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| EBOLA OUTBREAK |
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| DR. ADA IGONOH |
"On the night of Sunday July 20, 2014, Patrick Sawyer was wheeled into the Emergency Room at First Consultants Medical Center, Obalende, Lagos, with complaints of fever and body weakness. The male doctor on call admitted him as a case of malaria and took a full history. Knowing that Mr Sawyer had recently arrived from Liberia, the doctor asked if he had been in contact with an Ebola patient in the last couple of weeks, and Mr. Sawyer denied any such contact. He also denied attending any funeral ceremony recently. Blood samples were taken for full blood count, malaria parasites, liver function test and other baseline investigations. He was admitted into a private room and started on antimalarial drugs and analgesics. That night,
the full blood count result came back as normal and not indicative of infection.
The following day however, his condition worsened. He barely
ate any of his meals. His liver function test result showed his liver enzymes
were markedly elevated. We then took samples for HIV and hepatitis screening.
At about 5.00pm, he requested to see a doctor. I was the
doctor on call that night so I went in to see him. He was lying in bed with his
intravenous (I.V.) fluid bag removed from its metal stand and placed beside
him. He complained that he had stooled about five times that evening and that
he wanted to use the bathroom again. I picked up the I.V. bag from his bed and
hung it back on the stand. I told him I would inform a nurse to come and
disconnect the I.V. so he could conveniently go to the bathroom. I walked out
of his room and went straight to the nurses’ station where I told the nurse on
duty to disconnect his I.V. I then informed my Consultant, Dr. Ameyo Adadevoh
about the patient’s condition and she asked that he be placed on some
medications.
The following day, the results for HIV and hepatitis screening
came out negative. As we were preparing for the early morning ward rounds, I
was approached by an ECOWAS official who informed me that Patrick Sawyer had to
catch an 11 o’clock flight to Calabar for a retreat that morning. He wanted to
know if it would be possible. I told him it wasn’t, as he was acutely ill. Dr.
Adadevoh also told him the patient could certainly not leave the hospital in
his condition. She then instructed me to write very boldly on his chart that on
no account should Patrick Sawyer be allowed out of the hospital premises
without the permission of Dr. Ohiaeri, our Chief Medical Consultant. All nurses
and doctors were duly informed.
During our early morning ward round with Dr. Adadevoh, we
concluded that this was not malaria and that the patient needed to be screened
for Ebola Viral Disease. She immediately started calling laboratories to find
out where the test could be carried out. She was eventually referred to
Professor Omilabu of the LUTH Virology Reference Lab in Idi-Araba whom she
called immediately. Prof. Omilabu told her to send blood and urine samples to
LUTH straight away. She tried to reach the Lagos State Commissioner for Health
but was unable to contact him at the time. She also put calls across to
officials of the Federal Ministry of Health and National Centre for Disease
Control.
Dr. Adadevoh at this time was in a pensive mood. Patrick
Sawyer was now a suspected case of Ebola, perhaps the first in the country. He
was quarantined, and strict barrier nursing was applied with all the
precautionary measures we could muster. Dr. Adadevoh went online, downloaded
information on Ebola and printed copies which were distributed to the nurses,
doctors and ward maids. Blood and urine samples were sent to LUTH that morning.
Protective gear, gloves, shoe covers and facemasks were provided for the staff.
A wooden barricade was placed at the entrance of the door to keep visitors and
unauthorized personnel away from the patient.
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| EBOLA VIRUS |
Despite the medications prescribed earlier, the vomiting and
diarrhea persisted. The fever escalated from 38c to 40c.
On the morning of Wednesday 23rd July, the tests carried out
in LUTH showed a signal for Ebola. Samples were then sent to Dakar, Senegal for
a confirmatory test. Dr. Adadevoh went for several meetings with the Lagos
State Ministry of Health. Thereafter, officials from Lagos State came to
inspect the hospital and the protective measures we had put in place.
The following day, Thursday 24th July, I was again on call.
