Diary from Angola's virus frontline
Apr 18, 2005
There was quite a lot of blood so we kept spraying our hands with the chlorine.
Medecins Sans Frontieres (MSF) has launched an emergency intervention in Uige province following an epidemic outbreak of Marburg disease, a fever similar to Ebola.
Zoe Young, an MSF water and sanitation specialist, arrived the town of Uige in the north-east of the country, which has so far been the town worst hit by the epidemic.
10 April, 2005
I am absolutely exhausted. Today I went into the isolation centre in Uige hospital for the first time. There are two zones, the low risk and the high risk. In the low-risk zone I changed into a medical scrub suit and put on some white boots and thin blue gloves. Then I put on the next layer of protective clothing.
You do it using a kind of buddy system where you check your partner has everything on correctly and hasn't forgotten anything. It took us ages to put our kit on and I was completely covered from top to toe. Not an inch of skin could be seen - just my eyes.
We walked into the high-risk area where the patients are kept. My specs and mask immediately fogged up so much that I couldn't really see.
I found that if I tilted my head and looked down my nose I could see through a small band at the bottom of my mask.
It was a horrible feeling being completely encased, crinkly sounds in my ears from the head protection, hot sticky hands under two pairs of gloves, tripping along because of my long rubber apron and not being able to see.
Body bag
Three people died yesterday and the only patient still left in the ward died this morning. Everyone was really sad as we had been hoping that she would survive.
Marburg is a viral hemorrhagic fever rather like the infamous Ebola. Most people seem to die within about two days of coming into the ward, but this patient had been here for a week. She was lying on her side on the bed in the ward for confirmed cases, covered up by various pieces of clothing.
We needed to put her in a body bag so that she could be buried. Body bags are used because even though the patient is dead they are still extremely infectious. To protect the burial teams who have to transport the body, it is really important that it is safely wrapped up.
We went back into the low-risk area for a while to cool down and rest before dressing up again from scratch. I was really dreading trying to move the patient since I was scared of what I might see.
We went into her ward with a spray machine filled with a very strong chlorine solution. There was a plastic fitted sheet on the mattress underneath her so we carefully undid it from underneath and wrapped her in it.
There was quite a lot of blood so we kept spraying our hands with the chlorine and moved very slowly and deliberately to avoid splashing. We laid out a body bag on the mattress next to her and then lifted her into it using the plastic sheet. It wasn't nearly as difficult as I was expecting: The body bag opened very wide so we didn't have to do lots of fiddling and pushing to get her into it.
I was down at the foot-end trying to avoid seeing too much, but when she was inside we wanted to make sure that she looked OK for when her family looked at her. She was curled on her side and looked like she was sleeping.
Patients
There have been quite a few cases that have been linked to the maternity ward of the hospital so we went in there this afternoon to spray everything. The virus is very sensitive to chlorine and soap, so spraying with chlorine solution is an effective way of cleaning.
All the nurses were wearing face masks and long plastic bags around their feet to make boots. We sprayed the floors, the walls and all the beds, and even the director's desk and papers - that was one of the spray men being a bit overzealous!
With everyone dressed up in full length gowns, aprons, masks, goggles, gloves and hoods, it is impossible to see who anyone is, so everyone has their names written on their aprons. We must have been in there for two hours at least, absolutely sweltering and breathing in the chlorine.
We are worried that no more patients are coming to the hospital because people are really frightened. I think that they are terrified of letting their loved one go into this place surrounded by plastic sheeting only for them to come out in a bag. So people are staying at home to die and being cared for by their relatives.
Most of the cases in the isolation ward so far have been women: Maybe this is because they are the carers and have taken care of a family member who was dying of the disease.
11 April, 2005
This afternoon we started training some new teams of local people to work on disinfecting and burial. We have a team that collects patients; a team that goes to the cemetery with the bodies and a team that goes to people's houses to disinfect the area where the patient was.
We explained the tasks of each team to the new recruits. I am not sure how they managed to persuade people to be on the burial team - I think that it must be the worst thing - going to people's houses and collecting the bodies, which are probably in a fairly poor way, with all the family members wailing and mourning. Then we gave a demonstration of how to put on the protective gear.
I did the putting on and taking off. It was like being an air stewardess, as I pointed to my mask and goggles and put everything on. Then we got them to try on the clothes themselves. I hope that they understood. They looked OK at the end, so they should be ready to start working tomorrow.
