Threshing Ebola

A worm the size of a pencil, the color of the pencil eraser, was on the floor next to Marie's bed yesterday.  When a person has worms compounded by a high fever they naturally want to get out.  She vomited it up.  It was a type of worm called ascaris by appearance, the so-called roundworm seen in the tropics, usually in children.  We treat it with medication and when the worms die off they often are excreted in the feces.  When the burden of worms is very high, however, they can clog up in a mound in the GI tract and cause an obstruction.  This can be an emergency and require an intervention, sometimes surgical, to be fixed.  Combine this with Ebola and you have a volatile, tropical sickness.

Today when I rounded I drew blood on patients.  Men and women offered their tough, leathery arms with tendons bulging out like fleshy violin bows.  Most of the patients did not even wince when the butterfly needle punctured the skin.  One of the babies, Kadiatu ,was very dehydrated and I couldn't find a vein plump enough from which to get blood for her Ebola test.  I had to get it out of a large vein called the femoral vein which is in the groin.  The caretaker, herself an Ebola survivor who now helps by staying with the children without the need for PPE in the ward, had to hold her hands and legs as I stuck her in the groin, careful not to go through a superficial infection she had in the region.  She cried very little and, because of her dehydration, produced no tears.  Her mother had died of Ebola in our unit a few days ago.

Marie, the woman who vomited the worm, was in attendance at a recent funeral as were two other women now in our confirmed ward.  When the dead are buried here in the village, they often use a rice paste to cleanse the body in preparation for the afterlife.  An Ebola corpse is highly contagious and continues, despite a public education campaign, to be a significant vector of new infections.  

I hung a liter of IV fluids for Marie when I saw her and, because of severe abdominal pain, gave her morphine through her IV.  People here have never had any narcotics.  I watched as I pushed in the morphine as her breathing became less labored and the wrinkles on her brow relaxed.  It didn't last long, though, and she appeared uncomfortable by the time I left the tent.  She was found dead two hours later, her pain and fear shut off at last.

It is said that for every one Ebola patient we identify there are at least 2 more who contracted Ebola from that person.  I don't know how true that is.  Frankly, I don't know how true any of the numbers the government is releasing are.  If we are to believe them, then the epidemic seems to have slowed over the past two weeks.  Our organization's focus has shifted to reflect this, at least in planning.  We are opening up several "screening and referral units"(SRU's) which will function to screen all patients entering a local medical facility for Ebola before they can be seen.  If they screen positive they will be sent to our center.  If they screen negative they can be seen by a local medical team for whatever afflicts them.  This is how the medical system is gradually going to open its doors.  Safely and deliberately.

The most extraordinary people I have met here are the national staff we work alongside.  I have gotten to know many of the nurses well and am blown away by their courage, trust, and love.  A few days ago I was out walking in the village and ran into one of the nurses, Mbalu, who was threshing her rice , separating out the rice from the husk, or chaff.  She has two children back in Freetown but came to Lunsar to take one of the few, precious jobs available in the region.  Another woman was pounding away with a giant pestle to pulverize cassava in the wooden mortar.  Children ran around kicking a tin can, laughing.  Papaya trees, no taller than me, already boasted green bosoms of fruit.  The sound of flip flops fell in a muted ricochet off the pile of tin roof sheets leaning up against the mud brick house.  There were so many village scenes in one visual field, all resonating off one another, there in the fading afternoon sun, like a stage set.   I thought of my time in the Peace Corps so long ago.  I saw the birth of my children in soft, holy light and how, eyes closed, they rooted for Sandra's nipple.  I saw my parents on their first date in New Bedford, MA at a soda fountain where my motherworked.  I thought of how at peace this moment is right here, at this very place, at this very second.  We do what we can, when we can, where we can.  And when we do, the whole universe seems to be threshed from the limiting grip of its husk and we are granted passage into the inner sanctum, where the golden mystery of all mysteries was conceived.  Only to  leave again, our steps untraceable as air.

Mbalu and Me, Lunsar