At about 10.00pm Mr. Sawyer requested to see me. I went into the newly created
dressing room, donned my protective gear and went in to see him. He had not
been cooperating with the nurses and had refused any additional treatment. He
sounded confused and said he received a call from Liberia asking for a detailed
medical report to be sent to them. He also said he had to travel back to
Liberia on a 5.00am flight the following morning and that he didn’t want to
miss his flight. I told him that I would inform Dr. Adadevoh. As I was leaving
the room, I met Dr. Adadevoh dressed in her protective gear along with a nurse
and another doctor. They went into his room to have a discussion with him and
as I heard later to reset his I.V. line which he had deliberately removed after
my visit to his room.
At 6:30am, Friday 25th July, I got a call from the nurse
that Patrick Sawyer was completely unresponsive. Again I put on the protective
gear and headed to his room. I found him slumped in the bathroom. I examined
him and observed that there was no respiratory movement. I felt for his pulse;
it was absent. We had lost him. It was I who certified Patrick Sawyer dead. I
informed Dr. Adadevoh immediately and she instructed that no one was to be
allowed to go into his room for any reason at all. Later that day, officials
from W.H.O came and took his body away. The test in Dakar later came out
positive for Zaire strain of the Ebola virus. We now had the first official
case of Ebola virus disease in Nigeria.
It was a sobering day. We all began to go over all that happened
in the last few days, wondering just how much physical contact we had
individually made with Patrick Sawyer. Every patient on admission was
discharged that day and decontamination began in the hospital. We were now
managing a crisis situation. The next day, Saturday 26th July, all staff of
First Consultants attended a meeting with Prof. Nasidi of the National Centre
for Disease Control, Prof Omilabu of LUTH Virology Reference Lab, and some
officials of W.H.O. They congratulated us on the actions we had taken and
enlightened us further about the Ebola Virus Disease. They said we were going
to be grouped into high risk and low risk categories based on our individual
level of exposure to Patrick Sawyer, the “index” case. Each person would
receive a temperature chart and a thermometer to record temperatures in the
morning and night for the next 21 days. We were all officially under
surveillance. We were asked to report to them at the first sign of a fever for
further blood tests to be done. We were reassured that we would all be given
adequate care. The anxiety in the air was palpable.
The frenetic pace of life in Lagos, coupled with the
demanding nature of my job as a doctor, means that I occasionally need a change
of environment. As such, one week before Patrick Sawyer died, I had gone to my
parents’ home for a retreat. I was still staying with them when I received my
temperature chart and thermometer on Tuesday 29th of July. I could not contain
my anxiety. People were talking Ebola everywhere – on television, online,
everywhere. I soon started experiencing joint and muscle aches and a sore
throat, which I quickly attributed to stress and anxiety. I decided to take
malaria tablets. I also started taking antibiotics for the sore throat. The
first couple of temperature readings were normal. Every day I would attempt to
recall the period Patrick Sawyer was on admission – just how much direct and
indirect contact did I have with him? I reassured myself that my contact with
him was quite minimal.
I completed the anti-malarials but the aches and pains
persisted. I had loss of appetite and felt very tired.
On Friday 1st of August, my temperature read a high 38.7c.
As I type this, I recall the anxiety I felt that morning. I could not believe
what I saw on the thermometer. I ran to my mother’s room and told her. I did
not go to work that day. I cautiously started using a separate set of utensils
and cups from the ones my family members were using.
On Saturday 2nd of August, the fever worsened. It was now at
39c and would not be reduced by taking paracetamol. This was now my second day
of fever. I couldn’t eat. The sore throat was getting worse. That was when I
called the helpline and an ambulance was sent with W.H.O doctors who came and
took a sample of my blood. Later that day, I started stooling and vomiting.
I
stayed away from my family. I started washing my plates and spoons myself. My
parents meanwhile, were convinced that I could not have Ebola.
The following day, Sunday 3rd of August, I got a call from
one of the doctors who came to take my sample the day before. He told me that
the sample which was they had taken was not confirmatory, and that they needed
another sample. He did not sound very coherent and I became worried. They came
with the ambulance that afternoon and told me that I had to go with them to
Yaba. I was confused. Couldn’t the second sample be taken in the ambulance like
the previous one? He said a better-qualified person at the Yaba centre would
take the sample. I asked if they would bring me back. He said “yes.” Even with
the symptoms I did not believe I had Ebola. After all, my contact with Sawyer
was minimal. I only touched his I.V. fluid bag just that once without gloves.
