Ebola Diary: On the Ground in Sierra Leone
A CDC fellow shares her experiences tracking the spread of the Ebola virus in West Africa.
Kimmie Pringle, MD, an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention (CDC) and board-certified emergency medicine physician, began her 4-week rotation in Sierra Leone on the morning of Sept. 24.
Pringle's mission, along with her 11 colleagues at the CDC, was to track the spread of the Ebola virus and to break the chain of transmission between contacts. This meant traveling to isolated villages where foreign healthcare workers were not always welcome, wrestling with heart-breaking decisions to protect staff and patients, and leaving far sooner than she would have liked.
From the moment Pringle's journey began, she never stopped trying to understand the harsh, beautiful, and complicated world she'd stepped into. Pringle witnessed the anger, fear, and suspicion pervasive in parts of West Africa, particularly in regions that have experienced years of violence and loss, but still she saw hope.
Pringle has chosen to share with MedPage Today excerpts from her "diary," a series of emails to friends, to illustrate the daily triumphs and challenges of life as an epidemiologist working in Kenema, Sierra Leone, and the surrounding countryside.
Through these letters, Pringle shares the pivotal moments of her journey, the days when she felt frightened and powerless, as well as the moments where she drew strength from the warmth, the dedication, and the resilience of her colleagues.
Pringle left Sierra Leone in late October, but the war on Ebola continues. As new and old friends soldier on, she remains optimistic that their unflagging commitment and perseverance in fighting the virus will ultimately prevail.
NOTE: This "diary" has been edited for length, clarity, and the security of certain individuals. When names or places have been changed those changes are indicated with an asterisk.
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Hungry Patients, Fighting the Fear
Sept. 26, 2014
I remember my first climb up the hill from our office to Kenema Government Hospital (KGH). There were several stray dogs, basking in the sun lazily. I actually thought to myself, "Just enjoying themselves. So peaceful." Then, out of nowhere a hospital employee, a family member?... An adult bearing a metal rod came out and smacked one of the dogs right on the ribs. It yelped in pain jumped up and scrambled off. The other three dogs did as well.
Kindness also wasn't shown to a mentally ill patient who was found unzipping body bags in the morgue and was chased down outside our office and then beaten with sticks by hospital security. Maybe the constant stress, lack of resources, grief turned to anger resulted in these aggressive actions. Maybe it's that the country just came out of a brutal civil war in 2002.
Looking around at Sierra Leonians, one sees a lot of hardened faces. But that is not my experience with Gladys, the Sierra Leonian who runs the Psycho-Social Wellness program out of Kenema Government Hospital. She's about my height, has a beautiful smile, wears a wig with a stylish short haircut, and says "Ka-mmy. Ow are YOU?"
Gladys is responsible for the discharged Ebola patients. She along with her team of four people have a small room that is kept incredibly neat. Everyone who enters is required to wear plastic shoe covers. Chairs line the walls, plastic mats are available for the discharged patients to sit on, and a terrible Nigerian soap opera is always playing on a small TV in the background.
That day, Gladys was looking after a teenage boy there, Adom.* He was waiting for his brother to become negative so that they could travel back to their neighboring district together. During that visit, I also learned that Adom had only had sodas and biscuits since his discharge and that he had no means of getting food.
Gladys and I came up with a plan. She said, "Ka-mmy! My sista' is good wid da cooking."
After taking a trip to the local market (where bare-handed women tend to young children laying on a nearby floor or sometimes next to the fish!) we purchased fish, rice, peanuts, spices, oils, and onions and gave them to Gladys' sister.
The next day, Adom came back to the wellness center and he and four other patients were served a delicious hot meal, ground nut stew ... Though Adom usually looks away when you ask him a question ... he has the most beautiful smile and the most perfect teeth I've ever seen. He was smiling so big that afternoon it was great.
Sept. 30, 2014
Given the number of cases in Sierra Leone and the survivors reintegrating into communities, one would assume that Ebola would be known across the country no matter how remote. Not so.
We learned that a 29-year-old woman from a neighboring town had presented to a trained birthing assistant (TBA) at a center in a village Northwest of Kenema. The woman was 28 weeks pregnant with vaginal bleeding. She walked there in the late afternoon leaving a trail of blood behind her. A man from her home village, who accompanied her, left quickly after she was received.
The patient came from a community with over 20 positive Ebola patients and was also febrile. Alarm bells started going off for the birthing assistant. The assistant attended to the woman with the only personal protective equipment (PPE) she had, gloves. She said the woman expelled the fetus but hemorrhage continued despite giving methylergonovine. She gave her oral rehydration solutions (ORS) for fluid loss and called an ambulance, but the woman died overnight a few hours later.
The next morning the birthing assistant found dozens of people from the neighboring village gathered outside of the health center. They began shouting at her. They accused her of not helping the woman.
Our job was to explain to the community that the woman's corpse had tested positive for Ebola and to try and get a complete list of contacts.
Mark,* a very experienced case investigator, explained to the chief that we were there because the woman had tested positive for Ebola. The village elders disagreed: "She had a miscarriage, not Ebola!"; "You are here to defend and protect the [the birthing assistant]!"
We explained that Ebola can cause miscarriages and that the case did test positive.
The chief's circular arguments continued for hours. Around 4 p.m. without progress made, I was thinking of the return trip home and driving on some of those tricky roads after dark.
Finally, the leaders agreed to give the ages of the village contacts we already had listed (no new contacts, but this was a small and important step!). This clearly divided the community. The crowd around us seemed to be getting louder and more emotional.
In front of us was a ridge signaling the beginning of the road -- the only road out of the community. On that ridge stood the people of that community and behind that line of people was our car. They were clearly upset regarding the decision of the leaders. There was a lot of shouting. I couldn't understand the content, as they were speaking in the local language, Mende. I don't consider myself an alarmist when it comes to security, but I whispered to Mark, "Are we safe?"
"Yes! Of course! Why not?!" he said under his breath and confidently smiled at me.
The crowd let us through respectfully, and we got into our car without a problem. They were more angry at their leaders than at us. We left with an invitation to see the paramount chief.
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