Intensive care: A day in the life of Swati Palekar, nurse at an Ebola ward

Swati Palekar, a nurse at a Mumbai civic hospital, took care of the first suspected Ebola patient in Maharashtra.

Written by Tabassum Barnagarwala | Updated: September 7, 2014 12:14:13 am
“Someone has to handle these patients. If not us, then who,” asks Palekar. (Source: Vasant Prabhu) “Someone has to handle these patients. If not us, then who,” asks Palekar. (Source: Vasant Prabhu)

On August 26, the usually bustling 10-bed paediatric ward at Mumbai’s civic-run Hindu Hriday Samrat Balasaheb Thackeray hospital turned grim. Until the previous day, the cries of infants rang through the ward, but now, as an isolation ward for Ebola cases, it was eerily quiet.

The entire 10th floor was closed to the public, with 20 private rooms disinfected to house confirmed Ebola cases. The staff, a few unsure about the fuss over “some new virus”, waited to receive 112 Indian nationals returning from Liberia that day. Swati Palekar, a 24-year-old nurse, seemed relatively confident. On August 25, the previous day, she had single-handedly monitored Maharashtra’s first suspected Ebola patient in the hospital’s isolation ward, a feat she doesn’t tire of narrating.

Barely five feet, in a pink salwar-kameez and a white coat, Palekar says she panicked the day she was told to handle a suspected Ebola case — a 32-year-old Indian who had arrived from Nigeria. After all, she had only joined work three days earlier, on August 22.

Her day had started at 6 am, and like always, she took a quick shower and set about making lunch and dinner in the one-room flat she shares with her uncle, a bus conductor, in a chawl in Mulund.

“I had read about the suspected Ebola case in the morning paper,” says Palekar. Throwing a guilty look at her medical officer (MO), she adds, “Till then, I only knew that Ebola had 90 per cent fatality and it spread through physical touch. I knew nothing about treatment or patient management.”

That day, she was on a 2-9 pm shift. At 1.45 pm, when she signed the attendance register, her matron told her, “Aapko Ebola wala mareez ka dhyan rakhna hai (You are in charge of the Ebola patient).”

While over 50 nurses in the hospital had earlier been trained in ‘Ebola protocol’, the newly-recruited Palekar knew nothing about it. For the next half an hour, a sister-in-charge gave her the demo and instructions: Make sure you wear your gloves and remove them only in the end, wear your personal protective equipment (PPE) the right way to guard against infection, do not touch the patient unless necessary, disinfect the PPE in hydrochloride solution after removing it.

The peon who had to mop the patient’s room was wearing his PPE and Palekar watched him closely. She followed his cue and wore the suit absolutely as he had done. Clad in a white impermeable gown, black plastic boots, enormous goggles, thin face mask and glove, Palekar left the matron’s office on the seventh floor to the isolation ward on the eighth floor with her insides churning. Then she took the 30-second ride up the elevator to the tenth floor.

“The moment I saw the ward locked from outside with two guards manning it, I knew this disease was more serious than I had thought,” she says. She remembers seeing the patient’s friend standing in the empty corridor. She asked the guard, “Why is the door locked?”, to which he replied, “Nobody is allowed inside without permission.”

As she entered, she realised that the usually well-ventilated ward had its windows shut. Twelve cubicles had been created for 12 patients. Her patient waited for her in Room No. 1. Adjusting her face mask, she ran through the instructions in her head: Do not touch him, check his temperature and pulse rate, give him paracetamol, keep his cubicle clean.

The patient was unlike what she had imagined. “I thought he would have boils or rashes on his body, or some internal or external bleeding. The doctors had told me he had red eyes and high temperature. But he just looked normal,” says Palekar.

She initiated small talk with him, asking him three questions: “How are you?”, “Where are you from?” and “Do you have a high temperature?” He assured her he was okay and that he worked in a Nigerian company but decided to return in the face of the growing Ebola fear. He also told her his temperature was lower compared to the previous night.

With health workers refrained from touching him, the man put a disposable thermometer in his mouth himself — it showed 100.4 degrees Fahrenheit.

But to check the patient’s pulse rate, Palekar had to touch his wrist, and she admits she did it with much trepidation. Such proximity to a suspected Ebola patient — the thought sent a shudder down her spine. But she collected herself quickly as the patient repeatedly asked: “When will the blood reports come? When will I be allowed to go home?” Palekar assured him, “It will come soon. Don’t worry”.

On a normal day, she takes care of several patients in the wards assigned to her. So, sometimes she looks after newborns in the paediatric ward, on other occasions, she monitors trauma cases.

But on August 25, she was told that her only job for the day was looking after the suspected Ebola patient. She checked his pulse rate and temperature at regular intervals, and updated visiting teams of doctors about his state. She also ensured the cubicle was clean at all times, calling peons to mop the floor.

At dusk, she asked a peon to get a plate of dal-chawal. While the patient ate, Palekar stood at the far end of his cubicle watching over him, trying to know more about him. “I was on the flight where I suspect there were infected passengers. I think I was exposed to Ebola there,” he told her.

After dinner, she placed a paracetamol on his side table and inched back. “It didn’t feel right, treating him as if he was untouchable. But our instructions were clear,” she says. The patient popped the medicine.

At 9 pm, just before her duty got over and she left for home, Palekar entered the patient’s cubicle for one last check-up. “Kaisa tha khana? Achhe se khaya?”, she asked. He, “extremely politely”, assured her he was feeling better.

“The fever was almost gone. And by night, both of us felt he just had some viral infection and there was no need to worry about Ebola,” says Palekar.

Off duty now, she followed the instructions again: Slowly remove your suit inside out, put it in hydrochloride solution, remove the gloves in the end.

The next day, she was told that the patient had tested negative for Ebola at the National Institute of Virology, Pune, and had been discharged.

That’s when she informed her parents, who live six hours away in Ratnagiri, about the entire episode.

“They had read about Ebola in the papers and asked me to stay away if anyone gets admitted,” she says.

“But someone has to handle these patients. If not us, then who?”

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