BO, Sierra Leone—Morning rounds have just begun at an Ebola treatment center here in the city of Bo, in central Sierra Leone.
The patients who are able shuffle out of a tent towards two layers of chain-link fence that separate them from the outside—2 meters minimum distance. Some clutch bottles of water, bright orange soda, or foil-wrapped nutritional bars. A woman in an orange printed wrap skirt lags behind the others, struggling to slide a sandal on to her foot. She came here in bad shape with her husband and three children, but she is improving; she was recently taken off intravenous fluids.
But this is a terrible day for her: She lost her three-year-old son here just yesterday. Today, another of her children stays inside the treatment tent, too sick to come out. Through the fences, a health worker tries to convince her that all is not lost, not to give up. "Drink fluids. Eat, eat," he tells her.
For all the medicine they provide at this center, physicians and staff from Doctors Without Borders spend as much time encouraging the patients to eat, drink, and keep fighting. Every patient gets a standard regimen of antibiotics, paracetemol and other pain medications, vitamins, oral rehydration therapy or intravenous fluids. Drugs can control nausea for those who need them; everyone gets antimalarials.
In the popular imagination, every Ebola patient has blood gushing from her eyes, but actual hemorrhaging has been rare in this outbreak. One study found bleeding in less than 1 percent of patients. For most others, battling Ebola is somewhat like battling cholera: a fight against the dehydration and weakness caused by continuous vomiting and diarrhea that sap patient's reserves and will to live. (Though caregivers caution that Ebola tends to have many more complications.) "In some ways I feel generic soft drinks are doing more for Ebola than anything else at the moment," says Kirrily de Polnay, a physician at the Bo management center.
When de Polnay and the other staff enter the containment tents where patients are housed, they attend to medical tasks first. Then, they coax patients to eat; the center's kitchen dishes up soup, rice, and local comfort foods like corn or rice porridge called pap, and cassava root-based foo foo, to encourage patients. "Take a bite for your son," de Polnay tells one patient, a mother whose toddler arrived here at the treatment center with her.
Many of the patients aren't in any condition to feed themselves, though—they need to be fed, to have fluids administered, and to be bathed. Doctors and nurses have limited time to spend with their patients, who total 54 today. The clock starts ticking once the health workers don their personal protective equipment: Tyvek suit, apron, two layers of gloves, boots, goggles, a hood and a respirator. It's almost too hot to actually work. After an hour or more with their entire bodies enclosed in rubber and polymers, the doctors' time with the patients is up.
Then it's up to the patients themselves.
Everyone who has worked with Ebola patients talks about the will to survive, and how much difference it makes. Maybe they say it because the treatment is symptomatic, addressing the dehydration and pain caused by Ebola instead of attacking the virus itself. Maybe they say it because they've seen patients who seem to be improving suddenly start to backslide. Or maybe they say it because they want to believe it. Unlike in a Western hospital, where patients this ill are plugged into monitors and watched over all day and night, even the desperately sick patients here spend a lot of time alone in their beds. It's simply too dangerous for someone to stay with them around the clock. Few people know what goes on in those lonely hours when patients are on the ward with only the sick for company.
On her first evening on the ward, de Polnay went to check on a boy in the treatment tent; the boy asked her to check on his father, lying next to him first. But the father was dead. The boy had spent the night beside his father's corpse.
Amid this routine calamity, some patients give up. De Polnay tells the story of an ambulance driver who was admitted here not long ago. Though he seemed relatively well to her, he told her one night: "You won't find me here tomorrow; I'll be dead." He was right.
But a pharmacist named Augustine Karbu, who worked with the ambulance driver, was admitted here 10 days ago, and today, Karbu is going home. I ask Karbu why he thinks he survived. He says he reported early for treatment, which doctors agree is a huge help. But Karbu has another theory. He takes his hands and puts one on either side of his head, in a gesture of concentration.
"Focus?" I ask.
A few days later, the woman in the orange skirt—the one who lost her three-year-old-son—will also leave, along with her surviving daughter. Her husband and son are scheduled for release on Thursday. In this center, 59 percent of patients survive Ebola. The medicine, food, care helped this family beat even those odds; four out of the five of them will walk out, cured.