Ebola: Indian doctor opens up about working with patients in epidemic-ravaged West Africa

It has been two months now, since Dr Kalyani Gomathinayagam, 46, returned to India. She is the only Indian doctor to have traversed the Ebola-ravaged terrains of West Africa since the outbreak began in March this year. She was in the Liberian village of Foya in September and October; there, she worked with three other doctors in a 40-bedded facility opened by Medecins sans Frontiers or Doctors without Borders. The biggest challenges she encountered on the field were treating sick children and convincing people not to touch the dead bodies of their family members. In a chat with dna, she talks about going back again for relief work.

Image credit: Medecins sans Frontiers

What drove you to work in Ebola-stricken areas of Africa? Did your family know about the risk you were undertaking?

Each of us had a mission briefing before departing for the project. Everybody, myself included, went there by choice. During the two months I spent there, I used to call back home frequently. Before departing, I had informed my parents that I was going to Liberia, but I had not told them that I was going to treat Ebola patients. I let them know a week after I reached there.

What were the challenges you faced while treating patients?

I had to shout out across a two-metre-wide perimeter, marked by orange tape, to communicate with fellow staffers and locals. I could not even borrow a pen from some one or shake hands, let alone hug any one. We maintained this distance so that the virus could not infect us. We could not stay for over an hour in the high-risk unit where ebola-infected patients were admitted. The personal protective equipment (PPE) would make us sweat so much that our goggles would become foggy. We would get blurry vision and would have to step out to rehydrate ourselves. If we stayed in PPE for more than an hour, we were at risk of passing out because of dehydration.

Describe a normal day in the case management camp at Foya.

We would reach out to any village resident suspected of having ebola-like symptoms. We would draw their blood for testing and put them in the 'suspect' area for six hours. If tested positive, they would be moved to the 'confirmed' area. Fresh blood tests would be conducted after 48 to 72 hours. We used to work in high-risk units with patients, a zone in which we could not make more than three rounds per day. We also conducted outreach programmes in the village. Some patients, who were symptomatic but were in denial, would refuse to come to the camp for treatment. So we had to counsel them and their families on taking proper care.

Could you describe a scene in an ebola high-risk unit? How were patients coping with the disease?

Ebola would manifest in flu-like symptoms and eventually get worse. It could get so worse that it would shred the dignity of the patient. People could get so sick and weak that they would lose appetite. They would have severe loose motions. It was painful to watch them while cleaning their linen or bodies. They would go into shock and shake their arms so violently that it would be impossible to administer intravenous injections or measure their body temperature. Even the adults were not able to tolerate the agony. There were men I saw shaking with fear and praying that they'd continue to live. But the disease is very unpredictable. Those whom we thought would never make it survived and those whom we pegged to survive would lose the battle.

Some staffers got infected and died of ebola even after wearing PPE and taking all possible care.

PPE is designed to protect the caregiver from the virus but it is not 100% safe. It is impossible to be in PPE all the time especially when you are moving around in the community and talking to infected families or identifying those who may need to be admitted. There is a need for strong research on how long the virus can survive outside the body, whether for a few hours or days. If you make accidental contact with the patient and then rub your eyes or put your hand in your mouth, then you may get infected. The virus enters through open orifices in the body and attacks the mucous membrane of the body. Some of the nurses in the staff who stayed in the community got infected after accidentally touching the linen or the clothes of the infected people.

What were the most heartbreaking incidents that you witnessed in the camp?

To treat children was the most heartbreaking thing. Up to 40% patients in the camp were children. There were children of all ages, and I had treated a newborn child and another who was three months old. They would not understand why they were in a high-risk unit. They felt scared in a strange atmosphere with staffers in yellow suits floating around, with only their eyes being visible. Some children had lost their parents but they did not know that yet. The sick children were very desperate for human warmth and in the absence of their parents they would hug the other children. Some who were really sick, could not make it, and we had nothing more to offer them.

Was the 40-bedded capacity overflowing with people? Did you have to turn away patients for lack of beds?

At one point in time, we had 40 beds and 120 patients. But we increased the bed capacity. We never had to turn away patients. We took every one in. Ebola has been around for 40 years now, but in any given year there were not more than 500 cases. This year, over 17,000 cases have been detected, of which 6,373 have died.

People across the world think that because cases of Ebola have come down, there is little need to worry. Is that true?

Even a single case, found in an area where all cases were cured, can restart an epidemic. In such a scenario we cannot afford to be complacent. We are not totally in the control of the situation. It is still a long way to go. We have to respect ebola.

How did the local communities react when they were not allowed to give their loved ones proper burials? Was there any resistance from them?

In any culture, proper burial of the dead is of utmost importance. But it was important for them to understand that dead bodies are the most contagious and hence dangerous. They were initially reluctant when prohibited from touching a dead body but they soon understood the gravity of the problem.

Do you want to go back to Ebola stricken regions for relief work?

I want to go back at some point for relief work. It will be interesting to observe how we are managing the epidemic and study how the disease has peaked and then its eventual recession. Because managing patients is a highly taxing job, no doctor is allowed to stay in the region for more than a particular amount of time. And so there is a huge churn of doctors and staffers in West Africa, with over 700 staffers having served there since March this year.