Triaging Day at St. John, Mabesseneh

I was triaging with the nurses and a doctor at St. John’s Hospital today.  We triaged through a wide window pane with the patients sitting in a separate room.  The doctors in the OPD have to have a lot of faith in our triaging to rule out possible Ebola patients.

Outside St. John

In the morning right in front of the hospital were chairs set up for patients waiting to be seen.  If there were “wet patients” those patients would be triaged first and the area decontaminated.  Today we had none.  At least twenty patients were already waiting patiently, they were quite well dressed and one woman in particular stood out, dressed in bright fuchsia traditional clothes with a headdress to match.  She sat bolt upright on a stool, smiling.   There were women with young children all waiting to be seen.

Our very first patient was brought in by her parents who looked quite concerned and worried.  The mother was unable to tell us her baby’s age, we guessed three months.  She had been having profuse diarrhea for two days, refusing to breast-feed.  She had no fever or vomiting and her parents denied any Ebola exposure.  Her sunken dry eyes, dry mucous membranes and limp body betrayed severe dehydration.  We asked mom to try breast-feeding her but the baby was too weak to do so.  We trudged to the hospital to look for a doctor to administer IVF but were told that the doctor was in a meeting.  Across from the out-patient department (OPD) we spotted some official looking people and went over to them.  Two foreign doctors with partial PPE approached us and one of them immediately took the reign and instructed one of the national healthcare workers to get ready to admit the baby.  I hope we did some good today.

As we made our way back to the triage area, we ran into a young woman with her four month old baby, sick for 5 days.  The baby was breathing very rapidly and showed abdominal retractions.  We sent her along to the OPD doctor.

Throughout the morning into the early afternoon, we triaged 39 patients and none of them were suspicious cases for Ebola.  They were all sent to the OPD to see the doctors at St. John.

In the afternoon, I went to the Pediatric Ward to check on the little babies.  I heard wailing coming from one of the rooms.  A young woman sat on the floor leaning against the wall, crying loudly, wiping her eyes with her wrapper.  She was inconsolable.  Her four-month-old baby, Mariatu, just passed away.  She probably had pneumonia but with the ongoing Ebola outbreak, the mother was not allowed to hug or touch the baby while the hospital staff alerted the burial team.  The baby was lying on a bed alone behind the screen.  Finally after quite some time, Mariatu's mother reluctantly dragged herself from her baby, still holding onto a corner of her wrapper, and rivers of tears flowed freely down her cheeks.  As she passed me, I could hear her choking as waves of sorrow welled up in her chest and reached her throat. 

The severely dehydrated baby, Fatmata, was luckier.  She was sleeping soundly, IV fluid flowing with her mother sitting by her side eating a sandwich.  She also was tested positive for malaria and was being treated for that.  She would do well once her dehydration is corrected.

Baby with Dehydration

The inpatient ward of the hospital opened a week ago and there were four patients in the Pediatric Ward this morning.  It would take time for it to slowly open to its capacity. At the beginning of January, when the triaging area first opened, the OPD saw six patients, gradually as words spread the number increased to twenty and now it sees on the average, 50 patients. 

Without the triaging, Fatmata would be one of many patients who potentially would die because the common medical conditions of diarrhea, pneumonia and malaria would not have been seen and taken care of because of the effects of the Ebola outbreak on the closing of healthcare facilities.