Not just the actual disease, but everything ebola has affected. The fear it has instilled in entire countries. The even further breakdown in an already fragile healthcare system. Villages lost by death. Families losing mothers and fathers, aunts and uncles, grandparents, children. Whole families lost. An entire village on one side of the street, gone. Families needing to be quarantined after a loved one dies—who will feed them to keep them quarantined? Who will meet their needs to keep them safe and in turn, everyone else around them? Stories of houses burned down out of fear. People getting forced out of villages from fear of them having the virus and no one being called to help. Found barely alive but no food or water for days. Stories of families hiding bodies or sick loved ones from fear of what an ETU does to whoever enters. A country that has a ‘Liberian hand shake’ and touches out of affection now has billboards saying, “No Touching”. It was, and is, a sign of respect and sharing condolences when someone passes to touch the body of the dead, to braid their hair, to be with them, and now it is known that a person who has died of ebola is even more virulent after death. Death breeds death if the body is touched.
When a patient is brought into an ETU, we test and treat for ebola. All patients get malaria medications when they arrive, vitamins and a broad spectrum antibiotic to help other possible infections. That is it. That is all. There are other medications we can give for nausea, pain and IV fluids if needed, but the treatment we give here is ebola focused. We can’t do testing for electrolytes or lassa fever, another hemmoragic disease. In the three weeks I have been here, we have had three pregnant women come in. Anyone with unexplained bleeding is sent to an ETU. Pregnant women come in with vaginal bleeding. A full term mother was here my first week. She had not felt the baby move for at least a day. There is nothing that can be done until blood tests come back, and the blood test needs to be negative three days after symptoms start, meaning a patient could be on the suspect side of the unit for three days until their lab results come back. During this time diagnostic tests can not be done. Tests can not be run for other things. Ultrasounds can not be done to check the status of a baby. People are sick and dying while waiting for test results. This is awful to see. A mother with a baby inside that she knows is not moving and there is nothing that can be done until the negative ebola test comes back. Hospitals outside of the ETU will not take someone with ‘unexplained bleeding’ until they have a negative test.
It has been around for awhile, ebola. Small outbreaks here and there. This is obviously the largest one yet and what is so crazy is that still very little is known about what treatment is best. Should you force IV fluids? Should you not? Should you give this medication or that? One ETU does it this way and another does it like this. Whose mortality rates are better and is it because of the treatments given or is it because more patients at one ETU have patients who have to walk two days to get there while another has patients who can be admitted the same day? What is best? What is right? Are you doing more harm or less by doing this or that? What antibiotic is best to give? What type of IV fluids? Question after question and it seems like there is never a good answer.