Diary from the DRC ebola outbreak

Zoe Young, a water and sanitation specialist with MSF, shares her diary from the Democratic Republic of Congo where she is dealing with an outbreak of the deadly Ebola virus.

Since the first MSF team arrived in Kampungu at the beginning of September, 25 severe cases suspected to be Ebola haemorrhagic fever have been hospitalised at Kampungu's health centre. Of these, eight patients have already died.

We have head covers, enormous white overalls with elasticated wrists and ankles so that they puff out making us look like little marshmallows.

Two pairs of latex gloves, ski-type goggles, a duck beak mask and an apron. The overall effect on the outside is rather like a spacesuit.
On the inside it's like a sauna. Pouring with sweat takes on a new meaning.
The tiniest activity, like moving a patient or carrying a bed, causes sweat to cascade down my face.
Of course, I can't wipe it off as I am all covered and have no access to my skin until I disinfect and leave the high-risk part of the centre.

Wednesday

Things were better today.  No burials. The isolation compound is coming along very well: Martin, our logistician, has been doing the most amazing job and there are washing slabs, changing rooms and latrines popping up like mushrooms.

Tomorrow we will be ready to move into our new and expanded quarters. I spent the morning employing more people to help us.  We now have guards who will stand by the front gate ensuring that everyone washes their hands when they go out and spraying their feet with chlorine. We also have some disinfectors who stand by the gate from the high risk area to the low risk area and disinfect people coming out.  

The new cleaning lady was amazingly calm and collected when I took her in to the ward to wash the floor.  She wasn't worried at all and didn't make any mistakes.  

Bit by bit the whole thing is looking more professional and becoming easier to manage.  Tomorrow I will be increasing the number of water points in the high risk area to make them more accessible.  Martin has been making stands for the water containers and they are now ready.  

We've got two patients who were looking pretty awful this evening when we left so I have my fingers crossed for them.  

Tuesday

Today didn't go quite as planned.  This morning a nurse from the outreach team came to tell us about a patient in a neighbouring village.  She had been preparing to bring the girl to the isolation centre, but when she went for a last check on her she had just died.  

I collected up the team and all the equipment that we might need.  Extra jerry cans of water, chlorine powder, lots of sets of protective clothing, bin bags, and a body bag.

When we got to the village we found the house and the dead girl's uncle.  He was quite calm and told us where her body was and what had happened.  

Apparently both her parents had died recently from the disease and she had been staying with him for the past few days.  Her body was lying behind the house on a low bed, covered with some plastic sheeting.  Some family members went to dig a grave while we disinfected the house.  We sprayed everything in the house with a chlorine solution and disinfected the latrine because a patient's faeces are very contaminated.  

Then I dressed in protective clothing along with one other member of the team and we went to put the body in the body bag.  The problem was that she was very stiff and was lying on her side.  I couldn't get her straightened out at all.  I was worried about this not being respectful but was assured that it didn't matter.  So we wrapped her up in the plastic and got her into the body bag.  

The burial pit was just by the side of the road on the way out of the village, not in a cemetery. It hadn't been dug deep enough so two of the team had to make it deeper.  Then we shovelled the earth back in using our hands.  By the time we finished it was dark.  Next time I am going to take a shovel.  

"When I got back into the MSF office last week after a holiday everyone was talking about a mystery disease in the Congo.

Apparently there had been lots of deaths, but it wasn't at all clear what it was.

There were different theories in the office, and we had to wait for the results of tests on samples that were sent to three different labs for analysis.

In the meantime, we sent our DRC emergency team to Kampungu, one of the affected areas, to set up the temporary isolation ward.

The first result that came through was a positive for Shigella. Then, late last Monday, the results came through from the Centre for Disease Control in Atlanta: some of the samples had tested positive for Ebola.

Everything changed straight away.

Exciting landing

MSF's Emergency Unit coordinated a meeting with our water and sanitation experts, epidemiologists, public health specialists and HR people to decide what equipment and staff to send.

I boarded a plane to Kinshasa, the capital of DRC, two days later.

The seven of us travelled from Kinshasa to Kampungu on a 10-seater plane with a pilot who had a huge handlebar moustache.

The scenery was lovely: mile after mile of jungly forest which looked like tightly packed broccoli with the odd dead white tree reaching up above the canopy.

I didn't see the airstrip until the pilot lined the plane up: it just looked like a footpath on a bumpy field. It was quite an exciting landing.

