By Michael StulmanSt. Joseph's Catholic Hospital in Monrovia had survived some of the worst periods in Liberia's history, providing essential health services through times of war and chaos—and now reconstruction—in a city where health needs have long outstripped treatment capacity.
On August 1, the unthinkable happened: One patient shut it down.
After months of hard work supported by Catholic Relief Services, St. Joseph's will reopen this week. The hospital was another victim of the Ebola outbreak that is now recovering from the effects of a disease that has brought such tragedy to the people of Liberia. With the doors of St. Joseph's now opened, there is new hope.
It was early in the morning on July 7 when an ambulance arrived at the hospital carrying a woman who was bleeding profusely. Her family presumed her condition was a complication from pregnancy, and St. Joseph's director, Brother Patrick Nshamdze, admitted her for care. The staff began doing everything it could to stop the bleeding and save her life.
Liberia's Ebola crisis had just begun. There were approximately 60 cases in the country. Everyone at St. Joseph's understood the protocols and took precautions to avoid contracting the virus. "Previously, St. Joseph's already had encountered two cases of Ebola. We identified them. The test was performed. The result came back positive. The patients were transferred to an Ebola treatment unit," says Dr. Omeonga Senga, general surgeon at the hospital. "We were taking precautions."
During that first day of treatment, the patient was tested for Ebola. That same day, she passed away from the uncontrolled bleeding. Three days later, on July 10, her tests came back positive. Brother Patrick had been among those caring for the patient. He was sick with fear that he had contracted the virus. Several days later, he was indeed feeling ill.
"I think I may have got infected," he reluctantly told Dr. Senga.
Dr. Senga says the health care workers treating Brother Patrick immediately began to wear personal protective equipment, or PPE. He was tested for Ebola on July 18, but the test showed him free of the virus. "Brother Patrick had the signs and symptoms of Ebola, but when the test came back negative, we started to consider other possible causes of his illness. We were not very strict on the PPE anymore," Dr. Senga says.
But when Brother Patrick continued to display worrying symptoms, Dr. Senga ordered additional tests. His colleagues visited Brother Patrick and prayed over him.
After a few days, Brother Patrick was not responding to medications, and his health was deteriorating. Dr. Senga ordered another test for Ebola.
Shocking Diagnosis
The result was shocking. Brother Patrick tested positive.
Upon hearing the news, one of the brothers collapsed at the hospital from grief and fear that struck the staff like lightning.
"Everybody was going to Brother Patrick's room, providing care, such as bathing him, feeding him, and so forth," Dr. Senga says. "All of us were so concerned when the second result came back positive." False negatives for Ebola are rare, but possible, especially when you aren't showing more advanced symptoms.
On August 2, Brother Patrick passed away at age 52. He joined the many Liberians whose lives have been cut short from the Ebola outbreak. St. Joseph's quarantined 20 people.
"Maybe it was the stress of the bad news, but we all got sick on the same evening. I had a fever and weakness," Dr. Senga says. "It was a difficult time, but to cope we were sharing how we felt. We were laughing sometimes, but after 2 days we couldn't even leave our homes."
Tests took time, but after all the results came in, 15 people had tested positive for Ebola. Dr. Senga was one of them. Their conditions quickly worsened.
"When we talk about headache, it's severe," Dr. Senga says. "It feels like your head is almost exploding. The weakness is intense. You cannot command your body. Nothing is responding. You see yourself becoming helpless. You just see yourself dying."
There were only two Ebola treatment units in Liberia at the time, and the outbreak was overwhelming the country's medical infrastructure. Although health care workers received priority care for Ebola, Dr. Senga stayed home for more than a week until a bed was available at ELWA 3, a treatment center in Monrovia managed by Doctors Without Borders.
A week later, Dr. Senga was one of the few fortunate enough to receive ZMAP, an experimental drug used to treat Ebola.
He survived the ordeal, and was discharged on August 22.
His colleagues—three brothers, one sister, two nurses, one X-ray technician, one lab technician and one social worker—were "wiped out, " Dr. Senga says.
In a matter of days, St. Joseph's was stripped of its capacity to treat patients, and closed its doors indefinitely.
Protecting the Lifesavers
Around the world, seasoned health care workers were taken by surprise when an unfamiliar disease erupted on an unprecedented scale. St. Joseph's was one of the many casualties in the Liberian health sector.
The result was another significant blow to a health system still weak from the country's 15-year civil war. Health care facilities that do not have the means to protect staff against Ebola are shutting down. As a result, people have had limited access to immunizations as well as treatment for malaria and other common diseases.
The World Health Organization has called failing health systems an "emergency within the emergency." According to Dr. Franco Pagnoni, formerly WHO's Ebola field coordinator in Guinea, who was quoted in a Huffington Post article, "If we don't pay attention, we will have thousands of deaths because of Ebola, but we will have tens of thousands of deaths for other diseases."
While St. Joseph's was closed, CRS supported the construction of a triage center, a screening point for everyone entering the hospital. If anyone is suspected of having Ebola, they are quarantined until further tests can be completed. CRS also supported the construction a community care center for those suspected of having the Ebola virus.
Vital Services Restored
St. Joseph's has now reopened, and health care workers are eager to provide essential services. With support from CRS, they have participated in months of planning and training to help them prepare for work and provide safe medical care.
"It is one thing to have the personal protective equipment, but it's another to know how to take it off [safely]," Dr. Senga says.
Health care workers around the country remain vulnerable, as they may come into contact with Ebola-infected people who don't know they have the disease. "Now we have those skills that will help us provide care, with safety to ourselves and the patients," Dr. Senga says. "We will be more ready now than before."
St. Joseph's will begin by providing maternity and child care. In the following several weeks, the hospital will scale up its services to meet other needs. "In one year from now, I'd like to see the hospital better than before. We should all learn from this outbreak and improve the health care delivery to the patients."
Dr. Senga says his survival from Ebola has led him to rededicate himself to his profession. "As a doctor, I knew the chances were slim," he says. "Now I'm more committed than ever. God is helping me help others."
Michael Stulman is the CRS regional information officer for Central and West Africa, based in Dakar, Senegal.