Posted for fair use and discussion. H/t Pixie
http://online.wsj.com/articles/ebola-doctors-with-no-rubber-gloves-1408142137
For Want of Gloves, Ebola Doctors Die
On the front lines of the Ebola outbreak in Liberia, health-care workers believe its toll on their own staffs could be mitigated if only they had enough basic hospital supplies such as gloves
By DREW HINSHAW
Updated Aug. 15, 2014 7:17 p.m. ET
SERGEANT KOLLIE TOWN, Liberia—Rubber gloves were nearly as scarce as doctors in this part of rural Liberia, so Melvin Korkor would swaddle his hands in plastic grocery bags to deliver babies.
His staff didn't bother even with those when a woman in her 30s stopped by complaining of a headache. Five nurses, a lab technician—then a local woman who was helping out—cared for her with their bare hands.
Within weeks, all of them died. The woman with a headache, they learned too late, had Ebola. {R0=7 here?}
Somewhere in the workplace exchange of handshakes and sweat, Dr. Korkor caught the virus, too. For five days, he read the Bible on a cot in an Ebola ward, watching his colleagues bleed to death from a disease they weren't equipped or trained to treat. Across the room, a nurse pregnant with what would have been her third child slipped away. "She told me 'Doc, I'm dying,' " he recalled Kou Gbanjah saying.
In the Liberian capital of Monrovia, the city's main hospital has very little staff and few patients — an exodus triggered by several Ebola-related deaths at the facility.
Though Dr. Korkor survived, his hospital has closed, as have dozens of other health centers in Liberia, Sierra Leone and Guinea. It is a devastating setback for countries facing a range of deadly diseases in addition to Ebola. The World Health Organization estimates the region's Ebola outbreak has killed 1,145 people, roughly half the 2,127 believed to have been infected. West African countries that had only begun to climb out from civil war and poverty have slipped into economic disarray.
Much of this toll could have been avoided or at least mitigated, hospital workers on the front lines say, if they had been provided with medical basics, starting with one of the simplest: disposable rubber gloves.
Instead, health workers have been treating many patients with unprotected hands, greatly increasing the risk the Ebola virus will kill the very professionals trying to fight it.
As of Tuesday, at least 36 health workers in Liberia had died from the disease, according to health ministry records. Many who have caught but survived the virus are traumatized, as are colleagues, and may prove difficult to coax back to work.
Their absence is deeply felt. Even before Ebola, Liberia—with just 51 doctors for four million people—had the second-fewest physicians per person on Earth, after Tanzania, according to the WHO.
Hospital staff members throughout Liberia, including at Dr. Korkor's Phebe Hospital, have gone on strike until the government meets their demands. They want rubber gloves, safety goggles, protective suits, life insurance and a fivefold pay increase for the hazardous work. The government has said it plans to meet those requests.
In the meantime, because doctors aren't at work, other diseases besides Ebola are going untreated. As a result, those ailments—chiefly typhoid and dysentery—may be killing more West Africans than Ebola, according to the United Nations Children's Fund.
Hospitals across the region have closed at the peak of malaria season. Meningitis, measles and polio vaccinations are on hold, said Liberia's information minister, Lewis Brown.
In countries with some of the world's highest rates of death during childbirth, women are having babies at home. They aren't bringing in children for check-ups in Liberia, a nation where nearly half of children are malnourished, according to Unicef.
It is an unprecedented toll for a viral illness first identified in 1976, which cropped up eight months ago in Guinea and quickly spread to Liberia and Sierra Leone. The virus is spread chiefly through contact with bodily fluids. It begins with vague feverish symptoms that could be due to any number of ailments, until patients worsen and often begin bleeding from their eyes, nose and mouth.
There is no approved vaccine or treatment, although two American health-care workers infected in Liberia have been treated with an experimental drug. The Liberian government ordered three courses of the drug to give to some ill doctors.
A Liberian clinic called Dolo Town Health Center shut down last month when it ran out of gloves and left staff members to choose between treating Ebola patients bare-handed or leaving, said MacFarland Keraulah, a physician's assistant. The clinic had received only one glove delivery since April, and it was a single box of 50 pairs.
Since the staff walked off, 37 people have died of Ebola in that area, two hours outside the Liberian capital of Monrovia. Seven were health workers at another now-closed health center, according to workers.