As we got out of the plane crowds of children and interested adults pushed forward to see us and then followed us shouting, "Comment ca va? Comment tu t'appelles? Comment ca va?"... on and on.

The din was amazing, piercing.

'My job'

Then an hour's drive to Kampungu on roads that forced the car to tip right over on its side.

So, my job. Ebola is transmitted by contact with bodily fluids so patients have to be treated very carefully and kept very separate from the community.

We have set up a small isolation unit which is made up of a low risk part where we can change into protective clothing and then a high risk part which is where the patients are.

The building was part of the health centre before and has been surrounded by a low fence made of orange netting to keep people out (and to stop patients wandering off accidentally).

Four of us work in the isolation unit: a logistics expert who is responsible for building any new structures, beds, tables, fencing etc that we need; a nurse; a doctor and me, responsible for water and sanitation.

Marshmallows

We are slowly improving the wards for the patients, but everything takes ages since we have to dress up in full protective clothing before we can go in.

We have head covers, enormous white overalls with elasticated wrists and ankles so that they puff out making us look like little marshmallows.

Two pairs of latex gloves, ski-type goggles, a duck beak mask and an apron. The overall effect on the outside is rather like a spacesuit.

On the inside it's like a sauna. Pouring with sweat takes on a new meaning.

The tiniest activity, like moving a patient or carrying a bed, causes sweat to cascade down my face.

Of course, I can't wipe it off as I am all covered and have no access to my skin until I disinfect and leave the high-risk part of the centre.

Brave and determined

We have some nursing staff that have been trained to work in the high-risk area and some Red Cross volunteers who disinfect and help move patients around.

We are slowly increasing the numbers of staff but it takes time because we first have to find people who want to work with us and then we have to train them very carefully to make sure that they are safe inside the high-risk area and don't make mistakes that would put others in danger.

One of the patients died today.

He had been a nurse in the health centre. He was an inpatient for a few days and was very brave and determined to get better. Every morning he sat on a wicker chair on the balcony to see what was happening and once or twice did a runner to go home.

That was OK.

When he came back we went back to disinfect the hut that he had been in.

Wailing and crying

Anyway, today he died and so I went into his ward with two of the disinfectors to tidy him up and put him in a body bag.

This is important because it is possible to get infected even when people have died.

I was trying out a new kind of very waterproof body bag so I had a few teething problems trying to put him in but soon it was done and I left him on a bed while we waited for a coffin to be brought (I could see it being made through the window).

I could hear his family wailing and crying: they live in a house about 200m from the centre. I could see them from the window of the ward.

When the coffin was ready we brought out the patient and the intensity of the wailing increased.

We put the body bag into the coffin and then we put it on the back of the pick-up truck, which set off for the cemetery accompanied by the burial team.

I disinfected myself rapidly and ran to catch them up at the graveyard.

Hot work

There was a big patch of cleared ground with sticks lying on it. They told me that this was where all the other recent corpses had been put.

But there were no markers.

The grave was ready but there was no path alongside so that the coffin carriers couldn't get the coffin next to the grave without falling in.

I shovelled along the grave to make it easier and then they inched forward.

The coffin started to fall so I wedged the shovel under it to hold it while they organised themselves and then they carefully lowered the coffin in.

I looked around expectantly for someone to shovel the earth back in.

Nobody around.

So, digging with our hands like badgers and with the single shovel, we backfilled the grave. Very hot work.

Some improvements to the burial procedures are definitely needed, I think, not least reassuring family members that it is perfectly safe once the person is in the coffin.

Long list

We are living in a large field that has been divided up with a campsite at one corner.

Five of us are sleeping in one big tent on inch-thick mattresses, under mosquito nets suspended from strings stretched from one side of the tent to another.

I seem to have a small hill under my bed which is not disguised by my rather thin mattress so I sleep curled around it like a snake.

Every night we have a meeting after dinner, which is how I find out what is going on outside the isolation unit.

The teams are working out where there might be more patients and visiting neighbouring health centres, talking to the communities and authorities and gathering information.

It is becoming clearer where cases have come from in the past few months and they are trying to work out what is going to happen next.

Some samples have also tested positive for typhoid, so we now have three epidemics at the same time.

Tomorrow I need to make changes in the wards to try and get more water in there.

I need to train a new cleaning lady and some more Red Cross volunteers.

I need to disinfect the deceased person's house.

I might try cementing up some holes in the ward floors to make cleaning better.

Hmmmm - long list!