The only time I actually touched him was when I checked his pulse and confirmed
him dead, and I wore double gloves and felt adequately protected.
I told my parents I had to go with the officials to Yaba and
that I would be back that evening. I wore a white top and a pair of jeans, and
I put my iPad and phones in my bag.
A man opened the ambulance door for me and moved away from
me rather swiftly. Strange behavior, I thought. They were friendly with me the
day before, but that day, not so. No pleasantries, no smiles. I looked up and
saw my mother watching through her bedroom window.
We soon got to Yaba. I really had no clue where I was. I
knew it was a hospital. I was left alone in the back of the ambulance for over
four hours. My mind was in a whirl. I didn’t know what to think. I was offered
food to eat but I could barely eat the rice.
The ambulance door opened and a Caucasian gentleman
approached me but kept a little distance. He said to me, “I have to inform you
that your blood tested positive for Ebola. I am sorry.” I had no reaction. I
think I must have been in shock. He then told me to open my mouth and he looked
at my tongue. He said it was the typical Ebola tongue. I took out my mirror
from my bag and took a look and I was shocked at what I saw. My whole tongue
had a white coating, looked furry and had a long, deep ridge right in the
middle. I then started to look at my whole body, searching for Ebola rashes and
other signs as we had been recently instructed. I called my mother immediately
and said, “Mummy, they said I have Ebola, but don’t worry, I will survive it.
Please, go and lock my room now; don’t let anyone inside and don’t touch
anything.” She was silent. I cut the line.
was taken to the female ward. I was shocked at the
environment. It looked like an abandoned building. I suspected it had not been
in use for quite a while. As I walked in, I immediately recognized one of the
ward maids from our hospital. She always had a smile for me but not this time.
She was ill and she looked it. She had been stooling a lot too. I soon settled
into my corner and looked around the room. It smelled of faeces and vomit. It
also had a characteristic Ebola smell to which I became accustomed. Dinner was
served – rice and stew. The pepper stung my mouth and tongue. I dropped the
spoon. No dinner that night.
Dr. David, the Caucasian man who had met me at the ambulance
on my arrival, came in wearing his full protective ‘hazmat’ suit and goggles.
It was fascinating seeing one live. I had only seen them online. He brought
bottles of water and ORS, the oral fluid therapy which he dropped by my
bedside. He told me that 90 percent of the treatment depended on me. He said I
had to drink at least 4.5 litres of ORS daily to replace fluids lost in
stooling and vomiting. I told him I had stooled three times earlier and taken
Imodium tablets to stop the stooling. He said it was not advisable, as the
virus would replicate the more inside of me. It was better he said to let it out.
He said good night and left.
My parents called. My uncle called. My husband called
crying. He could not believe the news. My parents had informed him, as I didn’t
even know how to break the news to him.
As I lay on my bed in that isolation ward, strangely, I did
not fear for my life. I was confident that I would leave that ward some day.
There was an inner sense of calm. I did not for a second think I would be
consumed by the disease. That evening, the symptoms fully kicked in. I was
stooling almost every two hours. The toilets did not flush so I had to fetch
water in a bucket from the bathroom each time I used the toilet. I then placed
another bucket beneath my bed for the vomiting.
On occasion I would run to the toilet with a bottle of ORS,
so that as I was stooling, I was drinking.
The next day Monday 4th of August, I began to notice red
rashes on my skin particularly on my arms. I had developed sores all over my
mouth. My head was pounding so badly. The sore throat was so severe I could not
eat. I could only drink the ORS. I took paracetamol for the pain. The ward maid
across from me wasn’t doing so well. She had stopped speaking. I couldn’t even
brush my teeth; the sores in my mouth were so bad. This was a battle for my
life but I was determined I would not die.
Every morning, I began the day with reading and meditating
on Psalm 91. The sanitary condition in the ward left much to be desired. The
whole Ebola thing had caught everyone by surprise. Lagos State Ministry of
Health was doing its best to contain the situation but competent hands were
few. The sheets were not changed for days. The floor was stained with greenish
vomitus and excrement. Dr. David would come in once or twice a day and help
clean up the ward after chatting with us. He was the only doctor who attended
to us. There was no one else at that time. The matrons would leave our food
outside the door; we had to go get the food ourselves. They hardly entered in
the initial days. Everyone was being careful. This was all so new. I could
understand, was this not how we ourselves had contracted the disease?
