fever on the evening of June 23.

Phebe was known as one of the best hospitals in rural Liberia, supported by the
local government and international religious and academic partners. Phebe was
especially known for its high-quality nursing care, serving as a training
hospital for nearby Cuttington University, one of the country’s few nursing
schools.

A few hours after arriving in the emergency room, the woman was admitted to the
medicine ward with a list of potential infections – all the usual suspects in
Bong County: malaria, typhoid, sepsis.

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An epidemic had been raging for months in nearby Guinea, but Ebola was not
considered as a possible diagnosis. After all, nobody at Phebe had ever seen a
patient before with Ebola, and as the axiom goes in medicine, when you hear hoof
beats, think horses, not zebras. Certainly don’t start imagining unicorns.

Adam Levine is a member of the emergency response team for International Medical
Corps.
Stuart Sia/International Medical Corps

The nurse who cared for the woman that night drew her blood and helped her to
the toilet to urinate. When the woman began vomiting and soiled her sheets, the
nurse cleaned up the mess, as nurses do all over the world every day.

For a disease whose transmission depends on the direct contact of one human
being with the body fluids of another, Ebola has no better customer than nurses.

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The other thing about nurses that the virus finds particularly helpful is they
tend to work in shifts. Before the week was out, Bong County’s first Ebola
patient had died, and seven nurses caring for her had fallen ill. Six of them
would also die in the coming weeks.

The remaining clinical staff, watching their colleagues falling ill all around
them, abandoned the hospital. When the patients saw what was happening, those
well enough to walk out did just that.

Over the ensuing months, the epidemic rippled across Bong. Hundreds of
individuals were infected, and perhaps more importantly, basic social
institutions also began to collapse.

orig elbagir ebola reflection liberia_00001723.jpg
video

Avoiding Ebola: Bleach my 'best friend'

newday dnt cohen frontlines of ebola fight_00010921.jpg
CNN
video

Desperation grows in heart of Ebola zone

ac ambassador power on ebola_00005722.jpg
video

How the U.N. is battling Ebola

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video

Human trials offer hope for Ebola vaccine

One by one, all three hospitals in the county shut down due to fear of the
spread of the virus, followed by most of the primary care clinics. Women were
left without midwives to deliver their babies, accident victims without
emergency rooms to care with them. Next the primary schools closed, then the
secondary schools, and finally Cuttington University.

Guilty of Ebola until proven otherwise

Ebola is not just a disease of individuals but also one that infects society’s
most basic health and social welfare structures.

As a disease that afflicts health care institutions, it is perhaps fitting that
the most powerful weapon in the fight against Ebola is not a single drug or
vaccine but instead a particular type of health care institution: the Ebola
Treatment Unit, or ETU.

On September 15, I helped International Medical Corps open the first ETU in Bong
County. I have worked in many hospitals, both rich and poor, and have set up
refugee camp clinics and trauma field hospitals in poverty-stricken and war-torn
countries.

But managing an ETU has been an entirely different experience.

The primary goal of a hospital or clinic is to care for patients and, if
possible, to save their lives. The primary goal of an ETU is to protect the
lives of its staff.

The secondary goal is to protect surrounding communities and resuscitate local
health care systems by taking patients suspected of having Ebola out of their
homes and hospital emergency rooms, breaking the chain of transmission.

Caring for patients comes third on the list of priorities, though still remains
important. After all, why would people go to an ETU if they did not think there
was at least a chance that it would help make them better?

During the week before opening our ETU, I can honestly say that I worked harder
and slept less than during any other time in my life. The sheer number of
details involved in the construction and management of this unique type of
health care facility is almost endless.

Ebola’s $1 billion bill hits Africa’s bright economic lights

Nearly 12,000 liters of chlorine are required each day to disinfect the Ebola
Treatment Unit and its staff.
Stuart Sia/International Medical Corps

First, a site had to be chosen, which has been a significant roadblock to the
opening of other ETUs. Hospitals tend to be built close to the communities they
serve; most communities, however, tend to want their ETU as far away as
possible.

