After a while, you want to stop telling the stories.
Because, suddenly, after 13 weeks, they aren’t stories anymore. They aren’t unusual events, or unexpected happenings. They’re just normal.
Ebola becomes normal.
This is a horrible realization to have.
Ebola should never be normal.
But, then again, children dying of malaria shouldn’t be normal. Malnutrition shouldn’t be normal. Starvation and poverty shouldn’t be normal. Tuberculosis and HIV shouldn’t be normal.
Here is the trade-off for clinicians.
When you leave after six weeks of work and return back to your first-world country, you feel like you’ve left the work undone. You’ve left something unfinished. You’ve abandoned the co-workers you left behind. It’s a struggle to return to your clinic, or ER, or med-surg floor, and hear the 450-pound patient in the bariatric bed complain that he’s “starving.” Or hear the frequent-flyer beg for narcotics and complain of his “suffering.”
What was normal when you left the States is abhorrent and abnormal when you return.
And for those of us who extended our contracts, who took different responsibilities outside the ETU and led different teams to do different work, what was horribly abnormal when we first arrived in Sierra Leone is now just everyday, ordinary life.
And why on earth would I tell you the story of an ordinary day?
~ ~ ~
The pregnant woman miscarried at home, but the bleeding wouldn’t stop.
She put a lapa between her legs to catch the blood and hired a motorcycle to drive her to the government hospital. As they roared down the road at dusk, the world fading to black around them, the moon a tiny sliver in the sky, a dog ran in front of the bike.
Or maybe it was a sheep, or a goat. Or maybe he just took the corner too fast.
The bike went down, and they both flew off. She landed hard, her leg snapping like a twig as she tumbled across the pavement. She rolled off the road into the dirt and tall grass, and the lapa between her legs fell away.
Horrified but uninjured, the motorcycle driver hauled her up onto her unbroken leg, righted the bike, and helped her back onto the bike behind him. He drove like mad for the hospital, ignoring her weight behind him, heavier and heavier, as she leaned against his back and slowly lost consciousness.
When they arrived at the heavy double gates, he brought the bike to a stop, pushed her off the seat, and as she collapsed on the ground he gunned the engine and escaped into the night.
She died in a pool of her own blood as the security guard at the gate shouted for the nurses.
There was one body team still active, ready to park their truck and head home for the evening. The Command Center of the district pleaded with them to retrieve this corpse from where it lay, its small form looming large in the minds of all who saw it. In her death she stopped all the traffic at the hospital, for no one would pass near her to either enter or exit the gates.
The team arrived, donned into protective PPE – for now, in this time of Ebola, all bodies are treated as suspicious – and placed her in a body bag. Then they picked up the bag, and headed toward the hospital morgue.
And the hospital staff rioted.
Terrified of having a body that might have died of Ebola on the grounds of their hospital, the nurses and the aides and the cleaners grabbed rocks from the ground and began to fling them at the body team. The rocks bounced off their shoulders, their backs, their arms; as each one flew through the air it carried the real and deadly possibility that it could tear a suit, rip a glove, knock a face shield to the ground.
They threw the bag into the morgue, and ran for their lives.
An ordinary day where nurses throw rocks with intent to harm.
~ ~ ~
The woman carried her two-year-old child into the triage area. He was smaller than my eight-month-old nephew, his head disproportionately large, his arms and legs tiny and stunted.
I blinked with surprise when I saw him. “Is he hydrocephalic?”
The doctor shook his head. He had seen this over and over again when he worked in Sierra Leone before Ebola. “No. He’s a SAM child.”
SAM. Severe Acute Malnutrition. And he was dying.
We slid syringes full of liquid dextrose through to the mother in the red zone, and encouraged her to give him small, continuous doses of the sugar. He responded initially, waking up slightly, the glucose feeding his brain enough to bring him back to a groggy awareness of the world.
“Do we have any feeding tubes?” asked the doctor.
“No,” I said. We were again in the north, working now nearly full-time at the remote holding center there. “We might have some back at the main ETU, but I don’t have any here.”