Mosquitoes were our roommates until they brought us mosquito nets.
Later that evening, Dr. David brought another lady into the
ward. I recognized her immediately as Justina Ejelonu, a nurse who had started
working at First Consultants on the 21st of July, a day after Patrick Saywer
was admitted. She was on duty on the day Patrick reported that he was stooling.
While she was attending to him that night, he had yanked off his drip, letting
his blood flow almost like a tap onto her hands. Justina was pregnant and was
brought into our ward bleeding from a suspected miscarriage. She had been told
she was there only on observation. The news that she had contracted Ebola was
broken to her the following day after results of her blood test came out positive.
Justina was devastated and wept profusely – she had contracted Ebola on her
first day at work.
My husband started visiting but was not allowed to come
close to me. He could only see me from a window at a distance. He visited so
many times. It was he who brought me a change of clothes and toiletries and
other things I needed because I had not even packed a bag. I was grateful I was
not with him at home when I fell ill or he would most certainly have contracted
the disease. My retreat at my parents’ home turned out to be the
instrumentality God used to shield and save him.
I drank the ORS fluid like my life depended on it. Then I
got a call from my pastor. He had been informed about my predicament. He called
me every single day morning and night and would pray with me over the phone. He
later sent me a CD player, CDs of messages on faith and healing, and Holy
Communion packs through my husband. My pastor, who also happens to be a medical
doctor, encouraged me to monitor how many times I had stooled and vomited each
day and how many bottles of ORS I had consumed. We would then discuss the
disease and pray together. He asked me to do my research on Ebola since I had
my iPad with me and told me that he was also doing his study. He wanted us to
use all relevant information on Ebola to our advantage. So I researched and
found out all I could about the strange disease that has been in existence for
38 years. My research, my faith, my positive view of life, the extended times
of prayer, study and listening to encouraging messages boosted my belief that I
would survive the Ebola scourge.
There are five strains of the virus and the deadliest of
them is the Zaire strain, which was what I had. But that did not matter. I
believed I would overcome even the deadliest of strains. Infected patients who
succumb to the disease usually die between 6 to 16 days after the onset of the
disease from multiple organ failure and shock caused by dehydration. I was
counting the days and keeping myself well hydrated. I didn’t intend to die in
that ward.
My research gave me ammunition. I read that as soon as the
virus gets into the body, it begins to replicate really fast. It enters the
blood cells, destroys them and uses those same blood cells to aggressively
invade other organs where they further multiply. Ideally, the body’s immune
system should immediately mount up a response by producing antibodies to fight
the virus. If the person is strong enough, and that strength is sustained long
enough for the immune system to kill off the viruses, the patient is likely to
survive. If the virus replicates faster than the antibodies can handle however,
further damage is done to the organs. Ebola can be likened to a multi-level,
multi-organ attack but I had no intention of letting the deadly virus destroy
my system. I drank more ORS. I remember saying to myself repeatedly, “I am a
survivor, I am a survivor.”
I also found out that a patient with Ebola cannot be
re-infected and they cannot relapse back into the disease as there is some
immunity conferred on survivors. My pastor and I would discuss these findings,
interpret them as it related to my situation and pray together. I looked
forward to his calls. They were times of encouragement and strengthening. I
continued to meditate on the Word of God. It was my daily bread.
Shortly after Justina came into the ward, the ward maid, Mrs
Ukoh passed on. The disease had gotten into her central nervous system. We
stared at her lifeless body in shock. It was a whole 12 hours before officials
of W.H.O came and took her body away. The ward had become the house of death.
The whole area surrounding her bed was disinfected with bleach. Her mattress
was taken and burned.
To contain the frequent diarrhea, I had started wearing
adult diapers, as running to the toilet was no longer convenient for me. The
indignity was quite overwhelming, but I did not have a choice. My faith was
being severely tested. The situation was desperate enough to break anyone
psychologically. Dr. Ohiaeri also called us day and night, enquiring about our
health and the progress we were making. He sent provisions, extra drugs,
vitamins, Lucozade, towels, tissue paper; everything we needed to be more
comfortable in that dark hole we found ourselves. Some of my male colleagues
had also been admitted to the male ward two rooms away, but there was no
interaction with them.