At about six o'clock we were told that there were two new patients coming in. Everyone bustled around getting things ready.
Finally the patients came in on stretchers and were carefully installed in the 'suspect' ward. It had been worrying us that patients hadn't been coming. On Saturday, the governor of Uige province was on the radio explaining about Marburg disease and what MSF is trying to do in the isolation centre.
One of today's patients came in with an attendant, who said that they had come to the hospital because they had heard the radio broadcast. This was really good news.
I am staying in a house with the rest of the MSF team. The house is fairly full as there are 17 of us. Everyone sleeps on the floor on mattresses, three or four to a room. I was lucky to get a space. There is no touching among us, so no good morning kisses or handshakes and everyone takes care not to sit too close to each other.
At the entrance is a drum of chlorine solution that we can use to wash our hands as we come in. All the plates and cups are washed first with soap and then with chlorine solution. It's strict but comforting.
MSF is sending more people out to help contain the outbreak. Soon we will go to Songo, north of Uige, where there have so far been nine confirmed cases.
14 April, 2005
Today we went to Songo, a small town forty minutes drive to the north of Uige. The hospital has about 100 beds and is freshly painted in blue and white. In front of the maternity ward they have planted flowers and there are pictures of cartoon characters on the walls. However, at the moment there are hardly any patients as they are scared of catching the disease, which they think is coming from the hospital.
As soon as we arrived we found out that someone had just died, probably from Marburg. We asked that a family member come to see us so that we could ask questions about the symptoms. She was the sister of the woman who had died and, although she had not touched the body, she had looked after the woman's child and so she was worried that she had caught the disease. She understood perfectly well what that meant. She said she was going to isolate herself to prevent anyone else from catching it.
The MSF doctor, Sophie, and I were lucky enough to find a nurse that spoke French to show us around (we are not far from the border with Congo here). We spent ages walking around the hospital deciding on a good place to make an isolation ward where patients from Songo can be held before being transferred to Uige.
One the way back to base, I stopped by Uige hospital to see what was going on. There was a team just going to collect a suspected case from the maternity ward. They needed someone to come with them with a spray machine full of chlorine, so I volunteered to do it.
The patient was in the maternity ward that we had disinfected just two days ago. She was on a bed in the corner, and was very quiet. I wasn't surprised, since it must have been terrifying having five people in full protective gear coming to get her. She stayed absolutely quiet the whole time. She was lying on a piece of plastic sheeting so the team was able to lift her carefully onto the stretcher and carry her into the isolation area.
15 April, 2005
I found out that the woman that we had taken from the maternity ward yesterday had died in the night. In fact they are now back down to zero patients in the isolation ward.
16 April, 2005
First thing this morning at breakfast we all took our temperatures. The alert symptom for Marburg is a high temperature, so now we are all going to take our temperature morning and evening. We are also taking malaria prophylaxis drugs because the symptoms of malaria are quite like those of Marburg so you can get a nasty fright if you suddenly get a fever. So every morning at home it is like a small dispensary as the doctor hands out our drugs.
We wash our hands with a fairly strong chlorine solution on the way into the house and all the dishes are rinsed in the same strength chlorine solution after being washed. The skin on my hands is all peeling off and they smell of chlorine all the time. I am sure I am going to get wafts of chlorine for days after getting home. Eau de Chlore.
When we arrived in Songo we found out that a woman had died in the hospital during the night. Her baby had been in the hospital about two weeks ago and had died last week. Sophie wanted to take a saliva swab before the burial team arrived so that we could determine whether she had died of Marburg but I was worried about how we would decontaminate ourselves and where we would put all the contaminated material afterwards. I certainly didn't want to put it in the car and travel back to Uige with it. It was frustrating not to know if this was definitely another case. We have now agreed that the burial team will go tomorrow morning so Sophie can go with them and take the swab.
This afternoon, I continued training our spray men in using chlorine to disinfect areas. Natalie, our logistics expert, wanted the new office building to be disinfected so it seemed like the perfect opportunity to give them some practical experience. They dressed up first in the protective gear and did quite well - they remembered all the steps and got them more or less in the right order. The room that we disinfected was absolutely soaked, with water running down the walls and forming puddles on the floor. I was quite pleased with their progress and tomorrow morning I hope that they can do the rest of the building before moving on to the real stuff and spraying some of the hospital wards.
