Uganda is fighting a strain of Ebola for which there is no vaccine or treatment | On the front line | future planet

I am a doctor and I worked continuously for Doctors Without Borders (MSF) between 2003 and 2017. My specialty is infectious diseases, for which I have been in different outbreaks of cholera, Ebola and also in food crises.

From my long career with MSF, I think the experience that marked me the most was the 2014 Ebola outbreak in West Africa. I was sent as a medical coordinator to launch a project in Monrovia at the height of the outbreak. It was a truly traumatic experience because we could not offer a good level of care, since the number of patients outnumbered us.

During the outbreak in West Africa we served more than 20,000 people in a year, compared to 2,000 in the previous 20 years. It was a privilege, and very exciting from a scientific point of view, to work on this outbreak and try to find practical solutions. It reminded me of the old days of HIV. I was a young doctor when that virus spread and we saw so many young people die; we would sit down at night to talk about what we could do to improve care. It was very traumatic, with 50 deaths a day, as if we were at war. On the other hand, it was very stimulating to work hard and try to find clinical solutions.

At the Mubende Reference Hospital in central Uganda, we currently have two wards. One of them is the Ebola Treatment Center (ETC), which is where I currently work. Before we had suspected and confirmed cases, but when more cases began to arrive we were forced to convert the area from suspected to confirmed to accommodate everyone. Since last September, we have been fighting a new outbreak of the Sudanese strain, for which there is no vaccine or treatment, and which has left 55 dead so far.

You have to do things that go beyond your normal scope of action. I would go around the room, and I would find myself laying lines, cleaning someone who was sick, providing nursing care, giving medical attention, doing cleaning, watching. We have to focus on the things that have the most impact. Health care is important, of course, but so is the dignity of patients.

Ruggero Giuliani, an MSF doctor, talks with other health workers at Mubende Hospital in Uganda.
Ruggero Giuliani, an MSF doctor, talks with other health workers at Mubende Hospital in Uganda.Sam Taylor (MSF)

Ebola is a very old disease. When it enters the body you see a massive reaction, you see a very rapid deterioration. Those who have contracted it can still walk when they arrive, but then the deterioration is very rapid.

We have to improve the structure of the ETC again so that doctors and health personnel can move around inside. So, in terms of structure, I hope that the new ETC improves this part in some way, because part of the ETC is designed to be able to see those admitted from the outside, without having to put on personal protective equipment (PPE). It’s a great idea. We need to have clear visibility of all of them and be there 24 hours a day. With the PPE we cannot do it.

The PPE greatly limits the ability to intervene. With this virus you have to be very careful with what you do, but, on the other hand, these suits reduce humane treatment. Also, when you have to find a vein, it’s not easy with gloves, you don’t have ease of movement, they hinder interactions with patients and also the ability to give them the best care.

And we sweat too. I don’t have my glasses in there, so I can’t see well from a distance; Now I’m getting older and I don’t see well up close either. Without glasses I have limited vision. The sweat and the heat inside limit the effectiveness of the PPE, although it is better than before and has been perfected in this aspect. We have light PPE that protect us and allow us to last longer.

As good as this is, the most decisive thing is to be able to monitor and see the patient from the outside. I can watch it every second, I can have a person check vital signs and check progression. We know that the disease evolves, so I want to be able to act quickly. If I see that his saturation is going down, I go in and give him oxygen, check his heart rate, I can give him fluids. This type of continuous monitoring is what allows us to intervene in time.

It is crucial to receive patients promptly and to be aggressive in clinical management. This is key to the survival of the individual.

A worrying issue is the late arrival of patients, when Ebola is very advanced, since everything is more difficult. That is why it is crucial to receive people early and be aggressive in clinical management. This is key to the survival of the individual. Studies show that if he is admitted on the second or third day of the disease, the probability of survival increases. It is essential that you know this.

It is very hard to realize that your patient is not going to survive, that he is not going to make it. You know you will do everything in your power, but when the most serious symptoms appear, you realize that there is no chance. And yet, that person is still alive, clings to you. I remember one occasion when I attended to a man who, a little upset, grabbed my hand and asked me to please stay with him. You realize that he is going to die.

The other side of the coin is the joy you feel for each person who gets ahead. The other day we discharged six survivors and it was a party. As a mechanism to overcome difficult situations, it helps a lot. Every time you discharge people who have recovered from the disease, you breathe a sigh of relief.

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