Ebola for the day

Jina Moore has a BuzzFeed article about the Ebola crisis:

Dr. Wvannie Scott-MacDonald wanted to talk about some good news. She oversees the John F. Kennedy Memorial Hospital in Monrovia, the capital of Liberia, and it had become one of the grimmest places in the country; no small distinction in an area wracked by one of the deadliest disease on earth.
Roughly a month ago, the hospital’s lead doctor died of Ebola, a rare but highly fatal virus currently burning through three West African countries. No one had known the contagious patient he was treating even had the disease, which spreads through contact with the bodily fluids of an infected person, and the doctor’s death caught the staff by surprise.
So the JFK hospital shut its doors, and just about every other health facility in the country did the same. It was an extreme reaction to an extreme disease: Once Ebola’s symptoms announce themselves, many people die within days. Until just a week ago, Liberia’s capital had only thirty-three beds for confirmed patients. In Liberia’s health facilities, everything was contaminated; no one was prepared. Most doctors and nurses rarely used rubber gloves, and hardly anyone had personal protective equipment (PPE), the head-to-toe “space suit” that’s considered essential when treating Ebola-infected patients.
Across the country, there’s too little equipment in too few health facilities. Supplies move slowly; Ebola, on the other hand, is infamously fast, and health care workers are especially exposed. In Liberia, they make up ten percent of the dead so far, according to the latest numbers from Liberia’s Ministry of Health.
So it was some small miracle when MacDonald reopened the maternity wing in her hospital two weeks ago. But it is not business as usual. There’s not a nurse in the ward who isn’t wearing a hospital gown and a long apron. Most cover their hair with what looks like a surgeon’s version of a shower cap, and everyone wears latex gloves, even the few who look like they’re just doing paperwork.
In the old says, all those layers would be alienating. “Now it’s a different type of care we give,” she said. “We want to care, but we have got to care in a different way, by caring for ourselves first.”
That also means triaging patients according to the relative risk they present, not the medical risk of their condition, but the infection risk of where they’re coming from. MacDonald and her team are fairly confident in the health of women who’ve been to JFK for checkups throughout their pregnancy. But strangers scare them.
“Anyone we don’t know? Red flag,” MacDonald said. “Anyone from a hot spot? Red flag.”
Hot spots are parts of Monrovia where Ebola cases are spiking. “Red flags” get attended by people in full PPE: masks, goggles, double gloves and all.
Last week, a woman no one in JFK had seen before could be found writhing on a gurney in the corner of an examination room. She was from a “hot spot”, but needed a Caesarean section.
“That’s a dozen people who are going to have to be in PPE,” MacDonald said. “Two surgeons. Two midwives. The anesthesiologist. The people who clean the bedding. The people who clean the equipment. The people who mop up the room after…”
PPE is cumbersome to get on, time-consuming to remove, and the suit isn’t reusable. They’re not cheap, either. The World Health Organization, the United States, and China, among other donors, have sent PPE to the country. But the supplies are creeping along, and right now, MacDonald is outfitting her staff with personal donations from old friends who ship gear from the US by DHL. “It’s the fastest way to get it in the nurses’ hands,” she said. But it’s not foolproof, either: Last week, two boxes got stuck in Customs because of confusion over whether MacDonald should would have to personally pay an import tax on the goods.
Still, MacDonald and her staff are more than making do. On a recent morning, nearly forty women waited for regular prenatal checkups. In just the first week the ward reopened, fifteen babies were born here, and gloved-and-garbed nurses seemed lighthearted, even relieved to be back at work.
That didn’t surprise MacDonald. “Newborn babies give you such joy,” she said. “You see life again.”

Rico says these are tough women dealing with very tough problems...

