An Ebola Clinic Figures Out A Way To Start Beating The Odds
One reason the Ebola virus is so terrifying is that it's so lethal. Researchers estimate that the strain circulating in West Africa is killing upward of 70 percent of those it infects. Even among those getting care, as many as 64 percent are dying.
But some doctors in Sierra Leone say it doesn't have to be that way. An Ebola treatment facility in the capital of Freetown claims to have improved the odds of survival — with few resources and little money.
Sierra Leone's government set up the Hastings Ebola Treatment Center in some classrooms at a former police training academy. When we visit the facility, it's payday, and the workers who are lined up to get their wages seem particularly animated.
But the lively atmosphere also reflects the broader mood here. In the midst of a lot of bad news about Ebola — a surge of new infections, and way more patients than space to treat them — the workers at this facility feel like they're finally having some success.
Health workers are disinfected with a chlorine solution after treating patients at the Hastings Ebola Treatment Center in Freetown.
After losing about 40 of their 70 patients in the first week the facility was open, in mid-September, the staff at the facility realized they needed a new strategy for dealing with the dreadful disease.
"We said, 'no, this cannot continue — we need to do something,' " says Dr. Santigie Sesay, who coordinates treatment at the center.
At a brainstorming session, staff zeroed in on a key problem: dehydration. People with Ebola are wrecked with diarrhea, they vomit, and some may bleed.
"So we said, 'if we can replace the fluids that are being lost, we can definitely help these people,' " Sesay says.
The usual way to replace fluids is with an intravenous drip, but it can be dangerous to insert a needle into an Ebola patient. All it takes is one prick to infect a health worker. Plus, running IVs takes careful monitoring. So Sesay was advised against IVs when the treatment center opened.
Isatu Koroma bathes patients at the Hastings Ebola Treatment Center and helps to clean the facility. She wears full protective gear during her rounds.
"During our training, we were told that we are not supposed to to go into the vein," he says.
Still, the staff at Hastings resolved to give IVs a try — with their most experienced nurses inserting them.
To date, none of the workers have gotten infected. And the effect on patients has been dramatic, Sesay says. It's difficult to pinpoint survival statistics for any one center when the overall number of patients is small and the outbreak is still unfolding. But based on the data so far, he says, Hastings' death rate is way down.
"Out of every 10 patients, four will die, and six will come out," he says.
Sesay also has noticed another effect: The medical staff at the center has realized that the patients now have a fighting chance.
"Everybody has become very, very enthusiastic," he says. The staff started interacting with the patients more, even helping the weakest ones eat.
"We started talking to the patients. We even started bed-baths," Sesay says. "We became so motivated, and things changed drastically."
Isatu Koroma, who cleans the inside of the ward, says she's been pulling for an older patient — a woman who reminds her of an aunt of hers who had died recently of Ebola.
"I fell in love with her," Koroma says. "Because I love her like my aunt."
The woman was in bad shape when she arrived.
"She was so sick, so weak," Koroma says. "I go to her, encourage her: 'Please, you have family. You have your daughter.' "
Now, that woman is among about 60 patients who have been moved to the recovery area, just across the yard, where a worker is calling out the names of people who soon will be released.
The moment is bittersweet. These people have survived Ebola and get to go home, but a lot of them have lost close relatives.
One women in the area lifts up a baby high into the air. He's tiny.
"This baby has no mother or a father," the woman says.
Both of the baby's parents have died of Ebola. The woman has been caring for him, even though she doesn't know the little boy's name.
"I call him Mohammed," she says.
The woman has two children of her own waiting on the outside. Her kids, at least, will be getting their mom back soon.
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Transcript
ROBERT SIEGEL, HOST:
Researchers estimate that the strain of the Ebola - that is, of Ebola - that's circulating in West Africa is killing more than 70 percent of the people it infects, even among patients getting care, as many as 64 percent are dying. But some doctors in Sierra Leone, the current hotspot of the outbreak, say it doesn't have to be that way. An Ebola treatment facility in the capital Freetown claims to have improved the odds of survival dramatically. NPR's Nurith Aizenman visited and filed this report.
