The opening of our hospital is upon us and it is time to visit the dreaded Moyamba Ebola holding centre where our first patients will be be referred from.
In the absence of a treatment centre patients in the district have been quarantined here since the start of the epidemic.
The name itself is off-putting with its punitive connotations - containment rather than care being the operative word.
Everyone warns me not to go and I am nervous. Experienced clinicians from other Ebola centres express alarm at the conditions in these ‘transmission units’ - the fear being that the poor standards of infection control mean they spread disease rather than contain it.
However, the patients that we will be decanting to our Ebola Hospital when we first open are here, and it’s important that we ensure that they are getting good upstream care and not ending up in our triage unit close to death and past medical care. I also want to reassure the nurses working there that we will look after them as we phase out the unit.
When I ask the driver to take me he chuckles and continues driving straight past the junction, assuming that I am kidding.
The District Medical Officer offers to meet me outside the unit, but he makes it clear he will not step foot inside. A home-made sign on the wall of what looks like a converted cattle shed announces that this is the Moyamba District Isolation Centre.
It has the look and smell of death and neglect. Empty shelves announce the dressing area into the red zone, and no one seems particularly sure about where the low-risk area ends and the high-risk area begins.
I walk through the main door to find a dark tin-roofed room is furnished by home-made cubicles of plastic sheeting where Ebola patients lie immobile on old rusty beds. It is a room of sickness and fear.
There are no drugs, no IV fluids, no medical equipment. The staff have no boots or scrubs, just basic protection equipment. In the backyard blue plastic sheeting and strips of wood have been assembled to create a disinfection area, and a large tent to accommodate or those patients who get the all clear. Behind this a brick incinerator bellows the toxic smoke of burning Ebola.
Alfred is the nurse in charge and I enquire about his story. He tells me he was the first person to treat a patient with Ebola at Moyamba Hospital back in April, and he has dedicated himself to caring for these patients ever since. I ask him how many patients he has seen since he set the unit up at the start of August and he methodically counts through his log-book. 220 patients, 120 of them positive for Ebola.
I am stunned and humbled. For five months this decrepit, DIY isolation centre has been on the deadly front line of the battle against Ebola. Everyday staff have risked their lives working in inadequate facilities in high-risk situations.
Then we arrive with great fanfare, six months too late, in our fleet of shiny new 4x4s and helicopters, building £2 million worth of Ebola hospital and base camp, staffing it with 200 staff, and prevaricating about the wrong sort of biohazard suits.
I listen to their stories of how they have coped with the infection and death, shunned by their community and the outside world. Amazingly, none of the staff have become infected - testimony to the professionalism of their low-tech approaches to infection control.
These are the true heroes of the war on Ebola and I am in awe. I want to swap sides and go and work with them.
I explain how we will gradually start moving patients from the holding centre when we open, and I offer them all jobs at the hospital in recognition of how they have put their lives on the line, but also to capitalise on their unique expertise.
I walk back to the car conscious that this is the most dangerous place I have been in my Ebola journey. The red zones here and in Bo may be high risk, but with all our protection equipment and infection control facilities they are probably the safest places to be in the current epidemic.
My driver jumps out of the car when he sees me coming. He is edgy and scared. I get a glimmer of insight into the parish-status that the staff at the holding centre must feel every day. He insists on multiple rounds of hand washing and chlorine spraying of my feet and legs before he lets me back in. We continue our journey in nervous silence.
Back at our Ebola hospital we meet to finalise the opening date. Everyone must agree as safety is paramount.
There is one persistent obstacle and that is the PPE. Our risk-averse health and safety lead continues to be paralysed by risk analysis, and for 30 minutes we debate small print of different PPE instructions.
This is a theological debate where faith triumphs over evidence. Chris and I turn to each other trying to hide our despair.
We are going to have to resign ourselves to further delay - now four days from our original start date and getting ever more distant as every day passes.
MORE BLOG POSTS FROM PROFESSOR JOHN WRIGHT
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