I had to turn people away from an Ebola treatment centre. It’s desperate work

http://www.theguardian.com/commentisfree/2014/sep/11/ebola-treatment-centre-liberia

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Soon after arriving in Monrovia, I realised that my colleagues were overwhelmed by the scale of the Ebola outbreak. Our treatment centre – the biggest Médecins Sans Frontières has ever run – was full, and Stefan, our field coordinator, was standing at the gate turning people away. This wasn’t a job that we had planned for anyone to do, but somebody had to do it – and so I put myself forward.

For the first three days I stood there, it rained hard. People were drenched, but they carried on waiting because they had nowhere else to go.

The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car. 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. At that point I had to go behind one of the tents to cry. I wasn’t ashamed of my tears but I knew I had to stay strong for my colleagues – if we all started crying, we’d be in trouble.

Other families just pulled up in cars, let the sick person out and then drove off, abandoning them.

One mother tried to leave her baby on a chair, hoping that if she did, we would have no choice but to care for the child.

I had to turn away one couple who arrived with their young daughter. Two hours later the girl died in front of our gate, where she remained until the body removal team took her away. We regularly had ambulances turning up with suspected Ebola patients from other health facilities, but there was nothing we could do. We couldn’t send them anywhere else – everywhere was, and still is, full.

Once I entered the high-risk zone, I understood why we couldn’t admit any more patients. Everyone was completely overwhelmed. There are processes and procedures in an Ebola treatment centre to keep everyone safe, and if people don’t have time to follow them, they can start making mistakes.

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. You can’t overstay or it starts getting dangerous. The patients are also really unwell, and it is a lot of work to keep the tents clean of human excrement, blood and vomit, and to remove the dead bodies.

There was no way of letting more patients in without putting everyone, and all of our work, at risk.

But explaining this to people who were pleading for their loved ones to be admitted, and assuring them that we were expanding the centre as fast as we could, was almost impossible. All we could do was give people home protection kits, containing gloves, gowns and masks, so that they could be cared for by their loved ones with less chance of infecting them.

A week ago, MSF’s president spoke at the UN and called on states with biohazard response capability to urgently send teams to west Africa. To have any hope of getting the outbreak under control we need more treatment beds for Ebola patients and we need them yesterday. We are worried that if left to UN agencies and NGOs it will take too much time to respond – more lives will be lost and the virus will spread even further.

MSF is currently providing 160 beds in Monrovia, we will soon have 200, and we will carry on expanding as fast as we can. But we are stretched to capacity by our work elsewhere on the outbreak and through the rest of the world.

In Monrovia, we estimate that there needs to be more than 1,000 beds to treat every Ebola patient. There are currently just 240 in total. Until that gap is closed by treatment centres with hundreds, rather than the small numbers pledged so far, the misery of turning people away at our gates will continue.

After one week on the gate my colleagues told me to stop. They could see the emotional toll that it was taking on me. That same afternoon a nurse came to find me, saying there was something I had to see. Whenever people recover, we have a small ceremony for the patients who are discharged.

Seeing the staff gather to celebrate this exceptional moment, hearing the words of the discharged patients as they thank us for what we did, gives us all a good reason to be there. Looking around I saw tears in all of my colleagues’ eyes. Sometimes there are good reasons to cry.