Worker PTSD

It would be crazy to say that being here in Ebola land does nothing to your psyche.  I think of the hundreds of workers who have been here for some months, trying to make a difference in a terrible disease.  But most of us are not used to having 60-70% of our patients die, the statistic that seems to be relatively steady in our treatment center.  The only thing that gives us the impression that we are making any difference is by looking at the total number of patients, and factoring those into our psyche.  For example, the other day, we discharged 6 patients from the center in 1 day, but all of them were Ebola negative from the beginning, so they never had the disease.  So although it seems like some progress is being made, it is a false mirage, one that promises water without delivering any.  The disease itself continues its terrible rampage, and the benefit of our treatment center may be in getting those with Ebola out of the community, more so than actual benefit to those patients.  

So far, in this blog, I have avoided giving much personal introspection, and have made it more of a travelogue.  However, the individual cases eat at your insides, and linger long after the patients die.  Yesterday, we admitted the husband of “Fatimata” (not her real name).  She died last week, after the battle was lost. We thought that she might be the very first pregnant lady to survive the disease in our clinic, and for a couple of days, it looked like that she would make it.  But then, she rapidly deteriorated and died over the course of a couple of more days.  And so now, here comes the husband.  What about the 4 children who are at home, wondering if they will get to see Dad again?  One of his symptoms is hiccups and bloody diarrhea, and both of these are not good signs….I am certain that he will be positive, (he was) and the question is--will he make it home and return to his family?  ...This randomness of death and destruction plays with your mind.  I think of one doctor who was a pediatrician here who stated that he had certified more deaths here in 6 weeks than he had in his entire career up until now.  In Family Practice and ER work over the years, I cannot say the same, but the degree of deaths and percentage are like no other disease that I have seen. And so all of us are weary in a way that defies compartmentalization. We absorb all of this into our psyche and it wears you out emotionally.

We discharged “Mamood” earlier this month….Mamood’s mother had died in our center, and it appeared that the disease might escape the rest of the family, when a week went by with no problems...but I remember the day that Mamood and his father were both admitted to the unit.  Both of them walked in, but only one walked out--the orphan Mamood, at age 8 facing an uncertain future.  Will his village take him under their wing? It certainly seemed that way when they returned him to his village.  We hope that they will take over for his absent parents.  But what really will happen?  These are the questions that haunt, and we know that this same scenario has happened so many times over the past months here in Sierra Leone, Liberia, and Guinea.  

These are the questions rolling around in the back of the mind, as I trudge through the Ebola ward tonight.  The questions roll back and forth, and do not go quietly into the night..

Here are photos from the ETC.  Here is the main street in the compound

The Probable Ward across the red fence

Inside the medical tent, where charting and computer work is done

Looking towards the psycho-social department from the medical tent

The doffing station, where we take off our Personal Protective Equipment

This is the Suspect Ward in the background, and on this side of the fence, the donning station, where we put on our PPEs

Boots drying in the sun, ready for reuse

Pharmacy tent