After the discovery of Ebola at the only children’s hospital in Sierra Leone, nurses and doctors alike fled. German physician Werner Strahl of the aid organzation Cap Anamur, who stayed behind to provide care amidst the chaos, shares his story.
Werner Strahl, 70, is chairman of the Cologne, Germany-based medical aid organization Cap Anamur. The organization has operated Sierra Leone’s only children’s hospital in the capital city of Freetown for the past five years. Strahl, a pediatrician who has worked for Cap Anumur for three decades, visited the Ola During Children’s Hospital in August just as its staff unwittingly admitted its first Ebola-infected child. In the following account, compiled from an interview Strahl conducted with SPIEGEL reporter Katrin Elger, the doctor describes the chaos that ensued. Strahl says he has never returned from a trip feeling as “glum” as he did his harrowing visit to Freetown.
We were sitting in the morning meeting when it dawned on us that something must have gone terribly wrong. A few days earlier, a four-year-old boy with a high fever had been brought to us at the hospital. As a matter of course, a nurse responsible for admissions asked the father if he had been in contact with anyone who had suddenly fallen ill. Had anyone in the family been buried recently? Any suspected cases of Ebola?
The father answered “no” to every single question and a blood test also confirmed that Melvin-Vincent, his gravely ill son, was suffering from Malaria.
It’s suboptimal to have to rely on people’s honesty, but often you have no other choice. As a precaution, we could put every single child into quarantine. After all, almost all the sick people are being delivered with symptoms like fever, headaches, diarrhea and nausea that are typical not only of Ebola, but also for illnesses like malaria and typhus.
We have capacity for 150 patients, but during the rainy season, we are often forced to keep children two or three to a bed.
On the Monday morning in question in mid-August, we were sitting together when one of the doctors told us that the child’s stepmother had come during the night to take over for the father of the sick boy.
A Father’s Lies
The doctor started growing nervous because what the woman shared with him didn’t sound good. Melvin-Vincent’s grandmother had just died of Ebola. The boy had been living with the elderly lady and his fever broke out after her burial.
His father had lied to us.
At that moment, it became clear to all of us that it wasn’t just malaria that was robbing the child of his strength. It’s possible the boy had been lying in our packed admissions ward for days with Ebola, highly contagious and sharing a single bed with two other children. The laboratory results confirmed our suspicions.
We acted immediately. We cleared out the ward, moved the child to an isolation station and brought the other children into their own beds. At the time, it was pouring rain and we had to look for a dry place where we could burn the bedding and clothing. Everything was contaminated. But with torrential rains pouring out of the sky, don’t even bother looking for a dry spot for a fire. In the end, we had to build an oven just to do the job.
We quickly began the so-called “tracing,” documenting who had come into contact with the boy with Ebola. It was only at that point that we became conscious of the full scope of the drama. Six of the eight doctors providing care in the station had touched the child, as had at least 25 nurses.
The law in Sierra Leone stipulates that in such cases, any worker who has come into contact with a person infected with Ebola must leave the hospital and stay at home for 21 days, the duration of the incubation period. So we sent the medical personnel who had been caring for the boy away — and that’s when panic broke out. They all stormed out, gathering in groups.
Suddenly all the doctors were gone. Then the nurses were gone. The only people left were the chief physician, two female pediatricians from Cap Anamur and me. We had to provide treatment to 120 seriously ill children in what became a nightmare situation.
We had no other choice but to close the hospital. We sent 80 of the children home with their parents. Many were still receiving infusions and we first had to get medication for them so that their parents could administer it to them in juice form at home.
We allowed the remaining children, who were either hooked up to ventilators or were too sick to be discharged, to stay. We also sought assistance from the Health Ministry, but our efforts were in vain.
We also weren’t able to persuade the medical personnel to return. Even our Ebola expert, an experienced local doctor, simply turned off his mobile phone. Everyone was afraid because, of course, word had gotten around that in Sierra Leone alone, 30 nurses and four doctors had already died of Ebola. The disease has even claimed the life of the country’s best known virologist.
Some nurses have since returned because they otherwise would have had to forfeit their pay, but by then, most of the children had already left the hospital. We had Melvin-Vincent taken directly to a special treatment center outside of Freetown. He has since died.
So far, I haven’t heard reports of any of the other children, doctors or nursing staff getting infected as a result of the incident. At the same time, it’s not a given that we would even be informed. In Sierra Leone, isolation in such cases means that people are initially not allowed to leave their homes. We haven’t heard back from everyone.
The hospital remains closed as well. The whole thing has been very depressing — in no small part because we had been so successful prior to this disastrous setback. We had truly succeeded in building up a children’s hospital that functioned well. There’s even a station for preemies. The hospital still isn’t totally up to Western standards of hygiene, but it’s pretty good by African standards. You have to keep in mind that there is only one doctor for every 30,000 people in Sierra Leone. In Germany, that ratio is 230 to 1.
Rituals with Deadly Consequences
I’m deeply concerned about the country. I read in the news today that there are bodies lying in the streets and everybody is afraid of touching them because people have learned how infectious the corpses can be. The situation is reminiscent of the era of the plague. People who are ill and left to fend for themselves no longer stand a chance of survival. Nobody is willing to help them, and understandably so.
It’s actually part of the burial ritual in the country to wash the dead and to kiss them on the forehead as a way of saying goodbye. But most people in Sierra Leone now understand that doing this can have deadly consequences.
Signs are placed all over the streets reading, “Ebola kills, but only when you don’t follow our instructions.” Police and the military are omnipresent in the country, taking care to ensure that no one enters a public building without first washing their hands in chlorinated water.
The markets are usually open until midnight, but now they are closing at 6 p.m. Motorcycles are banned at night and people have been told to avoid direct contact with each other.
Theoretically, these rules make sense. The problem is that they won’t make a difference because people still need to go about their daily lives — shopping, working and running errands. And anyone who has ever been to Freetown knows that it is impossible to get through the city without having physical contact with people. The streets are incredibly crowded, there is dense traffic and there are often torrential rains. The markets and streets are all potential incubators for infections.
There were days when I had almost no hope left, but it isn’t helpful to be pessimistic all the time. In any case, I’m happy that I will soon be able to end my own self-imposed isolation here at home in Essen soon. I’ve now made it through the three-week incubation period. I never touched little Melvin-Vincent, but there’s always a risk.
In order to avoid endangering my wife and my grandchildren, I have stayed away from them since my return. I don’t shake hands or hug anyone.
I’m not too worried about myself, but I do feel a deep sense of responsibility for my colleagues at Cap Anamur. We’re a small organization and we all know each other. Our pediatricians are still persevering bravely in Freetown.
They’re young women and they still have their whole lives ahead of them. Of course I’m very concerned about them. This week I even had talks with a gynecologist and a nurse who would like to work with us. I explained the risks to them at length. I mean, I would be very understanding if someone didn’t want to travel there.
Far more than half of all the international organizations once present in Sierra Leone have since pulled out because of fears of Ebola. If we all leave, though, the only things left will be the people and their desperation.