Life in quarantine: 21 days of fear

Posted on 25.07.2015.

It was not easy to get together with Solomon Samura for an interview. Not because I first to had build up his trust or because he did not want to talk to me - no, Solomon is always busy. So busy that it is hard to talk to him for more than the length of short phone talk. Fifteen-hour days are rather the norm than the exception for him. His bustle, his commitment and that one can not tell from looking at him how busy he is are probably his most defining characteristics. And yet, this text is not about his bustle, but about a three-week lasting break that Solomon was forced to take last year in August. Solomon is a community health officer in his home country Sierra Leone. The 30-year old works in a hospital, treats patients independently and performs minor surgical interventions like C-sections. When the Ebola Virus Disease (EVD) broke out in his country in May 2014 and spread quickly throughout the country within just a few months, he worked in the Government Hospital of Makeni, a city in the North of the country. “In the beginning of the outbreak there were only cases of Ebola in the Eastern Sierra Leone. Although we knew that the disease would most probably spread, we were not prepared when we started having suspected cases.” They had protective equipment (PPE) at the hospital, but did not know how to don and doff safely. For fear of getting infected, more and more of his colleagues stayed at home, when more and more doctors and nurses became Ebola patients in other parts of the country. EVD is transmitted solely through direct contact with the body fluids of an infected person that is displaying symptoms and the virus load increases with the progression of the disease. That is why doctors, nurses and care-giving relatives in particular got infected during the epidemic. Solomon, however, wanted to fulfill his medical responsibility and continued his work in the hospital. "As doctors and soldiers we fight as soldiers at the front against an invisible enemy. How could I leave the battle field, if it is my duty to fight?" He did not expect he would meet the disease at home. He shared a flat with three of his brothers and a friend, who also worked in the hospital. When his roommate Joseph complained about a headache on a day in August, Solomon was not particularly worried and simply gave him pain killers. When Joseph started showing other symptoms on the following day, Solomon got suspicious and insisted on admitting him to the hospital instead of giving in to Joseph's wish and keeping him at home. He took his blood for a test, but at that time, there was only one lab in the whole country that did Ebola tests and it always took a long time and many invalid results for every sample. As there was also just one treatment center throughout Sierra Leone, Joseph stayed in Makeni Government Hospital for the time being In Sierra Leone, hospitals usually only provide medical care, relatives and friends provide food and other care. Joseph's family lived far away and finally arrived in Makeni a few days after his admission. In the meantime, Solomon took care of him. “For several days, Joseph pretended that everything was alright and denied that he could have Ebola. But I heard him crying and throwing up behind closed doors and I knew he was not alright. Every day, Josep'hs condition worsened and Solomon anticipated that he would not survive. As his friend, he visited him several times per day, took along cold energy drinks so he could get new strength, he topped his phone up so he could talk as much as he wanted. As a doctor, he treated his pains, supplied his body with fluids and oxygen. “Shortly before Joseph fell into a coma, he wanted to use the restroom. I was always wearing gloves, but when he fell and I picked him up, our skins touched. Although we still did not know whether he had Ebola or not, I realized that this contact could have decide my fate - but how could I just watch him falling to the ground?” Only six days after his first headache, Joseph died in his mid twenties. One last time, Solomon and Joseph's relatives entered his room to bid him farewell. “When we left the room, his brother put his hand on my shoulder to show his gratitude. He was still wearing the gloves with which he had touched his brother only minutes before. To this day, I can feel the touch on my shoulder. When the lab confirmed a few hours later that Joseph had had Ebola, I knew had caught Ebola most likely. The only thing I could think about in that moment was the safety of my brothers at home and those close around me.” In August 2014, authorities were overwhelmed with the epidemic and the speed of its spreading. They did not yet quarantine every contact of an Ebola patient. But Solomon knew that he, his brothers and Joseph's family had to be put under quarantine for security reasons and took over the responsibility. He informed the authorities about the travel plans of Joseph's family and asked them to isolate the travelers. Indeed, Joseph's father and brother got infected, both died after a short while. He asked his own brothers to clean the whole flat with chlorine and to not enter Jospeh's room anymore. He picked up money from the bank and changed his clothes outside the house. He bought durable food supplies, drinking water and fuel for his motorbike. “In case I would develop symptoms, I wanted to drive to the treatment center myself. At that time, there were hardly any ambulances in the country and many people died on the wearing journeys.” At home, each person was assigned a chair, a cup, a plate and cutlery that only he was allowed to touch for the next three weeks as 21 days is the maximum incubation period of EVD. Each