In the DRC, a battle to survive ebola spreads deeper into a family
16 October 2007
On the day Ibrahim got on the back of his brother's bike, he had already lost his first wife and the child she was carrying, and his 19-month-old son. Stricken with fever, headaches, vomiting and abdominal pains, he clung to the bike that would take him to the isolation unit set up by MSF. His village, Kalombayi, is very isolated from the rest of the Kampungu area, the epicentre of the Ebola epidemic. Only a narrow track, impassable by car, links his village with the main road, a north-south axis. This track, ironically called "route nationale nÃ?° 20", links the towns of Mweka in the north and Luebo in the south, and passes through Kampungu, where MSF has set up its isolation unit to receive people who have contracted Ebola. Sitting on the back of the bike, Ibrahim knows about the isolation centre, and he knows that his symptoms match those of the Ebola virus. The MSF ambulance team has heard about the situation and set off to meet him. Ibrahim is put in the back of the pick-up to travel the remaining distance to the isolation unit, on what could be his last journey before death. When he gets to Kampungu, the fully equipped isolation team is waiting for him. Dressed in their complete protective clothing, gloves, masks, hoods and boots, they receive the patient and put him in a room for suspected cases. His whole face is a picture of fear, anguish and fatigue. The man is extremely weak. He has diarrhoea. The team first sets about re-hydrating and feeding him. They quickly take a blood sample which will be sent to the team the CDC (Centre for Diseases Control), whose laboratory at Luebo can give results in 24 hours. While waiting, Ibrahim's state of health varies depending on the time of day. In the mornings, you sometimes see him outdoors, sitting in his wicker chair behind the isolation building. He is quiet and calm when the medical team, in their "cosmonaut" clothes, come to look after him, give him something to drink and to eat, and to talk to him. But by the end of the afternoon, he has gone inside. Indoors, he is lying on his bed, seized with severe abdominal pains, incapable of ingesting anything without vomiting immediately. His diarrhoea, however, is not bloody, as is often the case with Ebola sufferers. Outside, his brother waits patiently. Members of the MSF team explain to him how the medical team is taking care of his brother, and suggest he come into the isolation unit to visit him. Briefed on the protection rules he must follow, he is dressed in a lighter protection suit than those worn by the medical and logistical teams, as he will not be allowed to touch the patient. He and his brother exchange few words but his presence helps the patient cope with his sense of isolation. He must be given every chance he can get to help his body fight the disease, since there is no specific vaccine or treatment for the Ebola virus. Survival is dependent on the strength and will of each patient. No vaccine nor specific treatment exists to combat this disease. All the medical teams can do is to rehydrate the patient, with water or by perfusion, help and encourage him to eat as much as possible, and give him some high protein food. The patient also receives anti-malaria drugs and wide spectrum antibiotics. Two days after his arrival in Kampungu comes the result of the blood test. Positive. Ibrahim is told. His condition is serious, but stable. In the mornings, you still see him outdoors, now sitting in front of the building. His loved ones, behind a one metre-high barrier, can see him, talk to him and give him food via the medical team. Now confirmed with Ebola, Ibrahim is moved into the building next door, the one for confirmed cases. The days pass... It has been ten days since he got on the bike back in Kalombayi. In the meantime, the MSF logistical team have turned the track into a road. A mammoth task, carried out with the help of the locals, sometimes needing 80 pairs of hands to cut down and clear the trees, build bridges and sweep away fields of bamboo. The effort is necessary to reach this isolated area, where the Ebola virus continues to circulate. The teams must reach the peoople who had contact with someone contagious with Ebola to control the possibility of other infections and its further spread. Ibrahim's brother, now accompanied by Ibrahim's second wife who has come from Kalombayi as well, see Ibrahim every day now. And they are also examined every day by the MSF team as they were both in contact with the patient when he developed the symptoms and became very contagious, via all his bodily fluids (sweat, tears, vomit, saliva). The last time I saw Ibrahim, sitting in the wicker chair, he asked me to read his cards with one of the nurses. I took some photos and printed one of them for him. "He is very happy", the Kasai team assure me. For about a week, Ibrahim has been convalescing. His temperature has fallen, his vomiting and diarrhoea have stopped, and the Ebola tests are now negative. He has left the isolation unit and will survive. He is lucky. Some patients develop enough antibodies to combat the virus, but they are rare cases. In this area, when the Zaire type of Ebola virus breaks out, between 70% and 90% of people infected die. For the epidemiologists, there is still the task of investigating Ibrahim's contact history: the death of his first wife, the intra-uterine death of the baby, the death of the 19 month-old child, as well as other possible contacts with Ebola. Back in the village of Kalombayi, the population is also made aware of the disease, of the precautions to take, and the dangers. From now on it will also be necessary to explain that Ibrahim has been saved, and that he can be welcomed back in the community without fear. Nevertheless, an MSF medical team is still tracing Ibrahim's contacts. Recently, what everybody feared happened: another of his sons has bacome sick. He had to be taken to Kampungu because of suspicious symptoms. Now, Ibrahim has to wear a protection suit to attend his bedridden child. He can only hope that his son will be able to follow him on the road to recovery.