Life, Death and Grim Routine Fill the Day at a Liberian Ebola Clinic
SUAKOKO, Liberia — The dirt road winds and dips, passes through a rubber plantation and arrives up a hill, near the grounds of an old leper colony. The latest scourge, Ebola, is under assault here in a cluster of cobalt-blue buildings operated by an American charity, International Medical Corps. In the newly opened treatment center, Liberian workers and volunteers from abroad identify who is infected, save those they can and try to halt the virus’s spread.
It is a place both ordinary and otherworldly. Young men who feel well enough run laps around the ward; acrid smoke wafts from a medical waste incinerator into the expansive tropical sky; doctors are unrecognizable in yellow protective suits; patients who may not have Ebola listen to a radio with those who do, separated by a fence and fresh air.
Here are the rhythms of a single day:
Soon after their arrival, about a half-dozen doctors and nurses gathered near whiteboards for the handoff from the night shift. There were 22 patients, and no deaths overnight. The center — which includes a triage area, a restricted unit for patients suspected of having Ebola infections and another for those in the grip of the disease — is not teeming like some clinics in Monrovia, more than four hours west. It is designed to accommodate up to 70 patients, but it is still scaling up after opening a few weeks ago and has just two ambulances to ferry patients.
An 8-year-old boy had been too weak to lift a liter bottle of oral rehydration solution to his mouth through the night. Bridget Anne Mulrooney, an American nurse, reported that she gave him a smaller bottle and sheets to keep warm. A woman who had lost both her baby and husband to Ebola and was suspected of having the disease herself was refusing food and medications for symptoms and other possible illnesses, such as malaria. A man in his 70s, a talkative staff favorite, was now confused, his sheet covered in blood. He had been admitted four days earlier, but laboratory tests confirming an Ebola diagnosis had not come back yet. “I think he’s positive,” said Dr. Colin Bucks, an American. “I think this will be an end-of-life event.”
Eight patients needed intravenous fluids to combat dehydration. One patient was described as happy. Another was playing cards.
Morning devotion began with a song and clapping, performed in triple time. About 18 local workers, most wearing rubber boots and blue hospital scrubs bleached so often that they were now pastel pink, danced and then prayed for God’s mercy on the treatment unit and those who worked there. Some folded their hands, sheathed in bright-colored gloves, at their heart. In unison, the Liberians sang, “Cover with your protective arms, O God.”
Sean Casey, an American who is the center’s team leader, gathered his department heads for what became a conversation about patient flow. The head of the ambulance crew said five patients with possible Ebola infections were awaiting rides to the center. But the ward with suspected cases was full, Mr. Casey said, and needed to be cleared first. Lab results were required, so patients without Ebola could be discharged and the confirmed cases could be moved to the other ward. The center also had some patients who were ill with other maladies. They should have been transferred to the local hospital, but it offered only limited care since reopening after six nurses died of Ebola.
The managers also discussed labor issues involving the 175-member Liberian staff, some of whom had walked out days before in one of the pay disputes common among the country’s health workers. The leaders and those who abandoned patient care would not be rehired because it was crucial to have a dependable staff, Mr. Casey said. Then he sent everyone off.
“Go forward and do well,” Mr. Casey instructed.
A Liberian woman scooped steaming yam porridge out of a blue bucket — breakfast for the patients and staff. The food is prepared off-site, at a university that is closed because of the outbreak and houses many of the staff members. The center has people working as cleaners, sprayers and waste removers — part of the so-called WASH (water, sanitation and hygiene) team — who continuously disinfect the site and remove contaminated material. Still, the sight was a little jarring: The woman was putting the food into plastic foam plates just a few steps from the dressing rooms for staff members coming out of the decontamination areas, the pharmacy, and past a refrigerator with a sign marked, “Ebola blood tests. NO FOOD.”