person was responsible for his laundry, no body contact was allowed and everyone had to check and note his body temperature three times a day. Solomon knew that he had had the closest encounter with the virus and prohibited his brothers to enter his room and use the same bathroom. Every time he left his room, he put on gloves and made sure that he never leaned against anything. Every day, they put money in a bucket filled with chlorine water for the neighbors who would then buy fresh food and drinking water for them and drop it on the door step. “I have never stayed inside for longer than three days. Three weeks seemed like an eternity. Added to this was the uncertainty, waiting for the disease.” In his mind, everything was turning around Ebola. Indeed, Solomon recognized a headache after the first week of quarantine. I am just stressed and tired, he tried to calm himself down. When a sore throat and muscle pains added to his headache, he became worried. “To this day, I do not know whether I had Ebola, but there are certain signs.” During the incubation period, patients are not infectious. The virus travels in the bloods and targets immune cells first, causing the immune system to overreact. After an average of eleven days after exposure, symptoms including diarrhea, skin rashes, muscle and joint aches begin abruptly and become increasingly severe. The symptoms appear differently and to varying degrees in every person. Although there is no cure for Ebola, the symptoms can be fought and increase the chance of survival, especially when the patient starts treatment at an early stage. To save his parents from worrying, Solomon did not tell them anything about Joseph, the quarantine and his malaise, but was closely in touch with two doctor colleagues. They dropped medication for him at the house and Solomon put himself injections and drips. He rested a lot, ate regularly and drank up to 10 liters per day to prevent dehydration. “On the first two days when I felt sick, I cried - but not for myself, but because I was worried about those that I would leave behind and that depend on my support. They would be the ones suffering.” There is no effective social welfare system in Sierra Leone. Those with a better education and higher income bear responsibility for other relatives. Solomon's parents would not have been able to afford to pay for his college fees, but his uncle Brimah recognized his potential and enabled him to pursue his studies. During his studies, he found a job and with his salary, he paid for his tuition. Today, although he is still in training for a surgical program, he is financially supporting four individuals. “My brothers were so afraid when they realized that I was not well. I calmed myself down to calm them down, but on one day I was feeling so weak and sick that I decided to call the hospital to pick me up. I do not know why, but when a colleague picked up, I just asked for an update and did not tell him anything about me.” In his faith, he found the strength and comfort to distract himself from the thoughts that revolved around the disease. “The quarantine brought me very close to God, nothing was in between me and God anymore. Day and night, I was reading my bible, learned verses by heart and researched. Whenever I felt strong enough, I stood up before him.” Solomon was born into a Muslim family and raised in Islam, but became a Christian when he moved to his uncle Brimah, who was a Christian. “It was a conscious decision to become a Christian and an inner conviction that this is the truth. With the years, my faith often drowned in day-to-day business and as doctor I often trusted my own skills and knowledge. During the quarantine, I realized that I am called to react responsibly, but that God is my only safety.” These thoughts are accompanying him ever since. On day 15 of the quarantine, Solomon felt his weakness decreasing. No government or health authority had ever come to their house to supply them with food, check on their health condition or to protect the neighbours. Solomon called a few journalists and gave an interview with some distance to them to draw attention to this weakness. “I knew how to react and voluntarily followed the precautions, but many do not know it. I wanted to inform publicly about that.” He neither noticed that one of the journalists was videotaping everything, nor that he made it to the evening news. Only when he received dozens of calls from friends and family, he saw the impact of his interview. Authorities also reacted quickly and appointed a police officer to stay at Solomon's house to make sure nobody left the house. “We still did not receive any food, but they must have realized what they failed to do.” Ebola was unfortunately far from being under control in August 2014, but escaping the danger was no option for Solomon. After his quarantine was over and he felt strong and healthy again, he resumed his work in the hospital and joined the Ebola emergency response a few weeks later. “Although I have been angry at my country fellows for reacting irresponsibly and enabling the virus to spread in such a way, I never thought about giving up.” A year after the first case of Ebola was brought to Sierra Leone, the number of infections has dropped drastically and authorities were able to establish a close network to react immediately to new outbreaks, but the country still struggles to get down to zero cases. Solomon is working again in a hospital, mainly in birth assistance. Such as he has learned important lessons during his three weeks of quarantine, he hopes that his country has learnt its lessons from the outbreak.


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The life after Ebola

Posted on 25.07.2015.