“We need to transfer him there. He needs to be tube-fed.”
I nodded. “I’ll call them and call the Command Center for the ambulance.”
The mother made a sound of distress. We looked over the fence. The child had gone limp, his eyes rolled back in his head. His breathing was slowing. The nurses called to her again and again to give him more dextrose, and she tried and tried, but he could no longer swallow.
The doc turned on his heel and headed for the donning area. “I’m going in. I’ll try to get an IV and give him the dextrose that way. Can you mix me D10 in water?” We ran the calculations quickly in our heads, and I wrote it in pen on my left arm, reverting back to my ER habit of writing stat orders on the closest surface possible: myself.
In less than five minutes I ran out of the med room with the D10, and met the doctor as he ran out of donning. We walked back to triage, and looked over the fence.
The woman was writhing in agony in the triage chair, tears streaming down her face, her dead child clutched in her arms.
An ordinary day, where children die because they don’t have enough to eat.
~ ~ ~
Another day at the same triage, and we chose to separate the mother from her 7-month-old child. The mother clearly had Ebola. The child was fat and healthy and showed no signs at all. But every time the mother held that child, or breastfed it, or wiped her own eyes and then touched her child, she risked transmitting just enough virus to that little body to start a cascade that would end in a terrible, seizing death.
We called the Child Protection desk of the district. “We have an observation home,” they said proudly. “It’s brand new, she will be our first child.” The observation homes had been set up nationwide, a space where orphaned or abandoned children exposed to the virus could be monitored for 21 days to ensure they didn’t get sick.
A survivor caretaker picked up the child at the holding center, and an ambulance drove them away.
The next day the doctor and I called the Child Protection desk. No answer.
We called the woman from the Social Welfare desk. No answer.
Finally, we went to the Command Center, where an epidemiologist from the W.H.O. just happened to have the number of someone from UNICEF, who referred me to another UNICEF staffer. She was the only person who actually knew where the observation home was. She hopped into the car with us.
We heard the baby wailing as soon as we got out of the car. There was one staff member there to greet us, a middle-aged man. There was crumbled and broken BP-100 RUTF scattered across the floor.
“Are you the caretaker?” asked our doctor.
“No, I am the security guard.”
“Where is the caretaker?”
“She is in Freetown. She said she had a meeting. She said she will be back tomorrow.”
“Who is caring for that child?”
He shrugged. “I am trying my best.”
We entered the house, our hands locked together behind our backs, a physical reminder to touch nothing in the home. We found the baby, naked, lying on her stomach on a soiled sheet on a bed, screaming.
The doctor, calm and compassionate, asked, “Do you have Pampers for her?”
The security guard shook his head.
He opened the pantry and showed us a single can of powdered milk.
We burst back into the Command Center. “Where’s the Major?”
The Captain raised an eyebrow at us. “He’s meeting with the folks from MSF.”
“We’ve just been to the observation house,” I started, my temper flaring again.
He raised the other eyebrow. “It’s bad, then?”
The doctor nodded.
“Very bad,” I said.
“How much ‘oomph’ do you have here?” asked the doctor, unsure of how high we needed to escalate the situation in the district.
The Captain gave us a look. He’d served in the Royal Artillery in Afghanistan. He’d volunteered to come to Sierra Leone to run the campaign against Ebola.
“Oh, I have enough ‘oomph’ to fucking fix this,” he said, and grabbed his phone.
Ten minutes later the Captain towered over the Child Protection Officer, and told him in no uncertain terms that he had twenty-five minutes to improve the observation house, or the Captain would close it permanently.
We have many discussions about residual post-colonialism in West Africa, and the long-lasting effects, positive and negative, that it brings to this country. Regardless of the outcomes of our dinner table intellectualizing, there is still unquestionably a color divide here. There are still benefits, implicit although unasked, that go with being white.
When the doctor drove back over to the observation house twenty-four minutes later, there were suddenly Pampers, clothing, milk, and a new survivor caregiver.
Child abandonment and overt racial disparities.
Yet another ordinary story of an ordinary day.