Psychosocial Issues

The ETC in Lunsar

 As part of my training this morning, we had a psychosocial session.  The psychosocial team deals with issues among family members when some become infected with Ebola and have to be separated, loss, placement of surviving members of the family.  In Sierra Leone the Paramount Chiefs are the sole authority over the Chiefs of the Chiefdoms which comprise of villages,  each village has a Village Chief followed by a Mama Queen and a Youth Leader. The psychosocial team always has to work with the Chiefs to get acceptance of the patients back to their own villages.  The villagers tend to listen to the Chiefs.  

Recently the stigma attached to a single Ebola infected patient has now been transferred to an entire Ebola quarantined village or area.  Ebola survivors once shunned by their own village now are welcome back because they are being supported by NGOs with food, clothing, beddings, and a stipend of 500,000 Leones a month.  It is the custom of Sierra Leoneans to share what they receive so some relatives may potentially benefit from their home-coming.  They continue to have problem with loss of livelihood as few people would buy produce from Ebola survivors.

A quarantined village is guarded by soldiers or police.  Food is delivered by NGOs and pushed into the cordoned area.  Sometimes the delivery did not come on a timely manner and so the psychosocial team will have to advocate for them.  However if one person in the quarantined village comes down with Ebola, the rest will have to restart their quarantine period from day one all over again.

Sierra Leoneans treat their sick ones with a lot of care and love.  The sick person becomes like a child, he is washed and fed, made to lie down on someone’s lap while his head and body are stroke and touched.  A dead person has to be washed and touched before the burial.  Ebola has changed all that.  There is to be no washing or touching.  Here in the Lunsar ETC, there is no cemetery, so patients’ bodies are taken away to be buried either in Lunsar or Port Loko cemeteries.  If a patient is from very far away, the relatives will have to make do with a distant burial site.  If they could not attend the burial, they would be given the plot number so they could pay a visit to the grave site at a future date.  I am very appreciative and thankful of the proximity of the grave site in Bong.  

Attending burials of some of my patients and visiting the cemetery to reflect seemed to give me some closure of the emotional aspects of volunteering in the ETU.

Evidently fear and distrust of authority continue to be pervasive.  Accordingly to the psychosocial person in charge here, as recently as 2 weeks ago in a village in Makeni in Bombali District, a couple put their sick child secretly in a separate hut with no care and little food and she died a few days later. When officials came to the village for a headcount, they recruited another girl.  Fearing that they could be found out by the Village Chief and be fined, in the dead of night they tried to throw her body into a latrine which was too small.  In desperation they contrived to dump her body in a well but were caught.  

Despite counseling to abstain from sex for 90 days after being Ebola-free, a young man had sex with his wife who contracted Ebola, he is being held on a charge of intent on an act of grievous bodily harm.

In November of 2014, UNICEF helped to create the District Ebola Response Centre (DERC) for the Western Rural District where the Ebola transmission is still ongoing.  In order to bring Ebola cases to zero, many community social mobilizers have been trained to look out for Ebola cases for prompt medical response.

Finally in the late morning I donned and went into the ETC with two other doctors.  Today there are only 7 patients, 4 in the Confirmed Ward and 3 in the Suspected Ward where Joseph was later admitted.  Mamusa, a young lady in the Suspected Ward, is mainly weak with a fever and has to be encouraged to eat and drink.  We urged the caretaker to help her in our absence.  Here the Ebola tests are sent to Port Loko, half an hour away, but may take up to a day to get the results back.

The Probable Ward remains empty.

In the Confirmed Ward, Fatmata 1’s neck is like a bull frog today with swollen lymph nodes, she is unable to open her mouth wide enough for us to see her pharynx.  We started her on antibiotics: ceftriaxone and clindamycin yesterday afternoon.  Her fever persists.  Because of her pain I am leaning more towards a bacterial than a tubercular lymphadenitis.   

Augusta’s Ebola test turned negative on Valentine’s Day on day 12, she would have to wait for 48 hours to get another test before she is declared Ebola-free.  Sullieu and Gabriel remain stable.

We finished rounds in less than an hour.  Prior to going into the ETC while I was attending the psychosocial lecture, the doctors had gone around outside of the ETC in scrubs to round on the stable patients by talking over the fence querying them about their symptoms.  This helps to curtail the length of time spent in the ETC in full PPE.   The sick ones who remain in bed would be attended to in more detail later inside the ETC.  Here in Lunsar, one is not allowed to stay in the ETC for more than an hour and a half.

The white tents of the ETC are sweat boxes and there are no windows for cross ventilation or fans.  The very sick patients, who stay inside, sweat profusely.  This makes hydration even more urgent.  

After rounds I was shown the charting for the patients and transcribing of the signs and symptoms called over the orange fence in the morning.  There was no such consistent charting in Bong, at least out of the ETU, all our charting was done inside and the charts remained inside the ETU and we could not review them at leisure.  This also made our rounds in Bong much longer because of the documentation and ordering done inside.

Now that I have been through the ETC twice, I will be put on the schedule with the rest of the doctors starting tomorrow.  I am assigned the afternoon shift.

In the late afternoon back in Bai-Suba, I fed the baby lamb some blades of tender grass, she followed me and gamboled joyfully.  I saw her playing with a crow a few mornings ago.  She must be lonesome for a playmate.

Feeding Shikira