Doctors face tough treatment choices in the midst of the Ebola crisis

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    Next: a closer look at the growing human toll Ebola is taking on the communities of West Africa, the epicenter of the current outbreak.

    We have two updates from New York Times reporters who are working in the region.

    The first is from Ben Solomon, who filed this video report from inside an Ebola treatment center in the countryside east of the Liberian capital, Monrovia.

    GARMAI CYRUS, Psychosocial Officer and Nurse: What I see in the faces of the patients? Fear. Fear of the unknown. Right beside them, friends die. It's so, so frightening. Is this how I'm going to end up, too?



    My job is to help them to see, amidst Ebola, that there's still hope.



    I come here every morning. We sing to build up our hopes, then get prepared.

    I'm a nurse. I'm a mental health clinician. And I work here as a psychosocial officer. When I go in, I'm like an aunt to them inside. Most of them refer to me as big sister.

    It's within my spirit to give care, do it without touching or so, but there are other things that we can do, like build their hope, make them to feel more confident that they can come in here and walk out.

    At the moment, we are discharging. We have one patient who her test proved negative, and so we had to discharge her out.

    What gives me the most, most hope, people come in here so frustrated and sick, and, after, they walk out of here. It makes me feel that I'm working and I'm able to do something. It makes me happy. It makes me feel fulfilled.


    That report prepared by reporter Ben Solomon.

    Sheri Fink has also been reporting from Liberia for The New York Times. In addition to her journalist credentials, she's also a medical doctor. I spoke with her a short while ago over Skype from Monrovia.

    Sheri Fink, welcome.

    You have been writing some very moving stories recently, the overwhelming tragedy, but also some very tough decisions that the doctors have to make. Talk about that.

  • SHERI FINK, The New York Times:


    One of the doctors here named Steven Hatch, he speaks of it as Solomonic decisions, and, really, every day brings some of these tough choices. Ebola treatment units, in a way, they're kind of simple. They're not a lot of advanced care that's offered. In fact, it's sort of a protocol. Every patient gets a mix of medicines when they come in to cover things like, you know, a coinfection with something like malaria.

    Sometimes, you know, Ebola can reduce the effectiveness of the immune system. So people even get antibiotics, even though Ebola is a viral disease. So you would think it's sort of simple fluids and some of these extra medicines, but, in fact, there are all these choices that have to be made.

    For example, if you have somebody who tests negative, but then they develop symptoms while they're in the suspect ward, well, then, you know, it's possible that they still will turn positive. So do you keep them there and possibly expose them to other people who have Ebola in order to test them again?

    And, you know, all these difficult choices come up, even with children. That's another example, where, you know, a parent tests negative air, a child tests positive. So what do you in that situation?


    You wrote about a mother who died, a pregnant woman who died and had to make a decision about what to do with the infant when it was born.

    You also wrote about another mother who lost an infant and how she struggled with an infection and her treatment.



    I think these were two of the more really heart-rending stories. I guess there are stories like that every day. And they really sort of emphasize why the doctors and nurses who I have been chronicling for the last few weeks, they feel a lot of joy when people survive.

    But they get — over time, they realize that what the world has to offer for people who have Ebola just isn't quite there. So even take the pregnant woman. It turns out that Ebola is very highly — you know, it's even more fatal in people who are pregnant, and, you know, just the tragedy of that alone.

    This particular woman, they didn't know if she had Ebola. She hemorrhaged after having a spontaneous childbirth of an eight-month-old — eight months into her pregnancy. And she went from hospital to hospital while she was still alive, while she was, you know, struggling to survive.

    No hospitals would let her in, because that's kind of a classic presentation with Ebola, and highly infectious, obviously, if there's blood. So finally, the car with her parents and the lady and her baby make it to the Ebola treatment unit. And, by that point, she had passed away. But the doctors and nurses had to struggle with this decision of, what do we do with this infant?

    They had no idea. Could the infant be positive? There's not a lot of science around that or data or information, because we just haven't studied this disease as much as it would have been good to do. So they made the best choice they could. They sent the baby home with the grandparents, and you know, with gloves, with formula, in the hopes that they could give the child a chance at surviving.

    The child died three days later. And then two weeks after that, the mother, who had helped deliver her — the grandmother who had helped deliver her daughter's baby and had cared for the baby ended up coming down with Ebola and dying in the clinic. So these are the sort of — like, if you stay there long enough, you see how this disease moves through families that way.

    And, again, it's those high-risk contacts, the real contact with the body fluids that seems to be the theme over and over again.


    Right. Just — just terrible.

    Finally, Sheri Fink, the last story you wrote, despite all this, is surprisingly low numbers of patients being treated in these newest hospitals around Monrovia, where you are.


    Actually, it seems to be a pattern across the country.

    Now we have the WHO saying that there really has been, they believe, a slowdown in that upsurge in infections. And they really emphasize it's not a reason to pull back on any of the plans, because there are large swathes of the country that don't have treatment units.

    And that's part of what the U.S. is doing is trying to build and staff these treatment units that are in distant parts of the country, where there's not great surveillance. There aren't good options for people who have no access to cars, no cell phone service, and just — also just these really bad roads, frankly.

    So, right now, it's hard for them to be safe. You know, you have a family member who is sick. If you have to wait two days to get somebody to get them to a treatment unit, or if they die, to have a safe burial, that's really tough.

    So what the numbers are suggesting is there is some positive news, that some of these interventions that we have seen so much work on in the last few weeks and months may be starting to slow this epidemic, which is great news, but certainly not a reason to let up, according to the experts here.


    Sheri Fink reporting from the front lines there in Liberia, we thank you.


    Thanks a lot.

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