San Juan de Dios

In September, 2014, four months into the Ebola crisis here in Sierra Leone, Dr. Manuel Garcia Viejo, a Spanish priest and physician at San Juan de Dios hospital in Lunsar said his morning prayers with his staff in the small concrete church on the hospital grounds, took a cup of tea and assumed his customary role seeing patients in the busy outpatient department.  The missionary hospital was started in the early 1960's as a midwifery ward  by a Spanish nun who died from burn wounds suffered after an accidental gas stove immolation.  The Spanish Catholic priests who came to Lunsar for her funeral decided to expand the operation into a full hospital, which opened in 1967.  It continued to offer more and more medical services including an operating theatre, a 100 bed inpatient hospital, a lab, x-rays, and a full maternity ward.

Dr. Garcia Viejo started working here in 2002.  The hospital built a strong reputation throughout Sierra Leone and beyond.  People would travel from Freetown and from as far away as Guinea and Liberia to receive their care here.  On this day in September, 2014 several patients who came to be evaluated had high fevers, headaches, and joint pains.  He saw them all, taking some personally into the hospital to minister to them as they unexpectedly deteriorated rapidly.  They were all young, healthy, and followed a similar, sinister path towards death.  One of the staff reportedly cautioned Dr. Garcia Viejo about the possibility that these patients could have the deadly filovirus, Ebola. "I am an old man and if I contract Ebola and die, then it is the will of God."  Within several weeks Dr. Garcia Viejo and 8 of his nursing staff died of Ebola.  The missionary hospital that attracted patients from Liberia, Guinea, and all over Sierra Leone was in essence attracting Ebola sufferers from the most affected locations on the planet.  And it wasn't prepared in the least to protect its patients or its own healthcare workers.

San Juan de Dios was shut down by the local government when word got out that staff and their families were dying en masse.  The village of Lunsar, who trusted this medical institution for over 45 years, was thrown into a complete panic.  If their hospital couldn't stop Ebola, then surely they themselves couldn't stop Ebola.  The hospital gate has been locked since September, 2014.  Until this past week when it slowly and deliberately opened its doors in the outpatient department.  My organization, IMC, was asked to help prepare for this re-opening by building a labyrinth of partitions and installing a chlorinated water system to effectively triage possible Ebola cases.  If they screen negative then they can see the Nigerian doctors who staff the hospital now until the Spaniards return. If they screen positive then they are sent to our treatment center for testing and care.  I went there today for the first time to help make sure everyone was following infection control protocols and help with the triage process.

Hawanatu and Aminata sat in a small triage room with a plastic window through which patients were screened using a series of questions to assess their risk of having come into contact with, or had symptoms of,  Ebola.  One after another, patients came to the hard plastic window complaining of vaginal bleeding, complaining of cough, complaining of neck pain.  But not one today screened positive as a suspected Ebola case.  On the concrete walls were colorful murals depicting African life.  A mother nursing her baby while she cooked a pot of greens over an open flame.  A boy in flip flops carrying his books to a one room schoolhouse, the red dirt carpet in front at the foot of a giant mango tree.  A photocopied picture of the departed Spanish priest was taped up just underneath the right bottom corner of an African version of the last supper and included the handwritten letters "RIP Brother Manuel."  I talked to Abdulai, a recent physician's assistant graduate, about the African Nations Cup games played last night.  He made flirtatious comments to Hawanatu between patients and she attempted, unsuccessfully, not to smile. Hope, and life, were now returning to San Juan de Dios.

There is a definite transition happening here now.  Institutions and establishments are starting to discuss when they will open their doors and unshutter their windows again.  Schools have not announced when they may follow suit but people are starting to think about stepping back into their lives again.  The UN choppers overhead are less frequent.  The markets have more colorful produce.  But we are still seeing new cases everyday in our district.   Smoldering coals can re-ignite.  This is the biggest public health fight Sierra Leone has ever faced and complacency and crisis fatigue are not an option.

As I finished work at San Judas de Dios hospital today, I could feel the absence of Dr. Garcia Viejo on the grounds.  The concrete fountain with a statue of a monk tending to children looked like it had been dry for years.  The grass behind the admissions foyer grew up onto the wrought iron fence.  The operating theatre table slumped like a dusty leatherette cross alone in the windowless daytime dark.  The autoclave door was ajar in the recovery room.  The doors were all closed in the hospital and the silence interrupted only by overhead birds, perched on the corrugated tin roof.  Beyond the birds I saw the solar panels tilted toward the afternoon sun, patiently waiting to be of service. A few vehicles unloaded medical supplies.  A nun behind a desk smiled as a little girl peeked into her office from between her mother's skirted legs.  Men gathered around a transistor radio placed on a tree stump to listen to a soccer match.  The smell of roasting plantains wafted through the iron gate. A resurrection was underway.