December 6: Into the 'Red Zone' - my first Ebola centre encounter

The donning of PPE (personal protective equipment) was less rigorous than I had been trained, and all the MSF equipment is different from our UK equipment, but the principles are the same – absolute protection.

My initial nerves getting dressed up for real for the first time quickly settle as we stride out in pairs into the red zone for our medical ward round. The flow of Ebola Centres is one way – from suspect ward through to confirmed wards and finally the convalescence ward and out.

The suspect tent is empty but for two crying children, about 18 months and four years old, prisoners in makeshift cots of upturned plastic tables with cheap orange fencing wrapped around the legs to form the walls.

Their mother had been admitted to the confirmed ward the day before but they were afebrile, so while the children are likely to have been infected, they were not Ebola cases yet, so could not follow her. Abandoned suddenly and incomprehensibly, they were crying helplessly their hearts out for her.

The four-year-old takes one look at us – scary monsters in our biohazard uniforms – and doubles his efforts, streams of (probable Ebola rich) nasal mucous pouring down his malnourished body.

The 18-month-old is still too young to be put off by our alien appearance, and holds up both her hands to me, pleading for human contact and love. I hold her hands and she desperately tried to climb up the fencing into my arms. Her crying stops, but only until we walk on, when the duet of misery starts up once more.

The main confirmed wards are surprisingly familiar to me from my African hospital experience. Some patients are sitting outside in the fenced off area, some sitting in their beds, the sicker lying curled and immobile.

There is more evidence of diarrhoea and vomiting, the lethal vehicles for Ebola, on the floors and in the buckets. However this was not House-type medical mystery – most of the patients require simple nursing care: pain relief, fluids, anitemetics.

One corner of the ward houses a family of five, both parents and three children. All but the mother are very dehydrated and severely ill. I put my first IV line in and start to resuscitate the father – for all the cautious training about putting in IV lines as part of my army training, it is surprisingly reflexive. IV lines are not left up between rounds; as the patients are confused and inevitably pull them out, so each visit over the Ebola fence provides a chance for a quick life-saving bolus of fluid.

In the convalescent ward a 4-months pregnant mother is awaiting discharge, having been confirmed to be clear of Ebola. However, her unborn child is sadly doomed. The concentration of the virus in the placenta spells certain death, and the toxic amniotic fluids of birth are a public health threat to her family. She is facing a bleak choice of a medically-induced termination of her baby while still under medical care, or to stay on the Ebola centre for five months until natural birth with the same inevitable outcome. How do you explain these choices to a young woman who has escaped death herself?

After half an hour in the PPE I feel like I am in an out-of-control sauna. My goggles are fogging up and my vision is impaired. After an hour I have a pounding headache and sweat is literally pouring down all my body and filling my boots, which squelch when I walk. My mask is wet with sweat which creates a feeling of drowning.

I start putting an IV line in a severely dehydrated five-year-old, but am thick fingered from double gloves, seeing out of a steamed up window, so do the right thing and pass it over.

I last an hour and a half on my first trip over the Ebola fence - much longer than I had expected - my discomfort distracted by the work involved. However, it is still just mid-morning and dread to think what the rounds are like in the African afternoon heat.

With relief I head to the doffing area knowing that this ritual is going to add another 15 minutes. The doffing monitors are the Kings of the Ebola Centres. They have no qualifications and little literacy, but in the doffing station they have all the power.

With chlorine sprayers on their backs like Ghostbusters, these are the guys who will decontaminate me and make sure I am not exposed to any of my heavily exposed protective suit. I am pretty stoical normally but now I am feeling completely shit.

The monitor is shouting at me and ordering me what to do, wash my hands, head back, turn around, wash your hands, outer gloves off without touching outsides, undo your gown strap; gown off; stop! don’t touch your hood; wash your hands; gown off; slowly! wash your hands; close your eyes; lean forward; goggles off; dip them three times in chlorine; wash your hands; break your hood ties, all four; lean wash your hands; remove your hood; wash your hands; undo your gown; stop! don't touch the outside; unzip; wash your hands; remove tape from legs; wash your hands; pull off gown over boots; stop! don't touch your boots; wash your hands; step out of the gown and push to me for spraying; wash your hands; lean forward and close your eyes; remove your mask; wash your hands; step forward for boot spraying. I stagger over the demarcation into the green zone like an exhausted long-distance runner, my surgical scrubs drenched with sweat but relieved to have been guided down to land by my very bossy monitor.

I rehydrate and then observe the rest of the ward round in the clinical station, picking up ideas for Moyamba.

There is a major challenge in how we communicate the information we collect in the red zone to the green zone. It is difficult to write in PPE, and no documentation can leave the red zone, so MSF have come up with a numeric system for each patient (Patient 001; Bed C3; 1= fever, 2 = bleeding 3= vomiting etc) to shout out clinical updates to a scribe in the green zone.

It reminds me of the old jokes of prisoners being so familiar with jokes that they just use numbers. I restrain an urge to make a number up.

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