Working in an Ebola outbreak

I had a few doubts

I did have some doubts the night before we flew to Uganda as I realised the potential dangers. But once I met the local people and spoke to the staff I soon realised what devastation the virus had caused.

I arrived for the second wave of the epidemic in Gulu in the north, the poorest district in Uganda. This is an active rebel area, which in itself brings difficulties. HIV prevalence is approximately 10%; other common diseases include malaria, infective diarrhoea, and measles.

Gulu

I was based at Gulu Regional Hospital. Médecins Sans Frontières had converted a medical ward into an isolation unit surrounded by barriers and footbaths filled with a bleach solution. We followed the guidelines published by the Centers for Disease Control (CDC) and the WHO. These had been published after the Kikwit outbreak, when it was proved that barrier nursing techniques can control the spread of Ebola. We had specific ways of gowning up and decontaminating. However, working in temperatures of greater than 30°C was at times trying.

My day began on the ward at 8.30 am. My colleagues and I would take blood samples, which were sent to the CDC field laboratory at Lacor Hospital (8 km west of Gulu). The turnover time for an Ebola antigen test was about six to eight hours. All the doctors--from Uganda, Japan, the United States, as well as Britain--then did a ward round. The unit was split into two: the suspect ward and the probable or confirmed ward. Patients who we thought might have Ebola waited on the suspect ward for their test results. Ideally, we tried not to take a blood sample from anyone before the fourth day of the illness. If we had a high level of suspicion--for example, the patient presented with bleeding--then they went straight to the probable or confirmed ward. We could not do much for them other than show that we cared. We provided antimalarials and antibiotics if we thought they had patient coexistent illness. We hoped that they were developing antibodies more quickly than the virus was replicating. This outbreak was due to the Sudan strain, and the fatality rate was 53%.

The case definition was broad

Mobile teams usually brought the patients to us. These were made up of local people who were trained to go into the communities and find people who fitted the case definition. The case definition was broad but it had to be. You cannot afford to miss a single case of Ebola. The patients would be brought to our screening tent, where we took a history via an interpreter; in particular we asked about a history of contact with a patient with Ebola. We would then examine the patients. Finally a decision would be made as to whether or not the patients should be admitted. If not they were sent to the appropriate ward or to outpatients.

If the Ebola antigen result was positive then the patient was nursed on the confirmed ward. If the antigen result was negative and the clinician was still suspicious, a repeat test would be sent off. If the patient was antigen negative and the clinician was agreeable, then the patient would be discharged. If patients survived Ebola they were discharged only when they were antigen negative but antibody positive. Their contacts would be followed up for 21 days.

If the patient died a trained burial team buried the body in a specified area. There were 425 presumptive cases overall.

Many organisations from all corners of the world worked together to contain this outbreak. The courage of the staff in northern Uganda and of the local people has left a lasting impression on me and I feel humbled by my experience.