Get the hell out of town
My last day shift was calm. Most of our really sick patients have passed away and there have been few admissions in the last couple of days. We had fifty-three patients on Sunday, but that number decreased to below thirty by Thursday. This might be just a statistical blip, but I do not think so. The district surveillance officer told me that cases in all of Sierra Leone are on the decline. Yesterday, there were apparently only twenty-three new Ebola diagnoses in the entire country. Hopefully, this reflects a fading epidemic, but it is probably too early to tell. Ebola can get the hell out of town and never come back, as far as I am concerned.
Some people think that the Sierra Leone Ebola quarantine system may be hiding new cases. When someone dies from Ebola or calls the Ebola hotline with suspicious symptoms, their house is often blocked off for 21 days or more behind a 24-hour police guard. This means that no one can enter or leave, even for work or medical care. The government is supposed to provide food and water during the quarantine period but this apparently doesn’t always happen. If the quarantine house is attached to other houses or part of a row of houses, as is common in Freetown, all of the attached houses are quarantined. This may actually increase the spread of Ebola and other infectious diseases and it also makes people reluctant to call the hotline or report a death.
Tomorrow, I will sleep in a little bit, collect my passport and air ticket and work the night shift one last time. Then, I will have Saturday off to recover from my 12-hour night shift, pack and say my goodbyes before boarding the boat to the airport at 11pm for my departing flight at 5am on Sunday morning. Strange they would build an international airport on a peninsula across a long waterway from the capital city. Only a couple of intentional airlines still fly in and out of Sierra Leone. MSF uses Air Brussels and Royal Air Maroc (RAM). I am booked on RAM, which means a 5-hour stopover in the Casablanca. That may sound exotic. but in fact the Casablanca airport transit lounge is old, hot, and dirty, with most shops closed. On Saturday evening before I depart, I will meet up with a good friend from Bo who was with me at the Ebola training in Amsterdam and during my three weeks at Bo. He is a 30’ish Watsan (Water & Sanitation Officer) from Montreal. For some reason, we hit it off. We will debrief in Amsterdam on Monday, December 19th and I will head back to Vancouver on the 20th.
I am not sure what to expect when I arrive in Canada. If the re-entry restrictions for returning Ebola fighters have not changed, a British Columbia (BC) public health officer who will assess my risk of Ebola will greet me at the airport. If I have had a documented high risk exposure like a needle stick accident, I will need to say at home where I will receive a daily visit from the health department for a temperature and symptom check. If I have had no such exposure, I will be permitted to self-quarantine at home. I will take my own temperature every day and report it to the health department by phone. But, I can go about my normal activities except for seeing patients. I can go out to movies or the pool or to my UBC office as long as I do not have a fever before I leave, and I take my temperature when I return. If I do not have a fever before or after such an excursion, the people that I might have contacted will not need to be traced if I do develop a fever later on. But, if the BC regulations have changed, they have probably become more restrictive. Thank God I am not returning to the USA where the restrictions are inconsistent, complicated, and based on fear and politics rather than fact and reason.
My last patient yesterday was a 24-year old woman who arrived from a quarantine house in a coma. I managed to place an intravenous cannula and I quickly gave her a bolus of 500ml of Ringers Lactate before administering intravenous doses of an antibiotic (Ceftriaxone), an anti-malarial (Artusenate), and an antipyretic (Paracetamol). She seemed to perk up a little bit by the time I went home last night and the nurses told me that they sat her up and fed her today! I just checked in on her (from 5 metres away) and she seemed to be sleeping. She is Ebola and malaria negative so I am not sure of her diagnosis, but perhaps hers will be one life that I can be pretty sure I have saved.
I was very pleased to leave the EMC today walking between the Pangura brothers, 10 year old Peter and 12 year old Paul. They were skinny, unsteady and weak but Ebola-free. Sometimes, I forget that over half of our Ebola patients do survive. However, both of their parents succumbed to Ebola and the boys do not yet know. When someone is declared Ebola cured, all of their possessions are burned, they have a shower and they are given new clothes. As they walk from the high-risk zone through the low-risk zone to the EMC exit, this is the only time we can be sure they are not an Ebola risk to us. That means we can actually touch them. I very much enjoyed high-fiving the Bangura boys as they left. And, it suddenly occurred to me that I had not touched anyone for 7 weeks.