We were saddened by the news that Jato, the ECOWAS protocol
officer to Patrick Sawyer who had also tested positive, had passed on days
after he was admitted.
Two more females joined us in the ward; a nurse from our
hospital and a patient from another hospital. The mood in the ward was solemn.
There were times we would be awakened by the sudden, loud cry from one of the
women. It was either from fear, pain mixed with the distress or just the sheer
oppression of our isolation.
I kept encouraging myself. This could not be the end for me.
Five days after I was admitted, the vomiting stopped. A day after that, the
diarrhea ceased. I was overwhelmed with joy. It happened at a time I thought I
could no longer stand the ORS. Drinking that fluid had stretched my endurance
greatly.
I knew countless numbers of people were praying for me.
Prayer meetings were being held on my behalf. My family was praying day and
night. Text messages of prayers flooded my phones from family members and
friends. I was encouraged to press on. With the encouragement I was receiving I
began to encourage the others in the ward. We decided to speak life and focus
on the positive. I then graduated from drinking only the ORS fluid to eating
only bananas, to drinking pap and then bland foods. Just when I thought I had
the victory, I suddenly developed a severe fever. The initial fever had
subsided four days after I was admitted, and then suddenly it showed up again.
I thought it was the Ebola. I enquired from Dr. David who said fever was
sometimes the last thing to go, but he expressed surprise that it had stopped
only to come back on again. I was perplexed.
I discussed it with my pastor who said it could be a
separate pathology and possibly a symptom of malaria. He promised he would
research if indeed this was Ebola or something else. That night as I stared at
the dirty ceiling, I felt a strong impression that the new fever I had
developed was not as a result of Ebola but malaria. I was relieved. The
following morning, Dr. Ohiaeri sent me antimalarial medication which I took for
three days. Before the end of the treatment, the fever had disappeared.
I began to think about my mother. She was under surveillance
along with my other family members. I was worried. She had touched my sweat. I
couldn’t get the thought off my mind. I prayed for her. Hours later on Twitter
I came across a tweet by W.H.O saying that the sweat of an Ebola patient cannot
transmit the virus at the early stage of the infection. The sweat could only
transmit it at the late stage.
That settled it for me. It calmed the storms that were
raging within me concerning my parents. I knew right away it was divine
guidance that caused me to see that tweet. I could cope with having Ebola, but
I was not prepared to deal with a member of my family contracting it from me.
Soon, volunteer doctors started coming to help Dr. David
take care of us. They had learned how to protect themselves. Among the
volunteer doctors was Dr. Badmus, my consultant in LUTH during my housemanship
days. It was good to see a familiar face among the care-givers. I soon
understood the important role these brave volunteers were playing. As they
increased in number, so did the number of shifts increase and subsequently the
number of times the patients could access a doctor in one day. This allowed for
more frequent patient monitoring and treatment. It also reduced care-giver
fatigue. It was clear that Lagos State was working hard to contain the crisis
Sadly, Justina succumbed to the disease on the 12th of
August. It was a great blow and my faith was greatly shaken as a result. I
commenced daily Bible study with the other two female patients and we would
encourage one another to stay positive in our outlook though in the natural it
was grim and very depressing. My communion sessions with the other women were very
special moments for us all.
On my 10th day in the ward, the doctors having noted that I
had stopped vomiting and stooling and was no longer running a fever, decided it
was time to take my blood sample to test if the virus had cleared from my
system. They took the sample and told me that I shouldn’t be worried if it
comes out positive as the virus takes a while before it is cleared completely.
I prayed that I didn’t want any more samples collected from me. I wanted that
to be the first and last sample to be tested for the absence of the virus in my
system. I called my pastor. He encouraged me and we prayed again about the
test.
On the evening of the day Justina passed on, we were moved
to the new isolation Centre. We felt like we were leaving hell and going to
heaven.
We were conveyed to the new place in an ambulance. It was
just behind the old building. Time would not permit me to recount the drama
involved with the dynamics of our relocation. It was like a script from a
science fiction movie. The new building was cleaner and much better than the
old building. Towels and nightwear were provided on each bed. The environment
was serene.
The following night, Dr. Adadevoh was moved to our isolation
ward from her private room where she had previously been receiving treatment.
