Death and danger on the seething frontline of Ebola THE...

Death and danger on the seething frontline of Ebola

• THE AUSTRALIAN
• OCTOBER 04, 2014 12:00AM

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Jamie Walker

Associate Editor, QLD
Brisbane
https://plus.google.com/114365888741891144205/

Cairns nurse Sue-Ellen Kovack before her mission to Sierra Leone. Picture: Brendan Radke.Source: News Corp Australia
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WHEN the ambulance pulled in from Freetown, Sue Ellen Kovack was already waiting. Sweating in her head-to-toe safety suit, double gloved and masked, the Cairns nurse reached out to the desperately sick man lying on a stretcher in the back. He raised one leg, then the other, and lowered them slowly, exhausted by the effort.
Then he died.
A woman, aged 32, was strapped to the seat beside him. During the bumpy, five-hour road trip, she had slumped to the floor, still in her harness. Kovack will always be haunted by the expression on her face — “sheer terror mixed with helplessness”. Carefully, they lifted her from the ambulance and someone asked: Are you married? “Yes,” she whispered and looked away. Beyond all help, she too died.
“Ebola is a brutal disease,” Kovack says, describing her worst day in Sierra Leone after she joined the international effort to check the spread of the lethal haemorrhagic fever. The number of infected is increasing exponentially in the hot zone of West Africa, and an outbreak has erupted in the Democratic Republic of the Congo, 2000km away, while the world looks on, aghast. US epidemiologists fear the death toll could top one million.
Yes, help is on the way. US President Barack Obama is sending in a 3000-strong contingent of military personnel to buttress local health services and the foreign aid workers who have fought a tenacious but losing battle to contain the epidemic, and the Europeans are also putting boots on the ground, something at which Australia so far has baulked.
INTERACTIVE: Ebola red zone
Kovack, 56, is with the International Red Cross. For a month, she has been in the frontline at Kenema, a tumbledown town of iron-roofed huts and dirt streets in the south of Sierra Leone, 180km from the capital.
“I had many different ideas of what to expect before I left Australia,” she tells Inquirer. “My imaginations have given way to the realities and I have to take this back with me. The destruction and devastation of entire family groups is difficult to swallow.
“We had a lovely lady, Lucy … in the hospital, who has lost her husband and all her children to this disease,” Kovack says. “Yet she greets me with a massive smile each morning to ask me how I am, if I slept well. ‘How’s the body?’ she asks. Wow! The ravaging illness … I was expecting, but not this resilience. It breaks my heart to see what people are going through.”
Anaesthetist Jenny Stedmon, who is in home quarantine in Brisbane after returning from Kenema, also with the Red Cross, is still trying to process what she experienced. At 55, she has worked in war zones in sub-Saharan Africa, the Middle East and treated typhoon victims in The Philippines. Nothing, however, prepared her for the creeping horror of Ebola. “It’s not getting any better,” she says quietly. “You almost have this expectation that you are going to see a corner, that you will see some improvement in the situation. The reality is I didn’t see any improvement … in terms of the disease stopping or going away. It is like it is here to stay.”
Stedmon usually works in a surgical team. In Kenema, her advanced medical training counted for little. To begin with, she helped triage patients at the local hospital, which was overwhelmed by the sick and dying. A temperature is the first symptom of Ebola, but that also applies to malaria and yellow fever, endemic to the region. Those who admitted to having had contact with an Ebola sufferer or who showed other signs of infection, such as vomiting and diarrhoea, were sent to an isolation centre, with varying degrees of success. When Stedmon arrived five weeks ago, just ahead of Kovack, patients regularly were fleeing.
Her next job was to help set up a containment camp in a clearing outside the town. Ringed by a thigh-high orange fence, it has two clusters of tents: a dreaded high-risk area for confirmed cases and separate space for people known to have been exposed. She was soon nursing patients with Kovack. The medical staff wear full PPE — personal protective equipment of rubber boots, tear-resistant coveralls, apron, gloves, hood, mask and goggles. Not a sliver of skin is to show.
In the cloying heat, they can stay suited for only 45 minutes at a time, knowing that a single slip can put their own lives at risk. “I am not afraid of the Ebola virus while I am protected in my PPE,” Kovack says. “My fear is getting tired, making a mistake or other people making mistakes and having to suffer the consequences. Indeed, it can be terrifying.”

