The Silence of the Night
WHO reports that the number of new Ebola cases have decreased in Lofa and Montserrado counties in Liberia. President Ellen Johnson Sirleaf lifted the state of emergency for the Ebola crisis three days ago. But here in Bong, we have not seen a reprieve. We also receive slightly over 11% of our patients from remote Gbarpolu, from there the patients have to trek 3 to 4 hours through the jungle and then cross a river via a canoe to reach a health station, There they are transported for another 4 hours to Bong ETU. The very sick ones will never make such a journey; the not so sick individuals would be severely dehydrated by the time they arrive.
The Confirmed Ward is full with 31patients; in fact a few more beds were squeezed into some of the bigger rooms making it difficult and somewhat hazardous for us to move around. There are now 44 patients, 13 in the Suspected Ward and 31 in the Confirmed Ward. But we found Martha A. dead early this morning; she was agitated and delirious in the evening. Her roommate Gormai, seemed to display the same behavior with massive diarrhea all over her bed through her pampers.
The Juah family now lost two boys and Mama Juah and little boy Prince are spiraling downhill; Prince bleeding from his mouth and nose and Mama with copious bloody diarrhea, signs that do not bode well. Roland is also taking a turn for the worst, with massive diarrhea and now in semi-comatose state. A nurse and I rounded in the early morning and it took us some time to change all these patients to make them at least somewhat comfortable. Roland did have the hiccoughs.
Aaron had a rough day with diarrhea and a board-like abdomen; we did not rouse him as he finally was sound asleep. We have no strong analgesics other than paracetamol; morphine is still a pipe dream. Almost half of the patients now require at least a liter of IV fluid which means waiting for all fluids to be infused before we could leave the ETU and we have also started to give oral potassium and bananas.
Those who are able to sit on a bucket which serves as their commode use it by the bedside. I cannot imagine most of our US patients who are huge in size sitting on such flimsy device and not breaking it or worse falling. Many patients seem to have strong quads enabling them to squat or sit in a semi-squatting posture. The more ambulatory patients walk to the latrine.
Our youngest patient Satta, three years of age, has been here for 20 days and she is very likely to recover, her Ebola titer is coming down. To date in Bong ETU, we have no survivors among patients less than five years of age. Most patients however do not know their birthday or how old they are.
Sometime next week another ETU will open in Margibi halfway between here and Monrovia; it will be a bigger unit. Since we receive about 40% of our patients from Margibi, we expect a reduction in the number of patients in our unit. For now there is a discussion whether to use the morgue for patient rooms and have a smaller morgue for the deceased awaiting burial.
While the patients sleep or struggle in their nightmares, the night is alive and teaming with noise. It has never been silent in the jungle; croaking frogs, chorus of crickets creaking and sounds of bat echolocating, all seem to remind us that while death may silence some of our patients, we will keep that from being deafening.