On the Ebola frontline

What was it like when you entered the treatment centre in Foya for the first time?

My assignment was for six weeks, including travel time. I spent another three weeks in quarantine in Geneva, Switzerland, to rule out the possibility of having been infected. Foya, where I worked, is a small town close to the Guinea and Sierra Leone borders. It was one of the hotspots for Ebola in Liberia, other than Monrovia. Although we had a 40-bed capacity in our case management centre, we were treating up to 120 patients at a time.

We worked in three shifts. During each shift there were three doctors, 18-20 nursing staff, 20-25 hygiene staff, 10-12 laundry staff, guards, teams for outreach and psychosocial areas, logistics staff and administrative support. The centre was made of small hutments, plastic-sheeted from inside to prevent infection. Everything had to be sprayed with 0.5 per cent chlorine at least twice a day. We washed our hands 50 times each day and had our shoes sprayed every time we entered or exited. Even cars coming to or leaving the centre would have their tyres sprayed with chlorine.

While wearing layers of protective gear, did you ever question your decision to volunteer?

We wore two pairs of gloves, double masks, tychem plastic suits, a waterproof apron, scrub suits, gumboots, a hood and a pair of goggles. Not a micrometre of our skin was left exposed. At times, we would be completely blind as the goggles would fog up.

But it was the personal protection equipment (PPE) that gave me the courage to carry a terminally-ill child to meet his father one last time.

I could not do much for him in his fight against Ebola. I felt frustrated and helpless at how the Ebola virus dictates who lives and who dies.

We worked in buddy system. One person would always look out for the other, right from putting on the PPE to undressing and exiting the high-risk zone. It took us almost 20 minutes to put the gear on and by then we would be sweating because of the humidity. Within two hours, we would be dehydrated as we were losing at least a litre in sweat. Inside the safety gear, even the simple task of writing case notes becomes time consuming. Undressing when tired was difficult and we had to be careful to follow the right sequence to avoid contamination. The sprayers would spell out each action and we blindly followed their commands.

How tough was it to handle patients, give them a diagnosis? What was the impact on the psyche of the victims and their families?

In the high-risk zone — which houses patients, people awaiting lab results and the convalescent patients — prioritising a patient was a dilemma. Not all cases are clear cut in the symptom manifestations; some mimic other tropical diseases. Moreover, three or more specific symptoms like diarrhoea, vomiting, headache, body pain and stomach pain, have to be carefully weighed. The lab tests were conducted only when we admitted the patients. We could not admit a patient who simply had the possibility of having contracted the disease as we would be putting him in a high-risk environment with other patients. But if he was in an early stage, we could not let him leave for the fear of infecting others.

The six weeks I spent there felt too long because of the constant need to stay vigilant. It was physically and mentally draining. Each volunteer had a few sleepless nights wondering if the headache they had was simply because of dehydration, or whether it was something more. That is how Ebola impacts the psyche of people dealing with it.

Gomathinayagam and her team

Unlike other epidemics or disasters or calamities, what makes Ebola so scary?

Ebola is a disease that strips humans of dignity and demoralises the soul. As it spreads easily among the unprotected or poorly protected, it creates fear and panic. There are several misconceptions about the disease globally, even among health care providers, and this is the real reason for the poor response.

Beyond conquering the fear of getting infected, did the decision to volunteer require finding a balance between your emotions?

Compassion and empathy are the driving force behind any humanitarian aid worker. Most of us are so attuned to the situation that we don’t even realise the stress we are undergoing until we leave the project. Of course, we do have our own psychosocial support unit to monitor stress levels. If it begins to affect our work, we leave the project.

What were the major differences compared to your other emergency assignments in the past?

I became an MSF volunteer in 2010 and since then I have volunteered for seven missions. When the organisation asked me if I was willing to volunteer as a medical doctor to tackle Ebola in August, I readily agreed.

Though we had nicer accommodation compared to other emergency projects in the past, it was was a “no touch project”, meaning we didn’t even shake hands with our colleagues. I was ready to take a break after six weeks when I realised that I might become prone to making a mistake. I heaved a sigh of relief when I reached Geneva for the 21-day monitoring period. By then, it had become a habit to keep my distance from people.

Thousands more will be needed to fight Ebola and the mission is expected to go well into 2015. What is the situation now? What is needed?

The situation does not require a panicked response, but a well-planned strategy. Since 1991, the number of those infected never went beyond 500 in any Ebola epidemic. During the current outbreak, from March to October, the number of cases went above 14,000. Such an epidemic requires a synchronised and swift response from world health bodies, humanitarian organisations and governments concerned.

The sooner we get our act together, the more control we will have over the situation. Community and social support for the recovered and orphaned, safe burials to contain the infection, contact tracing, psychosocial support activities and reinforcement of collapsed health structures to treat other deadly diseases such as malaria, typhoid, maternal complications and childhood vaccinations have been not looked into so far. Moreover, the different organisations on the ground need to share information and their experiences. More scientific studies are needed to fill the lacuna about the disease and future prospects of drugs and vaccines.

What was the most cherished moment?

A child who had survived kissed my cheeks to show her gratitude. Also, the moment when a recovering patient asked me where I’d been in the morning. He recognised my voice despite the fact that I was wearing my PPE, and it was heartening.