NURITH AIZENMAN, BYLINE: The Hastings Ebola Treatment Center was set up by Sierra Leone's government in some classrooms at a former police training academy. It's payday when I visit, and a young looking crowd of workers lining up to get their wages seem particularly animated. But the lively atmosphere also reflects the broader mood here. In the midst of a lot of bad news about Ebola - a surge of new infections, way more patients than space to treat them - the workers at this facility feel like they're finally having some success.
SANTIGIE SESAY: I am Dr. Santigie Sesay. And I am the coordinator for the Hastings Ebola Treatment Center where we are now located.
AIZENMAN: Dr. Sesay specializes in neglected tropical diseases. He says the center's winning strategy dates to mid-September, just after it opened. That first week was grim. They took in 70 patients and by week's end...
SESAY: About 40 died.
AIZENMAN: And to lose this many patients...
SESAY: We said no, this cannot continue. We need to do something.
AIZENMAN: At a brainstorming session staff zeroed in on a key problem; dehydration. People with Ebola are wracked with diarrhea, they vomit, they may bleed.
SESAY: So we said if we can replace the fluids that are being lost, we can definitely help these people.
AIZENMAN: But the usual way to replace the fluids - an intravenous drip - can be dangerous to insert in an Ebola patient. All it takes is one prick from a contaminated needle to infect a health worker. And it takes careful monitoring to run IVs. According to an expert from the U.S. Centers for Disease Control and Prevention whose here in Freetown, IVs aren't in routine use at treatment centers in this country. Sesay says he was advised against using them.
SESAY: During our training we are we told that we are not supposed to go into the vein.
AIZENMAN: Still, the staff at Hastings resolved to give IVs a try. They had their most experienced nurses insert them. To date, none of the workers have gotten infected. As for the patients, it's difficult to pinpoint survival statistics for any one center when the sample size is small and the outbreak is still unfolding, but, based on the data so far, Sesay says Hastings' death rate is way down.
SESAY: Out of every 10 patients, 4 will die - 60 percent are cured and 40 percent will die.
AIZENMAN: Sesay also noticed another effect. The workers at the center - the nurses, the support staff - once they realized the patients had a fighting chance.
SESAY: Everybody became very, very enthusiastic and we started talking to the patients. We started giving bed baths. We started feeding our patients. So it was really - we became so much better and things changed drastically.
AIZENMAN: Some workers in protective suits who've just come out of one of the wards spread their arms while a colleague sprays them with chlorine. A young woman in blue scrubs and gold hoop earrings strolls by. Her name is Isatu Koroma, and she's responsible for cleaning inside the wards. She says she's been pulling for an older patient - a woman who reminds her of an aunt, who died recently of Ebola.
ISATU KOROMA: I fall in love with her because I love her like my aunt.
AIZENMAN: The woman was in bad shape when she arrived.
KOROMA: She was so sick, so weak. Not herself - less and less herself. I go to her, encourage her - please you have a family, you have your daughter. Yeah.
AIZENMAN: Now that woman is among about 60 patients who've been moved to the recovery area. It's just across the yard. A throng of these patients gather by a blue tarp fence, keeping them in the red zone, their heads just visible above it, while a worker stands on the other side yelling from the safe zone. He's holding a clipboard and calling out for names and addresses. Release is coming soon. But the moment is bittersweet. A lot of these people have lost close relatives. I ask how many. One girl holds up two fingers. A woman next to her holds up four. Then another woman lifts a baby high into the air so I can see him. He's tiny. Both of his parents have died of Ebola. She's been caring for him even though she doesn't know his real name. I ask, what have you been calling him?
UNIDENTIFIED WOMAN #1: Mohammed.
AIZENMAN: Mohammed. She has two children of her own waiting on the outside. She's glad that she's one of this center's success stories. Her kids, at least, will be getting their mom back soon. Nurith Aizenman, NPR News, Freetown. Transcript provided by NPR, Copyright NPR.
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