WHAT horrifies Stedmon most is that the death and suffering could have been averted by soap and water. The time to strike Ebola is when it is in the open, before it finds a human target; the virus has a fatty, proteinaceous layer that can easily be penetrated, killing it. Household detergent or antibacterial hand wipes will do the job. A chlorine solution is best, and that’s what the medical staff use. They shower in the chemical every time they climb out of their stifling PPE suits and douse their hands constantly with solution.
The tragedy is that Sierra Leone is so impoverished that chlorine has had to be imported since the epidemic took hold. “If people had access to it in the towns and villages from the start, I think things would be very different,” Stedmon says. Scientists know where and when the outbreak began, and how it probably broke into the human population on an unprecedented scale.
Ground zero is the tucked-away village of Meliandou, in the forest region of southern Guinea.
Traditionally, locals consume so-called bushmeat culled from whatever they can hunt, including monkey and squirrel. But years of civil war caused massive population displacement, hitting the availability of game. People have turned to eating fruit bats, which carry the Ebola virus in addition to other dangerous diseases (think rabies and Australia’s own Hendra disease).
The index patient, a two-year-old boy from Meliandou, is believed to have come into contact with an infected bat last December, perhaps as it was being prepared for the pot. His pregnant mother was stricken, followed by his sister, grandmother and a house guest. When the woman miscarried, her midwife was exposed, starting the slow burn that became a wildfire, exploding into neighbouring Sierra Leone, Liberia, Senegal and, worryingly, Nigeria, Africa’s most populous country. Fortunately, the outbreak there appears to have been contained.
Sierra Leone has reported about one-fifth of the 3338 known Ebola deaths to date, from a total of 7178 cases, surpassing the combined toll from all previous flare-ups. The virus can be transmitted only directly — that is, through the bodily fluids of an infected person. Theoretically, that should slow it down. However, the count of the infected is doubling every three weeks and on worst-case modelling will hit 1.4 million by mid-January.
Going by Stedmon’s grim experience, 70 per cent will die.
She did what she could, of course, but that was precious little, given there were so few resources. The vaccine for Ebola under development in the US and in Britain is a distant dream in Africa. The aim is to keep patients alive for as long as possible in the hope their immune systems will rally. The virus takes between three and 14 days to incubate, and can’t be detected until symptoms emerge.
Patients should be put on an intravenous line for hydration and sustenance as they fight, but no IV drips were available. Instead, Stedmon would take them in her arms and help them sip oral rehydration fluid or to swallow a bite of food. The crunch would generally come on the eighth day after symptoms appeared. That was do or die. If the person got through to day nine, they would have a good chance of recovering. “It’s extremely confronting,” she says.
While Stedmon plays down the danger she faced, it was very real. A drop or two of a patient’s sweat can infect someone else if, say, they were to rub an eye or scratch their nose with a contaminated finger, providing entry to the virus. Medical staff are instructed to keep hands away from their faces — no easy feat when you are sweating buckets in PPE. They work in teams of three or four to watch each other in case a set of goggles slip or some other breach in protection occurs.
To be blunt, there is no avoiding the mess an Ebola victim makes: Stedmon’s apron and suit were routinely splattered.
“Of course you are going to get contaminated,” she says. “But I never had an occasion when I thought my PPE wasn’t good enough … we were in a high-risk area, touching patients, so … we just got on with it.”
Getting home was more of an ordeal, in her view. Air France suspended services to Freetown two days after she landed in Sierra Leone, so she had to make her way to the border by road, be paddled across a swollen river by canoe, hitch a ride on a UN cargo plane to the Guinean capital, Conakry, where she linked into a succession of connecting flights to Brisbane. The journey took four days. When Inquirer caught up with Kovack on Wednesday, she was running for the bus, setting out on the same trip. She will not reach Cairns until tomorrow.
Will Ebola follow them to Australia? State and federal public health officials say it’s unlikely, but the emergence of a case in the US shows it is possible.
Worryingly, the treatment of Liberian man Thomas Eric Duncan, 42, was bungled after he presented to Dallas’s Texas Health Presbyterian Hospital on September 25.
Although he told the charge nurse where he was from and complained of fever and abdominal pain, which should have rung alarm bells over Ebola, he was sent home without seeing a doctor. He returned, dreadfully ill, three days later and was finally diagnosed.
Customs officers are the first line of defence in Australia, and they quietly take aside anyone off a flight from West Africa or the Democratic Republic of the Congo.
As of September 24, 578 passengers had been interviewed, five of whom were referred to specialist quarantine staff before being cleared.
Every international airport in the country has a contingency plan, with a hospital and the ambulance service on standby. In Queensland, the state government is equipping two retrieval aircraft with medical “isopod” units in case an infected traveller arrives before becoming symptomatic, as Duncan did in the US, and needs to be flown to Brisbane for treatment.
The preparations were tested three weeks ago when a man on the Gold Coast, recently returned from the DRC, complained of being ill in what turned out to be a false alarm. But Queensland chief health officer Janette Young insists the scare demonstrated the effectiveness of procedures now in place around the country.
“Things can always happen, but you have to go with the likelihood of them happening, and I think it’s unlikely we will get Ebola here,” she says.
In her parting message from Sierra Leone, Kovack says Australia should take no chances and fight the disease where it broke out, before it has the opportunity to arrive on our doorstep. Ebola kills quickly and without discretion, she warns. “The world really must urgently help now” — to help itself.