Part 1 is here.
Four of us drove to the hospital first thing the following day. At the gate, a nurse in a surgical mask and gloves took our temperature using one of the omnipresent and notoriously unreliable temporal thermometers. She dutifully recorded the temperatures into a blue logbook and waved us through, blissfully unaware that Ebola had already slipped through the entrance and was dancing through the wards.
My coworker approached the Matron, and after we were all introduced, she broke the news.
“The woman you sent to the CCC yesterday from this hospital had Ebola.”
We’d received the lab results in the car en route, and then moments later a text message informing us that not only was she Ebola positive, but she’d died at the ETU shortly after morning shift change. She’d been wildly shedding virus while the hospital nurse inserted the IV.
The Matron’s face fell. She made a disappointed clicking sound, and said, “Oh, dear.”
We waited a beat.
In America, all the department phones would be ringing off the hook to shut the hospital down. Upper management would be scurrying to their respective units to inform the staff, and implement a containment plan. The CEO would already be flying back in his private plane from Bora Bora to address the press.
Here, on a bright sunny morning, in a quiet dusty courtyard in Sierra Leone, a car drove by the gates, and honked. A goat bleated, a bird sang. A breeze pushed lazily at the trees.
My coworker reached into her backpack, took out a clipboard, blank paper, a red Sharpie, and got to work.
“Can you tell me the names of the nurses assigned to that ward?”
It was twenty minutes of the most comprehensive, clever, and thorough contact tracing I’ve ever witnessed.
What were the names of the nurses?
What are their phone numbers?
Where are they today?
Oh, one of them is out and about on her day off? Can you tell her to come in, please?
Did any doctors see this patient?
When did she start to get sick?
What day was the IV inserted?
Which ward was she in?
Is anybody else in this ward sick?
The Matron didn’t have all the answers, but she knew who to direct us to to get them.
Finally, we made our way to the ward. A small, low, brick building, the inside was shadowed and cool. With our hands tucked firmly in our pockets to remind ourselves to touch nothing, we peeked inside each of the four doors without crossing the threshold.
Another nurse: “I can see five people here.”
Me: “One has an IV.”
My coworker: “That patient over there has a visitor sitting next to her!”
The fourth nurse, stunned into momentary silence, stared through a barred window. “Guys? There’s a dead body on that bed.”
My coworker walked over to the window. A sheet was draped over the contours and silhouettes of a life long gone.
The situation was suddenly far more grave than we had imagined, and far beyond our capacity to control through contact tracing.
“Oh, my God,” she muttered. She reached into her backpack, pulled out her phone, called the Command Center for the district, and sounded the alarm.
The Command Center called a W.H.O. team, who mobilized immediately. They were more than two hours away.
One of the hospital staff, blithely going about their day, walked toward the ward and started to head inside.
“DON’T GO IN THERE!” we yelled in unison. He jumped back, startled, and beat a hasty retreat.
“We need to keep people out of that ward,” said the third nurse. He motioned to me. “We’re getting in light PPE and standing guard at the ward door.” He motioned to the fourth nurse. “Try to keep people from leaving the hospital until the W.H.O. gets here.” He motioned to my coworker. “Try to get as much information about the patients in that ward as you can.”
We donned light PPE, which is most everything except the TyVek suit, but still carries the look of an Ebola nurse. It was the strongest visual message we could send to people that this ward was unsafe. It worked. The visitor in the ward saw us, and shrank back against the wall, as if holding very very very still would prevent Ebola from finding her. The crowd milling around the courtyard started to rumble at the sight of Ebola nurses in their hospital, and then, as a group, headed for the front gate.
The cacophony from the gate hit us like a wave. The crowd inside screamed at the guards; the guards at the gate screamed at the crowd; the crowds that had gathered outside the gate yelled at each other just to join the fun. The fourth nurse was yelling at a military man, and he was yelling back at her — it was actually a civilized discussion, but if they didn’t yell, they couldn’t hear each other over the noise.
Then someone started pulling on the bar holding the front gate closed, and the fourth nurse recognized an incipient riot. “Forget it,” she said, and told the security guard to open the gate. The bar slid free with a huge CLANG, and a wave of bodies left the hospital and flooded the town.
There was no possible way to contact trace everyone who had been in that ward for the past 48 hours, and certainly no way to trace everyone in the hospital. We crossed our fingers and hoped that Ebola had stayed inside with us, rather than joining that mass of carriers into the community.
Inside the ward, a patient started to weep. Too debilitated to walk, she needed desperately to use the bathroom. There was absolutely nothing I could do. I had several sets of full PPE inside the truck, but without 0.5% chlorine and a way to safely decontaminate and dispose of the suit, I could not use them.
She cried and called out for more than twenty agonizing minutes.
The hospital went quiet. After more than an hour, when no further visitors entered the gate, we doffed out of our light PPE and joined a group of hospital nurses that had congregated in the shade near the dispensary. We talked for a long time, about Ebola, about fear, about viruses, about the future of the hospital, and of Sierra Leone. Everyone was painfully careful not to touch each other, not even to brush against another person’s scrubs.
A body team came, donned into full PPE, swabbed the body for Ebola, and placed it into a body bag and into a truck. A fully self-contained mechanism, their sprayer got them doffed, cleaned up the PPE, disposed of it, sprayed himself out, and when all was neat and tidy the truck drove away.
Three hours later, the W.H.O. arrived. We chatted with the lead medical officer, passed on my coworker’s contact tracing information, and climbed back into our truck. We were hot, tired, hungry, dirty, and emotionally exhausted.
“Are we heading over to the CCC?” I asked.
My coworker shook her head. “We are going home. We. Are. Done.”
The ride home was silent save for the BBC playing quietly on the radio. The news announcer talked about a plane crash, a politician’s arrest, attacks by a terrorist group, an election, a new book by one of their journalists.
It was as if we listened to news of a world that we might have known once, but had since forgotten.
And it was, without doubt, a world that had forgotten us entirely.