Medecins Sans Frontieres (MSF) has launched an emergency intervention in Uige province following an epidemic outbreak of Marburg disease, a fever similar to Ebola.
Zoe Young, an MSF water and sanitation specialist, arrived the town of Uige in the north-east of the country, which has so far been the town worst hit by the epidemic.
10 April, 2005
I am absolutely exhausted. Today I went into the isolation centre in Uige hospital for the first time. There are two zones, the low risk and the high risk. In the low-risk zone I changed into a medical scrub suit and put on some white boots and thin blue gloves. Then I put on the next layer of protective clothing.
You do it using a kind of buddy system where you check your partner has everything on correctly and hasn't forgotten anything. It took us ages to put our kit on and I was completely covered from top to toe. Not an inch of skin could be seen - just my eyes.
We walked into the high-risk area where the patients are kept. My specs and mask immediately fogged up so much that I couldn't really see.
I found that if I tilted my head and looked down my nose I could see through a small band at the bottom of my mask.
It was a horrible feeling being completely encased, crinkly sounds in my ears from the head protection, hot sticky hands under two pairs of gloves, tripping along because of my long rubber apron and not being able to see.
Body bag
Three people died yesterday and the only patient still left in the ward died this morning. Everyone was really sad as we had been hoping that she would survive.
Marburg is a viral hemorrhagic fever rather like the infamous Ebola. Most people seem to die within about two days of coming into the ward, but this patient had been here for a week. She was lying on her side on the bed in the ward for confirmed cases, covered up by various pieces of clothing.
We needed to put her in a body bag so that she could be buried. Body bags are used because even though the patient is dead they are still extremely infectious. To protect the burial teams who have to transport the body, it is really important that it is safely wrapped up.
We went back into the low-risk area for a while to cool down and rest before dressing up again from scratch. I was really dreading trying to move the patient since I was scared of what I might see.
We went into her ward with a spray machine filled with a very strong chlorine solution. There was a plastic fitted sheet on the mattress underneath her so we carefully undid it from underneath and wrapped her in it.
There was quite a lot of blood so we kept spraying our hands with the chlorine and moved very slowly and deliberately to avoid splashing. We laid out a body bag on the mattress next to her and then lifted her into it using the plastic sheet. It wasn't nearly as difficult as I was expecting: The body bag opened very wide so we didn't have to do lots of fiddling and pushing to get her into it.
I was down at the foot-end trying to avoid seeing too much, but when she was inside we wanted to make sure that she looked OK for when her family looked at her. She was curled on her side and looked like she was sleeping.
Patients
There have been quite a few cases that have been linked to the maternity ward of the hospital so we went in there this afternoon to spray everything. The virus is very sensitive to chlorine and soap, so spraying with chlorine solution is an effective way of cleaning.
All the nurses were wearing face masks and long plastic bags around their feet to make boots. We sprayed the floors, the walls and all the beds, and even the director's desk and papers - that was one of the spray men being a bit overzealous!
With everyone dressed up in full length gowns, aprons, masks, goggles, gloves and hoods, it is impossible to see who anyone is, so everyone has their names written on their aprons. We must have been in there for two hours at least, absolutely sweltering and breathing in the chlorine.
We are worried that no more patients are coming to the hospital because people are really frightened. I think that they are terrified of letting their loved one go into this place surrounded by plastic sheeting only for them to come out in a bag. So people are staying at home to die and being cared for by their relatives.
Most of the cases in the isolation ward so far have been women: Maybe this is because they are the carers and have taken care of a family member who was dying of the disease.
11 April, 2005
This afternoon we started training some new teams of local people to work on disinfecting and burial. We have a team that collects patients; a team that goes to the cemetery with the bodies and a team that goes to people's houses to disinfect the area where the patient was.
We explained the tasks of each team to the new recruits. I am not sure how they managed to persuade people to be on the burial team - I think that it must be the worst thing - going to people's houses and collecting the bodies, which are probably in a fairly poor way, with all the family members wailing and mourning. Then we gave a demonstration of how to put on the protective gear.
I did the putting on and taking off. It was like being an air stewardess, as I pointed to my mask and goggles and put everything on. Then we got them to try on the clothes themselves. I hope that they understood. They looked OK at the end, so they should be ready to start working tomorrow.