She had also tested positive for Ebola and was now in a coma. She was receiving
I.V. fluids and oxygen support and was being monitored closely by the W.H.O
doctors. We all hoped and prayed that she would come out of it. It was so
difficult seeing her in that state. I could not bear it. She was my consultant,
my boss, my teacher and my mentor. She was the imperial lady of First
Consultants, full of passion, energy and competence. I imagined she would wake
up soon and see that she was surrounded by her First Consultants family but
sadly it was not to be.
I continued listening to my healing messages. They gave me
life. I literally played them hours on end. Two days later, on Saturday the
16th of August, the W.H.O doctors came with some papers. I was informed that
the result of my blood test was negative for Ebola virus. If I could
somersault, I would have but my joints were still slightly painful. I was free
to go home after being in isolation for exactly 14 days. I was so full of
thanks and praise to God. I called my mother to get fresh clothes and slippers
and come pick me. My husband couldn't stop shouting when I called him. He was
completely overwhelmed with joy.
I was told however that I could not leave the ward with
anything I came in with. I glanced one last time at my CD player, my valuable
messages, my research assistant a.k.a my iPad, my phones and other items. I remember
saying to myself, “I have life; I can always replace these items.”
I went for a chlorine bath, which was necessary to disinfect
my skin from my head to my toes. It felt like I was being baptized into a new
life as Dr. Carolina, a W.H.O doctor from Argentina poured the bucket of
chlorinated water all over me. I wore a new set of clothes, following the
strict instructions that no part of the clothes must touch the floor and the
walls. Dr. Carolina looked on, making sure I did as instructed.
I was led out of the bathroom and straight to the lawn to be
united with my family, but first I had to cut the red ribbon that served as a
barrier. It was a symbolic expression of my freedom. Everyone cheered and
clapped. It was a little but very important ceremony for me. I was free from
Ebola! I hugged my family as one who had been liberated after many years of
incarceration. I was like someone who had fought death face to face and come back
to the land of the living.
had to pass through several stations of disinfection
before we reached the car. Bleach and chlorinated water were sprayed on
everyone’s legs at each station. As we made our way to the car, we walked past
the old isolation building. I could hardly recognize it. I could not believe I
slept in that building for 10 days. I was free! Free of Ebola. Free to live
again. Free to interact with humanity again. Free from the sentence of death.
My parents and two brothers were under surveillance for 21
days and they completed the surveillance successfully. None of them came down
with a fever. The house had been disinfected by Lagos State Ministry of Health
soon after I was taken to the isolation centre. I thank God for shielding them
from the plague.
My recovery after discharge has been gradual but progressive.
I thank God for the support of family and friends. I remember my colleagues who
we lost in this battle. Dr. Adadevoh my boss, Nurse Justina Ejelonu, and the
ward maid, Mrs. Ukoh were heroines who lost their lives in the cause to protect
Nigeria. They will never be forgotten.
I commend the dedication of the W.H.O doctors, Dr. David
from Virginia, USA, who tried several times to convince me to specialize in
infectious diseases, Dr. Carolina from Argentina who spoke so calmly and
encouragingly, Mr. Mauricio from Italy who always offered me apples and gave us
novels to read. I especially thank the volunteer Nigerian doctors, matrons and
cleaners who risked their lives to take care of us. I must also commend the
Lagos State government, and the state and federal ministries of health for
their swift efforts to contain the virus. To all those prayed for me, I cannot
thank you enough. And to my First Consultants family, I say a heartfelt thank
you for your dedication and for your support throughout this very difficult
period.
I still believe in miracles. None of us in the isolation
ward was given any experimental drugs or so-called immune boosters. I was full
of faith yet pragmatic enough to consume as much ORS as I could even when I
wanted to give up and throw the bottles away. I researched on the disease
extensively and read accounts of the survivors. I believed that even if the
mortality rate was 99%, I would be part of the 1% who survive.
Early detection and reporting to hospital is key to patient
survival. Please do not hide yourself if you have been in contact with an Ebola
patient and have developed the symptoms. Regardless of any grim stories one may
have heard about the treatment of patients in the isolation centre, it is still
better to be in the isolation ward with specialist care, than at home where you
and others will be at risk.
BBM: 7C081F30
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