Both clinics are in a 200-square-mile forest of rubber trees. "We are sitting inside one of the world's largest rubber plantations, and people are dying because we don't have gloves," Mr. Keraulah said.
Liberia's government said it didn't provide enough materials early on because it is still recovering from a 14-year civil war that ended in 2003 with both the federal coffers and hospital shelves left bare.
More recently, health funding faced opposition from lawmakers who believed Ebola was a scam perpetuated to draw aid money. In a heated congressional debate in May, one legislator called the virus "that thing you did to get donor funding," according to Liberia's FrontPage Africa newspaper.
Such sentiments were common within the government, said Tolbert Nyenswah, assistant health minister. "Even senior government officials were in denial, so it did not receive the political will," he said.
Some officials blame the shortage on another epidemic: corruption in the civil service, something that Liberian President Ellen Johnson Sirleaf has complained about during her eight years in office. Many workers on the government payroll earn as little as $5 a day. A government devastated by years of civil strife doesn't have the record-keeping skills to make sure its own members don't steal supplies, said Mr. Brown, the information minister.
"I don't think the government of Liberia has reached a point where it cannot afford gloves," said Marcus Speare, district superintendent of Liberia's Margibi County. "We have to look at where these things go after the government has made its appropriation.... We will launch an investigation to find out."
Now, the government faces the task of getting health-care workers back on the job. It has sent priests and politicians to speak with them.
This week, China donated 10,000 protective suits. But training workers at far-flung clinics in how to don them and take them off could take several weeks, according to Liberia's health ministry.
Other basic supplies remain stretched, ranging from plastic sheeting to painkillers to ambulances, said Mr. Nyenswah, the assistant health minister.
In the capital, the government is trying to turn some empty school classrooms into holding centers for people with symptoms suggesting Ebola. But workers don't have enough bedding, Mr. Nyenswah said.
Sitting at a desk stacked with papers waiting to be signed, Mr. Nyenswah shouted into a phone call with an aid agency: "I need 20 mattresses like yesterday!"
Shortages are something Dr. Korkor learned to work around.
In the four years he ran Phebe Hospital in rural Liberia, Dr. Korkor got used to treating patients without painkillers, anti-parasite drugs, test tubes or even scrubs. "We had to improvise," said a nurse, Martha Morris.
The staff members reused the few rubber gloves they had, and put them on only to treat the sickest patients.
On July 3, the staff realized that the woman they had been handling with bare hands wasn't a local villager with a headache. She was an Ebola patient who had broken out of a hospital about 100 miles away under circumstances that are still unclear. By July 15, the woman had died.
So had three nurses.
Days later, Dr. Korkor felt a chill rush through his body. He locked himself in a bedroom away from his family until a blood test returned—positive for Ebola. A car took him to an Ebola ward in the capital.
The room smelled of bleach, blood and vomit, he said. Most of the roughly 15 patients inside appeared to be health workers, including the man dying next to him in their two-cot cubicle.
One morning, Dr. Korkor realized he was lying across from the chief doctor at the country's top hospital, Samuel Brisbane, under whom he had done his residency. "He said, 'My son, you're here?' " Dr. Korkor recalled. "I said, 'Yes, Doc.' "
Dr. Brisbane died the next day, his obituary displayed prominently on front pages of the country's newspapers. He probably contracted Ebola giving a patient cardiopulmonary resuscitation without a pair of gloves, said Wvanne McDonald, chief executive officer of the John F. Kennedy Memorial Medical Center, where Dr. Brisbane worked.
For the next three days, Dr. Korkor forced down balls of rice and, by his count, drank 24 bottles of water—one every hour. Finally, he felt his chills disappear and his hunger rebound with ferocity. After a blood test and four showers in bleach-spiked water, the staff let him leave.
On a recent Tuesday morning, chickens were clucking in the yard at his home as he sat in a chair under a tree. "Ebola-free!" he laughed over the phone to a friend.
The ordeal, though, has left him torn. He can stay in Liberia and risk his life to fight the outbreak—on a $1,000-a-month paycheck—or try to move his family to America, to work his way up a hospital system that hasn't collapsed.
He glanced at the porch, where his wife, daughter, two sons, mother-in-law, niece and niece's daughter was hanging about. "If I'm going to die, God forbid, who's going to take care of them?" he asked.
If he stays in Liberia, Dr. Korkor said, he is going to need a great deal more supplies. He isn't going back to work until he gets them. "
This time around, we're not going to improvise," he said.
