To Be Triaged to the ETC and a Set-Back for Liberia

Our first patient was a six-month old baby brought in by his tired-looking mother, wrapped up in a worn lappa.  The baby did not breathe and once in a while, a gurgled breath rattled from the chest through his throat.  He looked lifeless.  Mom said baby had had trouble breathing for two days but according to her still nursing well as recently as this morning.  It was hard to believe a barely conscious child could be nursing.

For a while we were hesitant whether to let the mother and baby sit in a corner till he drew his last breath and informed the burial team, however a doctor from the hospital seemed to think the patient should be brought into the inpatient department.  There at least three quarters of an hour of resuscitative effort was performed with ambu bag and CPR.  Apparently his pulse returned and since there was no ventilator, no one could be squeezing the ambu bag for a prolonged period of time.  Eventually when there was no spontaneous respiration, the resuscitation stopped.  The baby was back to drawing a rattling breath every few minutes and there was still a flutter of a heartbeat.  The grieving mother was told there was no hope and she was quietly sad and tearful sitting in a corner with no other family for moral support.  Once the breathing and heartbeat stopped the hospital would inform the burial team.

The starving baby from yesterday was alert and drinking from a cup held by her mother.  There were still two thirds of the infant formula left. 

Back to triage, two women with their babies fulfilled the symptom criteria for the ETC but they had no Ebola contact.  They could just as well be any baby with gastroenteritis or malaria in ordinary time.  But these are not ordinary times.  Both women were robustly built and vocal.  After some time of waiting in the corner together, both of them came to the conclusion that they would not let their babies go to the ETC.  I probably would protest as well if I were the mother.  There is always a danger of exposing your child to patients with Ebola when he is staying for the few days in the ETC waiting for testing results.  Any mother would fear for her child and worse to be separated for days without the ability of any physical contact.

In the end the surveillance team came and agreed to let them stay home.  They would monitor them closely for symptoms.  The babies were discharged home with antipyretics and anti-malarials.

We learned from a woman that Ishmeil’s mother refused to admit him to Port Loko Hospital yesterday after his discharge from the ETC.  Last night this lady said Ishmeil was “trying to die”.  The last we heard he was brought back to the ETC. It might have been premature to celebrate his recovery yesterday as he did not seem to be out of the woods.  Ebola which has ravaged his immune system may still be waiting to claim its victim.

Liberia is no longer Ebola-free.  It suffers a set-back; a new case was reported after 20 days of being free from Ebola, a woman was diagnosed with the infection presumably through sexual transmission.