When he arrived in Liberia, West Africa, Pierre Trbovic began by helping to treat the sick — people who were powerless to move, much less eat or drink, young children who cried in pain. But within days, the situation began to deteriorate. There were too many sick, and far too few beds. Doctors barely had room to move among the endless rows of patients.
Then the line for the clinic reached the street. Heavy rains came, but still the line grew longer.
That’s when Trbovic, a Belgian anthropologist working with Doctors Without Borders to contain Ebola, volunteered for a terrible task: turning sick people away at the door.
“This wasn’t a job that we planned for anyone to do, but somebody had to do it,” he wrote in a post on the Doctors Without Borders website.
Caitlin Ryan / MSF
Pierre Trbovic, a Belgian anthropologist who arrived in Liberia with Doctors Without Borders in August.
The first person Trbovic turned away was a father who’d brought his sick daughter to the clinic. “He was an educated man, and he pleaded with me to take his teenage daughter, saying that while he knew we couldn’t save her life, at least we could save the rest of his family from her,” Trbovic wrote.
Why Exceeding Capacity Can Be Dangerous
If Trbovic hadn’t said no, the situation at the clinic would have deteriorated quickly, making it impossible for them to help anyone. Ebola is a terrible, messy virus — that’s likely why, despite doing their best to follow all the safety protocols, two American nurses who treated the first US Ebola patient became infected. In order to keep everyone safe, workers must adhere to strict, exhaustive procedures that apply to everything from getting dressed to feeding or cleaning up after patients.
It takes doctors in Liberia 15 minutes just to put on their protective gear — which includes gloves, protective goggles, headgear, rubber boots and surgical trousers. Because Ebola is spread through blood, saliva, feces, and vomit, and patients are often leaking these fluids, doctors have to be especially careful about getting accidentally sprayed or splashed. When someone is at the height of the illness (typically after five or more days), one-fifth of a teaspoon of that person’s blood can carry 10 billion viral Ebola particles.
An untreated HIV patient, by comparison, has just 50,000 to 100,000 particles in the same amount of blood; someone with untreated hepatitis C has between 5 million and 20 million.
The gear is its own hazard, too. In the 90-degree Liberian heat, people unaccustomed to the climate can overheat quickly. A hazmat suit, which can weigh up to 18 pounds, makes everything worse. “It can take 15 minutes to dress fully in the personal protective equipment and, once inside, you can only stay for an hour before you are exhausted and covered in sweat,” wrote Trbovic. “You can’t overstay or it starts getting dangerous.”
Without the ability to care for them inside, Trbovic and his co-workers handed out home protection kits, boxes of supplies that include gloves, gowns, and masks, so that loved ones can take care of one another with a lower chance of getting infected themselves.
For now, that’s all he can do for the people who don’t make it inside the clinic.
“We regularly had ambulances turning up with suspected Ebola patients from other health facilities, but there was nothing we could do,” wrote Trbovic. “We couldn’t send them anywhere else. Everywhere was, and still is, full.”
As international aid begins pouring in, more Ebola treatment centres — so desperately needed — will soon be built. To date, no federally approved vaccine or medicine for Ebola exists.
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