Am I the first person to be told that they have malaria and feel a sense of
relief? Possibly. However, my diagnosis five weeks ago was given while I was
working in a small rural hospital in Sierra Leone, where contact with the Ebola
virus was a real possibility.
I’d had a fever, cold symptoms and was struggling to walk for more than a few
minutes. Whatever was wrong with me, I attempted to reassure myself, it
couldn’t be Ebola, one of the most virulent of viral diseases, for which
there is no cure and a mortality rate of up to 90 per cent. The climate of
worry and the feeling of vulnerability that affected me and my fellow health
workers was far from unwarranted.
Figures from the World Health Organisation (WHO) show that the
latest outbreak of the deadly virus in western Africa has infected
more than 1,320 people and killed at least 729. Sierra Leone now has the
highest number of confirmed cases, at 473, surpassing neighbouring Guinea,
where the outbreak originated in February and where 336 cases have been
My colleagues and I were working at the 100-bed Masanga hospital in the rural
district of Tonkolili, which borders Kenema, the region where the Ebola
virus is most prevalent.
In the week before I developed symptoms, we had tried to save the lives of
three patients – two of them children – who had presented at the hospital
with non-specific symptoms. They all died despite the fact that we provided
treatment for the most likely causes of their illness. It was only
afterwards that I realised none of us working in that hospital had been
protected against the transmission of Ebola. It was a sobering moment.
Naomi with colleagues in Sierra Leone
I’m not sure what I had expected from my work experience at Masanga,
a hospital part-funded by a British, Danish, Dutch and Norwegian alliance.
In January, I had taken a three-month diploma in infectious diseases at the
London School of Hygiene and Tropical Medicine, and had been due to follow
it with three months of work in Sierra Leone in April. Early reports of an
Ebola outbreak delayed the sabbatical by a month, while safety was assessed,
but in May I went out with my fellow doctor-in-training, Aatish Patel.
I’ve travelled in Africa before, as my parents had lived in Zimbabwe, and I
have carried out a short research project in Burkina Faso, so there was no
great feeling of culture shock when I arrived in Sierra Leone. However, the
facilities at the hospital – which is surrounded by jungle – were more basic
than I had anticipated.
The infrastructure had been damaged during a civil war that ended in 2002.
There was no running water and a generator provided power for two hours a
day and during operations. There was no isolation unit and many common drugs
were not available. If someone came in with a non-specific set of symptoms,
such as fever, abdominal pain or diarrhoea – which
are also signs of Ebola – we would treat them with antibiotics for
sepsis or typhoid, antimalarials, paracetamol for fever, and fluids or oral
rehydration salts for diarrhoea. We could send blood for testing to Kenema,
Sierra Leone’s main treatment centre, but samples sometimes went astray, as
happened with those from one of our suspected Ebola patients. Waiting for
the results could mean delaying alternative, potentially life-saving
We mostly saw malaria, diarrhoea and non-specific fevers on our ward rounds,
but in the back of our minds was Ebola. I always imagined I would recognise
the disease the minute a patient arrived with it at the hospital. However,
most sufferers at an early stage have the same symptoms as the majority of
other patients; and only half of them experience telltale bleeding. With
Ebola, there is also a long incubation period of up to 21 days, so if you
see a patient with a fever that is unresponsive to standard treatment, you
wonder: could this be it?
As rumours reached us that the disease was spreading towards our region, we
began to feel very vulnerable. We’d talk about it at night, and senior
doctors kept us updated with the latest information from the Sierra Leone
government, but it was obvious that the hospital needed to prepare for
We asked for additional gowns, aprons and masks. I had visions of head-to-toe
boiler suits, thick gloves and full-face masks, with not a glimpse of bare
skin. The reality was thin gowns, latex gloves, hairnets and goggles like
those worn in science lessons at school. Better equipment was being sent
from Europe, but shipments invariably took weeks to arrive.
To control properly any infection, you need chlorinated running water; for the
entire isolation unit and decontamination area that we rapidly set up, we
had only nine buckets of it.
Perhaps our biggest problem, however, was the refusal of locals to believe in
the existence of Ebola. I met some who simply dismissed the disease, and
even learnt of one health officer who would not take precautions. Sadly, he
contracted the disease in June and died.
We had a problem with the first patient to use our isolation unit. He and his
family accepted that Ebola was real, but they could not grasp how easily it
is transmitted. On the ward round one morning, he was found naked on a bed
stripped clean of sheets. He had passed his clothes and bedding to his
mother through a window, which she had then taken away to hand-wash in a
communal laundry area. They thought they were doing the right thing for the
hospital, but had he been found to be suffering from Ebola, he could have
inadvertently spread the virus to his mother and the wider community.
The most upsetting cases I saw were when a 26-year-old woman and two children
arrived within the space of 48 hours, with fevers and diarrhoea. We gave
them what help we could, but soon after admission, they died without us
After trying desperately to resuscitate one of the children, I realised I had
done so without gloves. In the heat of a desperate moment, I had not
protected myself against Ebola.
It was that weekend when I began to feel ill. I could tell my fellow workers
were worried about me, but everyone was supportive. Malaria was the most
likely explanation, but when the first course of anti-malarial drugs didn’t
work, the chief medical officer moved me into his own house to take care of
me. He later told me he’d been quite worried at that point. A second course
of antimalarials did work, and lab tests confirmed that I had malaria rather
than Ebola. There was relief all round. I flew home feeling completely well
last month, as planned, while the Ebola epidemic has worsened.
Being in Sierra Leone has taught me that you can learn from these situations
as long as you respect the diseases and don’t think you are invincible.
Medical staff are at real risk – Dr Sheik Umar Khan, who died in Sierra
Leone last week, was one of the local experts we consulted when we had a
suspected case. Two American aid workers – one a doctor – are in a serious
condition with Ebola, and are being transferred back to the US to be cared
for in isolation units.
You can protect yourself, but you rely on everyone else to do that, too – that
nurses disinfect themselves, auxiliary staff handle equipment properly, and
lab staff correctly make the chlorine water vital for disinfection.
Masanga hospital has had to close to new patients, because of the crisis.
Knowing the staff as I do, they will struggle to turn away anyone who
requires treatment; however, there simply aren’t the facilities to cope. It
will take a mammoth effort, co-ordinated on a global scale, to get this
epidemic under control.
* To make a donation to help reopen Masanga, visit masangahospital.org
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