Jina Moore has another BuzzFeed article about the Ebola crisis:

It takes five grown men to get Orusko A. Gar Gar’s body into the back of the truck. He is in a thick black plastic bag with four wide handles, one at each corner. The men are other-worldly in bleach-white plastic suits, goggles, and red plastic bandanas wrapped around their noses and mouths, knotted tight beneath their white hoods.
These men are polyethylene pallbearers, slinging hands through handles, hoisting their uncooperative load, and swinging Gar Gar toward the industrial blue pickup truck.
Theirs may be the deadliest job on Earth right now. Ebola is at its most contagious in a human body when that body has just died.
Neighbors and relatives gather and watch, a cautious fifteen feet or so away. One is Gar Gar’s son, 28-year-old Prince, who knew he shouldn’t touch his sick father’s body. Another is Gar Gar’s brother, D. Wheaye, who says he accompanied a health ministry decontamination team to spray the body four days earlier, the day Gar Gar died. The team had protective gear, but the brother did not, and now he wonders if he could have gotten Ebola from that.
The body was sprayed where Gar Gar fell— right next to his bed, toes pointed directly upward— and it waited there for four days because the dead body management team doesn’t come unless a test confirms the person had Ebola. There’s only one lab that can do this in the country, and each test takes a full day to process. The lab, like the burial crews, gets backed up quickly.
Gar Gar’s head hits the truck bed first, and it sounds like a small boulder crushing a tin shack. The rest of his body clunks arrhythmically, and someone drags him toward the cab. This truck could fit another dozen or so bodies like his— and that’s just what it will do, when next it collects the previous night’s dead from the Ebola isolation facility at the nearby ELWA hospital.
Ebola is a rapid killer— symptoms show within three weeks, but most people here say their family members are dead within days, sometimes hours. It’s the clinical last rites of its victims that take time.
Korvayan and his team need around fifteen minutes to suit up and spray themselves with chlorine, which kills the virus, and another fifteen minutes to strip down. They do this for every body they retrieve, and in between, there’s bagging the body and maneuvering it out. Don’t trip. Don’t drop him. Don’t catch the plastic coffin on any jagged edges.
“I carried sixteen bodies yesterday,” Korvayan said. All four teams the Red Cross runs in Monrovia— they are the only group allowed to move the dead to burial or, more often, cremation— picked up forty-one. No one can remember now, as Ebola spikes in communities around the capital, if that’s normal or not.
His crew is younger than him by two decades. But they’re tired too. There is Yenti, who has a happy spirit, but this work could demoralize even the most sprightly soul. “It’s common that we see maggots,” he said. “Sometimes the eyeballs are falling out of their heads. Or the tongue. The tongue falls out. And then I have to pick up his head, because you have to hold the head along with the feet and the body.”
Yenti and the others make fifteen hundred dollars a month, paid by the Red Cross— a fortune in impoverished Liberia, and more than seven times what one worker said the health ministry paid him during an earlier phase of the outbreak— but they agree that it’s not enough.
How could it be? They are carrying a human cluster bomb— a corpse riddled with virus eager to spring out and find a new host. Ebola kills its victims by overwhelming them: too much virus, destroying too many cells too fast. And once it has killed its host, the virus sits in the flesh and the blood, dormant, waiting for new flesh, new blood to invade and reproduce.
The young crew says they’re here because they want to help the country. “I want to protect my living Liberians,” says one crew member. “Not the dead. They are gone. But the living.” Improperly disposing of corpses— touching them or burying them without those plastic bags— is an easy way to spread the disease, and probably how Ebola moved from the rural north to the capital. Still, he’s not taking any chances. “I told my wife not to come near me until the work is over,” he said. “But all my body hair is gone, man.” He holds up skinny, bare forearms, smooth as a child’s. “Burned away from chlorine.”
Korvayan, the team leader, has been doing this job for four months. No vacation. No rest. Every day a work day. At 36, he’s not as young as his teammates, and four months in, he’s not as idealistic. He’s seen the outbreak swell, and the latest expert reports estimate that the Ebola crisis won’t let up. It could be six months, Doctors Without Borders says, before it’s under control. If Ebola won’t quit, in two weeks, at the end of August, Korvayan will. “I just need to rest,” he said.

Rico says that these are tough guys dealing with unbelievably tough problems. (And you wonder how well we'll do, when it gets here...)