World Wide Webs

The internet at our housing site has been down for two days now.  I type this post from the medical tent that is smothered by the humid breath of the afternoon heat.  It seems to be a much bigger blow for most of the ex-patriates here than the generators being on the fritz.  We have had an influx of new staff in the last week with nurses arriving from Canada and the US, and a retired infectious diseases doctor who is now in charge of training all incoming staff in infection control.  There is a transient hierarchy here with a constant revolving door of medical staff with a vast, heterogenous global cache of experience.  Fortunately, there are a number of folks who sign on for extended 3,6, or 9 month contracts in addition to the country directors who are on yearly contracts.  Most of the newly arrived, myself included, have questions and suggestions surrounding existing protocols which are handled gently.  It is hard to change protocols that are set up by the WHO and CDC and are couched in the local limitations.  Our mission is very concrete with impervious boundaries- we are here to treat Ebola and only Ebola.

Ibrahim is a 10 year old boy who was brought from an outlying village after he collapsed when leaving the pit latrine.  He was brought in by an Ebola ambulance to our treatment center and was unconscious.  His body lay limp on the gurney, awash in a sweat that beaded on his forehead like mercury and then coalesced to pool at the small cave formed where his bird-like clavicles merged at the base of his neck.  He fulfilled the definition of a suspect case of Ebola based on family reported symptoms and a fever.  But we didn't think this was consistent with Ebola, but rather cerebral malaria, literally malaria that crosses into the brain.  It can carry a high mortality rate if not treated rapidly.  We started an IV and administered IV artesunate and fluids to rehydrate him.  Pulling down his eyelids, it was clear he had malaria for some time and was anemic, as the ordinarily beefy-red eyelid linings were as white as his teeth.  His chest rose and fell rapidly, exposing a rib cage that spoke of the lack of excess in his life.  He looked about the height of my 1st grader.  He had a significant chance of not making it through the night.

A former Ebola survivor was assigned to his bedside in case he had seizures and fell out of the bed.   We pumped him full of intravenous fluids and waited for the anti-malarial medication to take effect.  When we rounded on him in the morning, his eyelids opened with the slowness of a child trying to pull up a steel garage door.  But he was awake nonetheless, a good sign that it was malaria and that he was responding to treatment.  We all celebrated cautiously.  Malaria still kills more children here than Ebola, yet another fight that has been put on hold because of all the attention diverted to Ebola.  Ebola kills in many indirect, insidious ways.

The 18 year old woman who is ostensibly 28 weeks pregnant was face down on the concrete floor next to her bed when I rounded on her yesterday.  She has the increasingly distant stare I have come to fear  here and her voice trails off as if the power to supply her breath is short circuiting.  Her intricate system of nerves, blood vessels and pumps, I am afraid, is succumbing.  The viral insurgency, in wave after countless wave, has the palace surrounded and is preparing to enter without a sound, its mission totalitarian.  The boy whose bed is next to hers, Ibrahim, just today tested negative for Ebola after being in our center for 19 desolate, traumatic days.  One more negative test in 48 hours and he will make it out.  All analogies here seem to center on war jargon.  Understandable.  Enemy combattant.  Battle.  Defeat.  Surrender.  Inhumane.  Attack.  Assault.  Terror.  We retreat, first physically then emotionally, from it all in silent bursts of self-preservation.

I sweat it out on my morning runs and afternoon walks out into the restrained jungle that overtook this area during the civil war and is now groomed by hand into rice paddy fields.  As I walked yesterday on a road used by lorries transporting iron ore from the local mine, I felt a striking serenity.  A field of cassava was being prepared in crested rows of earth by women hunched over effortlessly into that familiar angle of labor in the bleached out noon sun.  The women were singing.  The coconut trees were displaying their encased treasures in neat rows, and judging by their height, were planted in the aftermath of the civil war.  At the end of the path I was given a ride by one of our IMC vehicles to meet the village Chief of Lunsar.

The village chief retains a position of social and political power in Africa.  I went to meet with him to introduce myself and thank him for giving me the opportunity to serve here, as is customary with any outside "dignitary" when entering a new chiefdom to work.  As I entered his home I was greeted by his four year old daughter who was no doubt perplexed with my appearance and loose smile.  She quickly retreated behind an entertainment center.  A stereo sat on the middle shelf with multi-colored lights inside the speakers that book-ended the shelves.  A cardboard white santa- claus hung from a sole nail in the wall above thick leather sofas.  We spoke for about 10 minutes about the current Ebola epidemic and his fear of what will happen in Sierra Leone in the future as all of this medical attention recedes.  His major wish was better training for the traditional birth attendants in his chiefdom to improve infant mortality.  His cell phone rang incessantly during our chat.  Outside a welding shop in his courtyard sparked and sizzled.  Chickens pecked at the edges of things.  The chief was gracious and laughed often, each time shaking his belly like a small earthquake.  We bumped elbows as I left, the new handshake in Sierra Leone, as his daughter peeked out from the hallway.