Tuesday, January 27, 2015

Day 4

This morning my plan was to walk briefly through the unit to introduce each patient to a newly arrived colleague.  We did not make it past the corpse in the second room.

I had admitted the patient yesterday from the triage tent.  He was a kind, well-spoken, middle-aged man, dressed in traditional Muslim garb.  A careful first look revealed several signs suggestive of Ebola infection: bloodshot eyes, painful hiccups.  He said that three days ago he had developed sudden onset fever, sore throat, overwhelming fatigue, and abdominal pain. I did not have to think twice before escorting him to the holding unit where his blood would be tested for the virus. I completed the admission paperwork and pulled on the layers of PPE before entering the unit to administer admission medications – ceftriaxone for possible bacterial infection, artemisinin for possible malarial infection, paracetamol for pain, metoclopramide for nausea and hiccups.  He looked sick and panicked.

Still, I was caught off-guard the next morning when I found him dead on the cot.  Long minutes feeling for a pulse, looking for a response to a deep sternal rub … nothing. After covering the body with a sheet, I told the other patients anxiously looking on from their beds that he had died.  We poured chlorinated water over the body and lifted him to a body bag on the floor. My muscles strained with the weight as I picked up one end of the stretcher and walked to the morgue.  

Back in the disinfectant room, we scrubbed our hands with extra vigor, knowing that infected corpses have incredibly high levels of Ebola virus.  Touching dead bodies carries one of the highest risks of Ebola transmission.

A few hours later, the deceased man’s young wife and father arrived to inquire for an update on the patient’s condition. No HIPAA  patient privacy regulations here; we stand in the center of the busy covered entrance to the hospital.  “I’m so very sorry, but he died this morning.  We are still waiting for the Ebola test results.” The father looked at me in mute disbelief and walked away. The wife stumbled to the sandy curb outside the hospital gate; wails and prostration; grief, intense and unreserved.

The blood test came back highly positive.  The burial team came in an ambulance to take the body to a guarded Ebola cemetery. The family could only watch from the fence, forbidden to perform customary funeral rituals.

In much of West Africa, funerals are of great cultural significance.  Merit as a person, as a family, is determined by how many people attend one’s funeral.  It is also widely believed that the recently deceased provide unique access to one's ancestors.  A funeral provides an opportunity to reconnect with the ones you have lost and to keep favor with departed souls.  Family and friends of the deceased demonstrate respect by cleaning the corpse and mourning physically over it. These beliefs cut across religion and socioeconomic status.

Due to the highly contagious nature of a corpse infected with Ebola, funerals of Ebola suspects have been banned. This policy has met stiff cultural resistance.  Frequently the family of a deceased person in our Ebola holding unit will gather in large numbers, pleading for us to release the body for a family funeral, sometimes tearful, sometimes angry, sometimes threatening. These conflicts between public health and longstanding tradition are emotional and difficult.  It is hard to deny a funeral to a mourning mother and not feel heartless.

Ebola strips people of their dignity, in life and in death.

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