Ebola patients rejected for overcrowding

Treatment centers must reject more and more patients

09/13/2014

Not without reason some governments of affected West African states see their countries threatened by the Ebola epidemic in existence. The established treatment centers are far from sufficient to supply the large number of infected people and doctors often have to reject sick people. An extremely unsatisfactory situation, such as the Belgian Pierre Trbovic, who has worked for MSF in the Liberian capital of Monrovia since the end of August, in one of the „dpa“ documented report.

The Belgian doctor took on the daunting task of sending the infected back home in the overcrowded Ebola treatment center in Monrovia, knowing they might be doomed to death and threatened with further infections. But in the treatment center is simply no more space for more patients and the staff is running in the face of extreme stress anyway at the limit. The infected people are queuing at the door and every day the local doctors experience incredibly tragic events. The Belgian report highlights the extreme impact of the Ebola epidemic on social life in the affected states and the desperate need for local people to seek help.

Medical staff overwhelmed
In his report, Trbovic stresses right from the start that immediately upon his arrival in Monrovia, he realized how overwhelmed his colleagues were with the scale of the Ebola epidemic. „Our treatment center - the largest that MSF has ever built - was packed, and our project coordinator Stefan stood at the entrance, sending people away because there was no room left“, quotes the „dpa“ the report of the physician. An extremely difficult task, for which Trbovic subsequently volunteered, because at „You need to be flexible in an emergency operation“ and „someone had to take her over“, reports the Belgian. The scenario described is extremely bleak. During the first three days that Trbovic stood at the entrance, it was raining continuously and people waiting in line at the door were drenched. But they stayed, because otherwise they could not go anywhere.

Despair in infected and relatives
„The first one I had to send away was a father who brought his sick daughter to the trunk of his car“, Trbovic reports. The father was an educated man who begged him to take in his adolescent daughter. Even if we could not save their lives, at least we should protect the rest of the family from infection, the man begged. But the doctors had no choice. „ I had to go behind one of our tents to cry“, quotes the „dpa“ the Belgian. He was not ashamed of his tears, but Trbovic wanted to stay strong for his colleagues. „If we all started crying, everything would be even more difficult“, explained the volunteer. Trbovic continues to report on other families who came to their cars, dropped out Infected and then immediately drove off again. Also a mother tried out of despair, „to put her baby on a chair and then to leave, hoping that we would have to take care of her child then.“

Dying and dead bodies in front of the treatment centers
The case of a couple who brought their young daughter to the Ebola treatment center and could not be admitted was particularly dramatic for the doctor. The girl had died two hours later at the entrance, according to Trbovic, and the body remained there until the body-disposal team picked her up. Other infected and suspected cases were brought by ambulance from other health facilities in the treatment center - but here they could not be helped. „We could not send them anywhere else - everything was overcrowded and still is“, so Trbovic. The extent of overcrowding is described by the Belgian based on the scenario in the so-called high-risk zone of the treatment center. When he entered these, he understood, „why we could not take in any more patients: everyone was completely overburdened“, reports the Belgian.

Overload of the auxiliary forces increases their infection risk
For reasons of infection control, certain measures and procedures must be followed in the Ebola treatment center to prevent transmission of the pathogens. If the medical staff has no time for these, the safety of the employees can hardly be guaranteed. For example, it could „It can take up to 15 minutes for employees to properly don the suit, and in the high-risk zone, they can spend as little as an hour“, explains the Belgian. Because then they are exhausted and completely sweaty. If the protective suits were worn longer, this could be dangerous. The patients in the high risk zone are very poor, „and it's a lot of work to keep the tents clean“, Trbovic continues. This is also related to the clinical picture of Ebola infections. Typical Ebola symptoms include fever, massive diarrhea, nausea and vomiting, and internal and external bleeding. Excrement, blood and vomit must be eliminated and the bodies removed, explains the Belgian.

Infected people are sent home with hygiene protection packages
Trbovic concludes that it is absolutely impossible, „taking in more patients without endangering our employees and our work.“ But to explain this to the people who beg us to accept their relatives remains extremely difficult. Also, the indication that the treatment center should be increased as quickly as possible, does not help those affected here. „All we can do is to bring people home protection kits with gloves, gowns and masks, so that the risk of infection is less if they look after their relatives“, so the sad conclusion of the Belgian physician. Trbovic continues to report that after the first three days of rain, the scorching heat followed, which additionally burdened the waiting people. One day, an old man waited five hours in front of the treatment center, with a broken umbrella as the only sunscreen. While waiting, his words to the Belgian were merely: „Too much sun.“ The son had been waiting with him, but for fear of being infected, he had not really dared to come near his father to console and support him. „When we finally got him up, his son came to me and thanked me with tears in his eyes“, Trbovic reports.

Mental effects for the auxiliary staff
In addition to the numerous Ebola infected, according to the report of the Belgian other people came to the treatment center, who wanted to be tested for a possible infection for fear of Ebola. „But if we have to reject the dying, how can we take in healthy people??“, so Trbovic. Last but not least, there were also several people who have been looking for work „and were ready to do anything, even if it was the removal of corpses.“ After the Belgian had performed the dramatic task for some time, the nurses began to feel sorry for him and stated that they could not do his job. This was the point where Trbovic realized that the activity was tougher than expected. „After a week, the others told me to stop. They saw the psychological effects this work had on me“, so the report of the Belgian.

But Trbovic refers in his remarks to the positive aspects of the auxiliary activity. That same afternoon, a coworker had come to him to show him something. He led Trbovic to a small celebration, which is celebrated here every time an Ebola patient gets well again. The Belgian „Saw the coworkers and coworkers come together to celebrate this extraordinary moment and heard the words of the dismissed patients thanking us.“ All colleagues had tears in their eyes, reports Trbovic and added „Sometimes there is a good reason to cry.“ (Fp)

Picture credits: Detlev Beutler