At about six o'clock we were told that there were two new patients coming in. Everyone bustled around getting things ready.
Finally the patients came in on stretchers and were carefully installed in the 'suspect' ward. It had been worrying us that patients hadn't been coming. On Saturday, the governor of Uige province was on the radio explaining about Marburg disease and what MSF is trying to do in the isolation centre.
One of today's patients came in with an attendant, who said that they had come to the hospital because they had heard the radio broadcast. This was really good news.
I am staying in a house with the rest of the MSF team. The house is fairly full as there are 17 of us. Everyone sleeps on the floor on mattresses, three or four to a room. I was lucky to get a space. There is no touching among us, so no good morning kisses or handshakes and everyone takes care not to sit too close to each other.
At the entrance is a drum of chlorine solution that we can use to wash our hands as we come in. All the plates and cups are washed first with soap and then with chlorine solution. It's strict but comforting.
MSF is sending more people out to help contain the outbreak. Soon we will go to Songo, north of Uige, where there have so far been nine confirmed cases.
14 April, 2005
Today we went to Songo, a small town forty minutes drive to the north of Uige. The hospital has about 100 beds and is freshly painted in blue and white. In front of the maternity ward they have planted flowers and there are pictures of cartoon characters on the walls. However, at the moment there are hardly any patients as they are scared of catching the disease, which they think is coming from the hospital.
As soon as we arrived we found out that someone had just died, probably from Marburg. We asked that a family member come to see us so that we could ask questions about the symptoms. She was the sister of the woman who had died and, although she had not touched the body, she had looked after the woman's child and so she was worried that she had caught the disease. She understood perfectly well what that meant. She said she was going to isolate herself to prevent anyone else from catching it.
The MSF doctor, Sophie, and I were lucky enough to find a nurse that spoke French to show us around (we are not far from the border with Congo here). We spent ages walking around the hospital deciding on a good place to make an isolation ward where patients from Songo can be held before being transferred to Uige.
One the way back to base, I stopped by Uige hospital to see what was going on. There was a team just going to collect a suspected case from the maternity ward. They needed someone to come with them with a spray machine full of chlorine, so I volunteered to do it.
The patient was in the maternity ward that we had disinfected just two days ago. She was on a bed in the corner, and was very quiet. I wasn't surprised, since it must have been terrifying having five people in full protective gear coming to get her. She stayed absolutely quiet the whole time. She was lying on a piece of plastic sheeting so the team was able to lift her carefully onto the stretcher and carry her into the isolation area.
15 April, 2005
I found out that the woman that we had taken from the maternity ward yesterday had died in the night. In fact they are now back down to zero patients in the isolation ward.
16 April, 2005
First thing this morning at breakfast we all took our temperatures. The alert symptom for Marburg is a high temperature, so now we are all going to take our temperature morning and evening. We are also taking malaria prophylaxis drugs because the symptoms of malaria are quite like those of Marburg so you can get a nasty fright if you suddenly get a fever. So every morning at home it is like a small dispensary as the doctor hands out our drugs.
We wash our hands with a fairly strong chlorine solution on the way into the house and all the dishes are rinsed in the same strength chlorine solution after being washed. The skin on my hands is all peeling off and they smell of chlorine all the time. I am sure I am going to get wafts of chlorine for days after getting home. Eau de Chlore.
When we arrived in Songo we found out that a woman had died in the hospital during the night. Her baby had been in the hospital about two weeks ago and had died last week. Sophie wanted to take a saliva swab before the burial team arrived so that we could determine whether she had died of Marburg but I was worried about how we would decontaminate ourselves and where we would put all the contaminated material afterwards. I certainly didn't want to put it in the car and travel back to Uige with it. It was frustrating not to know if this was definitely another case. We have now agreed that the burial team will go tomorrow morning so Sophie can go with them and take the swab.
This afternoon, I continued training our spray men in using chlorine to disinfect areas. Natalie, our logistics expert, wanted the new office building to be disinfected so it seemed like the perfect opportunity to give them some practical experience. They dressed up first in the protective gear and did quite well - they remembered all the steps and got them more or less in the right order. The room that we disinfected was absolutely soaked, with water running down the walls and forming puddles on the floor. I was quite pleased with their progress and tomorrow morning I hope that they can do the rest of the building before moving on to the real stuff and spraying some of the hospital wards.
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