Our ETU sits in the middle of a forest, 2 kilometers (more than a mile) down a
rough dirt road, on the grounds of an old leper colony. Perhaps it is not
surprising that the survivors of one of humanity’s oldest and most stigmatized
diseases would be among the few to welcome a treatment facility for one of the
newest stigmatized diseases.

Second, the design and infrastructure of the ETU had to be perfected, with
separate spaces and wards designating different levels of risk, where staff
members would know to take different kinds of precautions.

A borehole was drilled and giant tanks erected to mix up the nearly 12,000
liters of chlorine required each day to disinfect the ETU and its staff
properly. A giant incinerator was built to burn the vast amounts of infected
waste produced by the facility safely.

Third, supplies had to be purchased, both the normal kind present in any
hospital, such as bed sheets and intravenous fluids, but also the expensive (and
increasingly difficult to purchase) personal protective equipment. A single
outfit of boots, gloves, suit, mask, hood, goggles and apron costs as much as
$90, and at full capacity the ETU might go through 100 outfits a day.

Ebola hospital overwhelmed by patients

Finally and most importantly, local staff had to be hired and trained to work in
the facility. While a small team of expatriates working with International
Medical Corps manages our ETU, more than 90% of the staffing remains local.

During the week before opening our facility, I helped organize an intensive
training for our first 50 staff members, including physician assistants, nurses,
nursing aids, hygienists, sprayers, safety monitors, waste handlers,
chlorinators, laundry staff and burial team members, to ensure they knew how to
protect their health and the health of their colleagues while working in the
ETU.

Just 72 hours before our opening day, we had a checklist of almost 50 items,
ranging from goggles to gravediggers, that we still needed to be able to begin
admitting patients safely to the ETU. The pressure to open the ETU had been
building for weeks as the numbers of cases of Ebola in the county began to
skyrocket.

Somehow, and I’m still not sure how, we made it happen.


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A profile can be built about you and your interests to show you personalised ads
that are relevant to you.

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SELECT PERSONALISED CONTENT

Select personalised content

Personalised content can be shown to you based on a profile about you.

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CREATE A PERSONALISED CONTENT PROFILE

Create a personalised content profile

A profile can be built about you and your interests to show you personalised
content that is relevant to you.

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MEASURE AD PERFORMANCE

Measure ad performance

The performance and effectiveness of ads that you see or interact with can be
measured.

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MEASURE CONTENT PERFORMANCE

Measure content performance

The performance and effectiveness of content that you see or interact with can
be measured.

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APPLY MARKET RESEARCH TO GENERATE AUDIENCE INSIGHTS

Apply market research to generate audience insights

Market research can be used to learn more about the audiences who visit
sites/apps and view ads.

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DEVELOP AND IMPROVE PRODUCTS

Develop and improve products

Your data can be used to improve existing systems and software, and to develop
new products

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ENSURE SECURITY, PREVENT FRAUD, AND DEBUG

Always Active

Your data can be used to monitor for and prevent fraudulent activity, and ensure
systems and processes work properly and securely.

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TECHNICALLY DELIVER ADS OR CONTENT

Always Active

Your device can receive and send information that allows you to see and interact
with ads and content.

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MATCH AND COMBINE OFFLINE DATA SOURCES

Always Active

Data from offline data sources can be combined with your online activity in
support of one or more purposes

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LINK DIFFERENT DEVICES

Always Active

Different devices can be determined as belonging to you or your household in
support of one or more of purposes.

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RECEIVE AND USE AUTOMATICALLY-SENT DEVICE CHARACTERISTICS FOR IDENTIFICATION

Always Active

Your device might be distinguished from other devices based on information it
automatically sends, such as IP address or browser type.

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STRICTLY NECESSARY COOKIES

Always Active

These cookies are necessary for the website to function and cannot be switched
off in our systems. You can set your browser to block or alert you about these
cookies, but some parts of the site will not work.

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COOKIE LIST



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