Undiagnosis

We are accustomed to making decisions based on a constellation of data points.  We connect the dots, essentially, to give us the complete picture.  In developed countries these data are are increasingly refined.  In medicine, we have complex imaging to peer inside the body, thousands of blood tests to tell us what travels in the body, all the way from genetic defects to sinister pathogens.  Our investigations more and more magnify the microscopic world.  So much, at times, that we no longer listen to or touch the patient.  Technology in medicine is exploding.  This is not the case in the majority of the world.  Nowhere is this more evident than in our Ebola treatment center.  We have vital signs, a brief history through an interpreter that speaks Temne, and an awkward exam performed by double-gloved hands ,through fogged up goggles as the time we can withstand the heat and sweating slips by.  Fortunately, Ebola follows a fairly characteristic mortal arc.  High fevers with headache, lassitude, and body aches.  Followed by diarrhea, vomiting, lack of appetite and dehydration.  And finally shock, confusion, hiccups (thought to be irritation of the diaphragm or possibly neurologic), respiratory distress, occasionally bleeding, and then death.  As the epidemic has matured, we are seeing fewer and fewer confirmed cases of Ebola in the past two weeks but an increase in the number of patients being referred with similar symptoms as Ebola.  We triage them according to a pretty subjective protocol and they are often brought in out of an abundance of caution.

If we can identify all new cases and isolate them with us here in the tents, then we can break the chain of transmission.  But often they have other conditions.  Malaria, TB, HIV, etc.  The difficulty lies in not being able to run any other tests here.  They are often discharged with a letter stating they are Ebola free.  As far as what they have, they walk out undiagnosed to seek care elsewhere in a country with no resources for those who cannot pay for testing to determine what it is that is wrong with them.  Factor in the complete lack of an economic base to provide jobs, very few diagnostic tests even for those who can afford them, absence of immunization campaigns, and corruption --and you have the reason for the limited number of years a young Sierra Leonean can expect to live.

How would you live if you were a 25 yr old man who could expect to live only another 20 years??  You would likely live in the moment, and only in the moment.  (Not in the moment like we strive to live in the moment when we are tempted by the endless combination of possibilities afforded to us in the future.) You may not make decisions that would affect the landscape of things in 30, 40, or 50 years down the road.  That is what happens here. People live for the day.  Every new morning is a triumph, more singular than part of an optimistic procession of time.

The goats, like most people here apart from Ebola, died undiagnosed.  There wasn't a veterinarian.  There were no tests.  There were no drugs.  Most people in the village thought that the goats were poisoned by jealous neighbors or were the victims of a "juju" or form of African witchcraft cast upon them.  We are uncomfortable and restless with whatever we cannot diagnose.  Because we have grown accustomed to answers.  Answers which have generated more questions.  Which have led to more answers, which have led to more questions.....  This is suspended here.  Not because you give up or stop asking.  The pursuit is subsumed into a reluctant acceptance of things.  Temporarily.  Like the chunky gulp of cough syrup you took as a child after over-thinking how bad it was going to taste.
It was better not because it helped the cough, but because it was simply done

We grow superstitious here.  I, like a baseball player at the plate as he steps into the box-adjusting his batting gloves, digging his feet into the dirt, pushing his helmet down tighter-, have a ritual here when getting into the PPE.  I do everything exactly the same every time.  And there are several beds in our confirmed ward, C1, C2, and C18 that seem to have held a disproportionate number of bodies that have died, eyes wide open.  My heart sinks when I see new names on the board in those beds.  I quietly lobby to move them to other beds.  Superstition is sometimes all you got.  Vespers, like the treatment center's stadium-esque white lights that corrupt the African night sky, beam up in the distance.  A holy incandescence.  Diagnosed or undiagnosed, we still walk together in the light.  Prayers, after all, are only prayers when written in the first person. Right?