Courage and Fear, Helplessness and Hope: Our Friends on the Frontlines Against Ebola

 

My colleagues Dr David (right) and nurse Jeremy (left) in PPE (personal protective equipment), preparing to see an Ebola patient

An update from: Patrick, Anna, Luke, Miriam and Isaiah LaRochelle Serving in Nyankunde, Democratic Republic of Congo Hi all, warm greetings from my BioBox in Prague! At some point I will share more about the experience of my med-evac and those of my teammates, but for multiple reasons this is not the right time. For now, suffice it to say that Peter is doing so much better, the rest of the Stafford’s and I remain well, and all of us feel well cared for by our doctors and nurses —and by the many who worked to arrange our evacuations and to all those of you who have been praying. What I want to focus on in the rest of this update, however, is the courage and suffering of our Congolese friends in the face of a new Ebola epidemic. Perhaps the best way I can share is to translate their own words, which I hope to do in this post and the next.  I received but slept through a call at 4:17am the day of my med-evac. At 5:02 am I was called again by Dr. B, a young CME doctor who finished his 6 month training at CME after completing medical school in Lubumbashi and was subsequently hired to work in the surgery department. One of my best memories of Dr. B is during his training when he was on internal medicine. We were rounding on a diabetic patient. I proposed a treatment plan with insulin and Dr. B responded something to the effect of: “Oh no, Doctor, that’s not right! It doesn’t follow the Congolese protocol!” I think I decided to continue my flouting of the Congolese protocol but at the same time, I appreciated his courage and conviction in disagreeing with me. This is rare in the hierarchical Congolese medical environment where attending doctors and professors are often addressed as “Maitre” (Master)! Back to Wednesday. I answered Dr. B’s call and in a weak and desperate voice he explained that he was hospitalized, that he had been vomiting everything for the last 4 or 5 days and that he had had persistent fever as well as itching. I asked him if he had been tested for Ebola. He said yes but there was no result. I called a contact at the provincial lab to see if his result was available. It was subsequently communicated to our hospital leadership. Dr. B was positive. I spent the rrest of Wednesday in planes and it wasn’t until Thursday morning that I found that Dr. B still had not been informed. The hospital felt like he needed to be told by someone trained in psychologic care. They were worried that he might become suicidal. I pushed hard for him to be informed. Perhaps I don’t understand Congolese psychology, but it seems that waiting for the result must be even more torture than getting it.  The other thing I learned was that Dr. B had started bleeding from all his needle stick and IV sites. He had received several transfusions with some slight improvement. It was hard to stop thinking about the fact that my colleague and someone I had trained had Ebola, was having hemorrhagic signs, and there was nothing I could do. And there wasn’t even an Ebola Treatment Center open yet where he could be sent! What follows is the translation of messages of my colleagues on our staff WhatsApp group about Dr. B yesterday. It gives you a sense of their love and their courage—and the sense of helplessness that is so oppressive in the face of this disease. 6:40am: Dr S: “I just noticed that he is starting to develop abnormal behavior. He is saying things that don’t make sense. He is urinating on himself without realizing it. He is taking out his IV catheters….I don’t know if this is depression? He says he tried to drink overnight but vomited twice. [The good news, though, is that] he is no longer bleeding.” 6:43: Dr C: “May the Lord come and help us!” 6:46: Dr C “Lord remember us your servants. Help Dr. B! We’re together in prayer.” 7am Dr I “May God hear our prayers for Dr. B!” 7:03am Dr M “Is it possible to give him an intramuscular injection of something that will calm him?” 7:21 Dr. I “But can we give him an IM injection with his bleeding?!  Can we get full PPE (protective equipment) for someone so they can give him treatment?” 7:23am Dr. C “Certainly someone who is courageous can stay at his side to help him” 8:37am  Dr. M “This is looking like his brain has been touched by the disease—or perhaps he has a severe metabolic abnormality, or sepsis, or hypoxia??? The fact that “he doesn’t bleed anymore” is rather reassuring, but the fact that the sickness has reached his central nervous system is possibly even more serious than bleeding.” 7:54 PM “How is Dr B doing?” 8:55 PM Dr I “Yes he is still at the hospital [despite trying to leave earlier in the day]. But his cooperation has diminished. He is not accepting certain nurses and doctors.” 8:57 PM Dr. P “Someone please tell him that around a thousand people prayed for him today and yesterday—in America, in Europe, in Burundi and Rwanda and DRC! And they prayed for all of you as well!” 8:58 Dr I “Thank you for all these prayers! We desperately need them!” 10:06 PM Dr D “I just saw him and he is not cooperating at all and is agitated.” 10:09 PM Dr PM “May God come and help him! We are together in prayer with him.” 10:09 PM Dr C “Lord Jesus…”

A Doctors Without Borders isolation tent set on fire by family and community members that do not yet trust the Ebola response efforts Anna’s brave and committee team at the ISP displaced person’s camp which had its second probable Ebola death yesterday—a 10 year old boy—at CME.  Dr Davin, CME Bunia’s new medical director, motivating and organizing the hospital staff. Dr Davin was medical director of Nyankunde hospital when Ebola broke out in 2018 A training of the hospital staff in correct use and removal of personal protective equipment Nyankunde’s beautiful hospital, almost empty due to fear of the population after 10 cases of Ebola have been confirmed. Nyankunde staff face the double threat of Ebola infection and the dramatic effect that Ebola will have on hospital income and by extension their salaries Dr Faustin (at right) our friend whom we sent to general surgery training and who returned to Nyankunde this January, now shouldering the load of the surgical department in the absence of Peter (evacuated) and Warren (on planned home assignment). Every operation, he and his team face the significant possibility of a high risk exposure to Ebola. The advice of some is to stop all surgery in the contact of an Ebola outbreak, particularly if adequate PPE is not available. But how does a surgeon like Faustin balance his responsibility to himself and to his family with the needs of a patient for urgent surgery? There is no easy answer.