Day 7

25.01.2015

My temperature is 101, and my abdomen cramps painfully. I have many explanations for this.  It was a particularly warm day today.  I worked out earlier – morning run, then lifting weights in the local hotel gym.  I got a bit of heat exhaustion being out in the sun, maybe a touch of sunburn.  I had a few bouts of loose stools in the past few days, almost certainly run-of-the-mill traveler’s diarrhea.  A low-grade fever is not surprising.  But I can’t deny that if I came into the triage tent right now reporting fever, abdominal pain and loose bowels, I would be admitted to the Ebola holding unit for testing.

I carefully review my actions over the last week.  No known breaches of PPE in the holding unit.  Very limited physical contact with anyone outside the unit; shaking hands and social touching has become taboo in Sierra Leone since the Ebola outbreak.

My suspicion that I have Ebola is very low, almost zero.  Nonetheless, I am sitting on the edge of my bed, obsessively checking my temperature every 5 minutes.  I pop some ciprofloxacin from my travel medicine kit.

I start meticulously outlining all contacts in the last 48 hours, since the time of my first symptom onset.  In the off chance this is Ebola, this information will be critical to the contact tracing team run by the Centers of Disease Control (CDC).  Running through the events of the last 48 hours, I can think of 26 possible contacts.

I check my temperature again – still 101°F (38.2° C). 

Per our organization’s protocol, I call the doctor on call.  Keeping my voice steady, I outline my symptoms.  We discuss my options – I can stay quarantined in my room with strict orders to call again if symptoms progress, or I can go to the Ebola Treatment Unit (ETU) just out of Freetown which is designated for ill healthcare workers.  This ETU is run by the UK military and boasts state-of-the-art facilities.  I would be admitted to the ‘suspect tent’ where my blood would be tested for malaria and Ebola, and my stool for common pathogens.  I would get a line and IV fluids and any needed supportive care.  It’s a comfort to know such a place is close nearby, but it rankles that the standard of care is so different for me, a mildly ill Western aid worker, than for the many far sicker Sierra Leonese patients that come to our facility for care. 

I opt to stay in my room and re-evaluate in the morning.  I don't sleep well, but in the morning my temperature is down to 99.6°F (37.5°C) and my symptoms are tapering off.  A boring day at home, and I am ready to be back at work the next day.  

In the era of Ebola, even a simple febrile illness causes much anxiety.