Would you vol­un­teer to help fight an almost al­ways fa­tal, grue­some dis­ease in a coun­try with a weak, fail­ing health sys­tem? KATHRYN STIN­SON did – and it changed her life

Marie Claire (South Africa) - - YOUR STORY - mc

T he re­al­ity of the Ebola epi­demic is present as soon as we land in Free­town. We are ush­ered to a wash­ing sta­tion be­fore en­ter­ing the ar­rival hall and in­structed to wash our hands un­der a tap dis­pens­ing a wa­ter and chlo­rine so­lu­tion. After com­plet­ing health sta­tus ques­tion­naires, we start mak­ing our way across the Sierra Leone River es­tu­ary to the main­land via wa­ter taxi. I had vol­un­teered with Doc­tors with­out Bor­ders/ Médecins Sans Fron­tières (MSF) to work as an epi­demi­ol­o­gist, jut­ting my­self out of my com­fort zone at home. It’s be­com­ing clear that I am very far from com­fort in­deed.

We slowly make our way across Sierra Leone, tak­ing eight hours to drive the 400km from Free­town to Kailahun, where the MSF Ebola treat­ment cen­tre is sit­u­ated. We pass through rain­forests in­ter­spersed with rice pad­dies and small vil­lages. Poverty is ev­ery­where. We drive through Ken­ema, where the mar­ket place is teem­ing with peo­ple, and I won­der why the fear of in­fec­tion wasn’t keep­ing peo­ple away from cir­cle, a man lies in the road, ema­ci­ated and with his face con­torted in pain. With one arm he tries to shade his eyes. Far gone, too far gone. We drive on know­ing no one will ap­proach him – he will most likely die alone.

Kailahun, home to 30 000 peo­ple, looks like many of the other towns we passed. Dust roads are lined with trad­ing stores and ev­ery so of­ten ev­i­dence of the NGO pres­ence is no­tice­able as a 4X4 ve­hi­cle parks Kailahun used to be a trad­ing cen­tre alive a stand­still, with the po­lice and army do­ing bor­der pa­trols and man­ning check­points to help pre­vent the spread of Ebola.

The treat­ment cen­tre was built from noth­ing by MSF on the fringe of the town in June 2014. Con­sist­ing of sev­eral rows of white tents, com­plete with treated wa­ter, gen­er­ated elec­tric­ity and kit­ted out with ev­ery­thing needed to support an Ebola pa­tient, this is where I would be col­lect­ing data and in­ter­view­ing pa­tients. Inside, the cen­tre is care­fully or­gan­ised into high and

low-risk zones. Hand-wash­ing points, con­sist­ing of vats of chlo­ri­nated wa­ter, are strate­gi­cally placed through­out. The paths through the zones are cor­doned off with orange bar­rier fences and a care­fully planned open-wa­ter drainage sys­tem.

On en­ter­ing, we wash our hands and our shoes are sprayed with chlo­rine and wa­ter. We change into fresh scrubs and gum­boots in a room where noth­ing is to touch the ground ex­cept the soles of our shoes. Strict safety pro­to­cols are in place: wash your hands as fre­quently as pos­si­ble; don’t touch each other; touch as few ob­jects as pos­si­ble.

As an epi­demi­ol­o­gist, it is my task to draw the links be­tween the cases, to in­ves­ti­gate what may have given rise to the in­fec­tion, and to as­sist in preven­tion by in­form­ing the health pro­mo­tion team where I work to­gether closely, along with a street­wise team of lo­cal staff who are all else, brave.

Pa­tients would ar­rive after trav­el­ling for most of the day, emerg­ing from an am­bu­lance six at a time. Some were too weak to climb down and nurses in full pro­tec­tive gear would slowly and care­fully help them out. Some peo­ple don’t make it to the cen­tre at all, dy­ing en route.

I in­ter­view pa­tients at about their po­ten­tial source of in­fec­tion – had they been in touch with a sick per­son; at­tended a tra­di­tional fu­neral and cus­tom­ar­ily touched the body of the de­ceased; or had they eaten bush meat ( the dis­ease can jump from pri­mate to hu­man).

I also in­ter­view peo­ple in vil­lages, try­ing to un­der­stand the chain of in­fec­tion. Our ar­rival is of­ten met with cu­rios­ity and we need to em­pha­sise the ‘no touch’ pol­icy. Speak­ing to a com­mu­nity about the rea­sons for my pres­ence is highly sen­si­tive, and I feel a huge re­spon­si­bil­ity to es­tab­lish trust when the ques­tion, ‘ We’ve never had a white per­son visit us be­fore, so why have you come now?’ is on ev­ery­one’s lips.

de­spite the long hours and om­nipresent fear of con­ta­gion. For the health work­ers, per­sonal pro­tec­tion and safety are key – with­out healthy health work­ers, th­ese com­mu­ni­ties would have no one to help them. Con­tin­u­ous vig­i­lance re­gard­ing this leads to ob­ses­sive hand-wash­ing and we move around each other in a cu­ri­ous dance to en­sure we don’t touch. The ac­ci­den­tal brush of el­bows would lead to two peo­ple quickly jumping apart and apol­o­gis­ing.

By en­sur­ing that data reaches the na­tional and in­ter­na­tional re­port­ing frame­work to up­date the world about the epi­demic, I feel I’m mak­ing a small dif­fer­ence. En­gag­ing with pa­tients and their com­mu­ni­ties is a priv­i­lege, al­beit a harsh one: I’ll never for­get the im­age of a sick woman, whose daugh­ter had just died, be­ing gen­tly led away to spare her from see­ing her

child’s body. She was dazed and weak, wear­ing only a T-shirt and a di­a­per, I was struck by this tragic de­pic­tion of loss of life, con­trol and iden­tity that this dis­ease so cru­elly doles out. Lit­tle is known about the pathol­ogy of the virus. Death strikes sud­denly at times – all in the con­text of ex­treme poverty and an al­ready weak health sys­tem brought to its knees by Ebola.

After re­turn­ing to South Africa, I had to ob­serve a 21-day in­cu­ba­tion pe­riod, mon­i­tor­ing my health for any signs of Ebola. Ex­pe­ri­enc­ing the stigma at­tached to the virus – even from friends and col­leagues – was tough. I was asked to not go to a party in or­der to ‘pro­tect the guests’ and to ‘main­tain dis­creet so­cial dis­tanc­ing’ from my col­leagues, even though, to date, there has been no doc­u­mented re­port of an asymp­to­matic per­son in­fected with Ebola pass­ing on the virus. While we can ra­tio­nalise hu­man-to-hu­man trans­mis­sion oc­curs only fear of Ebola is to be ex­pected, given the high fa­tal­ity rate and that there is no vac­cine or cu­ra­tive treat­ment cur­rently avail­able.

I have no re­grets about vol­un­teer­ing in Sierra Leone. It gave me an op­por­tu­nity to see life and death on the front­line and as a re­sult, I ap­pre­ci­ate my own cir­cum­stances so much more. Go­ing to Sierra Leone will be with me for­ever.

Would you put your life on the line to vol­un­teer for hu­man­i­tar­ian work? Tweet us @marieclaire_sa

‘We drive on know­ing no one will ap­proach him – HE WILL DIE ALONE’

FAR RIGHT Med­i­cal teams work­ing in a re­mote vil­lage

OP­PO­SITE A burial team re­moves a highly con­ta­gious body

RIGHT Kathryn Stin­son

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