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Woman saves three relatives from Ebola

CNN – By Elizabeth Cohen, Senior Medical Correspondent, Fri September 26, 2014 – suggested reblog by How-Matters.com

Fatu Kekula has cared for four of her family members with Ebola, keeping three alive without infecting herself. Fatu Kekula has cared for four of her family members with Ebola, keeping three alive without infecting herself.

For more from Elizabeth Cohen on the ground in West Africa, watch CNN Saturday at 3 p.m. ET.

(CNN) — It can be exhausting nursing a child through a nasty bout with the flu, so imagine how 22-year-old Fatu Kekula felt nursing her entire family through Ebola.

Her father. Her mother. Her sister. Her cousin. Fatu took care of them all, single-handedly feeding them, cleaning them and giving them medications.

And she did so with remarkable success. Three out of her four patients survived. That’s a 25% death rate — considerably better than the estimated Ebola death rate of 70%.

Fatu stayed healthy, which is noteworthy considering that more than 300 health care workers have become infected with Ebola, and she didn’t even have personal protection equipment — those white space suits and goggles used in Ebola treatment units.

Instead Fatu, who’s in her final year of nursing school, invented her own equipment. International aid workers heard about Fatu’s “trash bag method” and are now teaching it to other West Africans who can’t get into hospitals and don’t have protective gear of their own.

Every day, several times a day for about two weeks, Fatu put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but Fatu was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Fatu is amazing.

“Essentially this is a tale of how communities are doing things for themselves,” Crowe said. “Our approach is to listen and work with communities and help them do the best they can with what they have.”

Two doctors for 85,000 people

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear — it’s just that those things aren’t available to many West Africans.

No one knows that better than Fatu.

Her Ebola nightmare started Juy 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

One woman walked in, and the Ebola nightmare began

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Fatu took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Fatu took him home, where he infected three other family members: Fatu’s mother, Victoria, 57; Fatu’s sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

Guilty of Ebola until proven otherwise

While operating her one-woman Ebola hospital for two weeks, Fatu consulted with their family doctor, who would talk to her on the phone, but wouldn’t come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients’ blood pressure plummeted so low she feared they would die.

“I cried many times,” she said. “I said ‘God, you want to tell me I’m going to lose my entire family?’ “

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

“I’m very, very proud,” her father said. “She saved my life through the almighty God.”

Now he’s working to find a scholarship for Fatu so she can finish her final year of nursing school. He has no doubt his daughter will go on to save many more people during her life.

“I’m sure she’ll be a great giant of Liberia,” he said.

Ebola patients left to lay on the ground

CNN – By Elizabeth Cohen, Senior Medical Correspondent – Tue September 23, 2014
Watch this video

Ebola overwhelms new hospital in Liberia

Editor’s note: CNN senior medical correspondent Elizabeth Cohen is in Liberia to report on the largest Ebola outbreak on record.

Monrovia, Liberia (CNN) — On the day the new Ebola clinic in Liberia opened, ambulances waited outside. Inside the ambulances were desperately ill patients who had come for treatment but instead would be left to lie on the ground as others walked by.

The Island Clinic and its 120 Ebola treatment beds opened to fanfare Sunday afternoon, with a ceremony attended by international health officials and Liberian leaders. But the clinic, located on Bushrod Island near Monrovia, the capital, did not appear to be ready for the number of patients that quickly flooded its doors.

Some lay motionless on the floors of the ambulances outside the center, too weak to get out. They had traveled for hours after being turned away from other hospitals in the area. No one from inside the hospital arrived to offer assistance.

Photos: Ebola outbreak in West AfricaPhotos: Ebola outbreak in West Africa

“Try to come down and walk a little,” a worker told him.

“I’m too tired,” the man said.

But he summoned his strength and got out of the ambulance — and immediately collapsed on the ground.

A little boy tried to walk out of another ambulance, but he too collapsed.

The two lay on the rocky ground just a few feet apart. The boy was completely naked and the man was naked from the waist down — Ebola patients often don’t wear pants because of the intense diarrhea caused by the virus.

“Get up and go inside,” workers told the boy. “You’ll only get food if you go inside.”

“Let him rest,” another worker said, and they agreed to let him stay where he lay.

When asked why no one from the hospital was helping them get inside, a hospital worker said staff was inside suiting up in protective gear. Ebola spreads through contact with bodily fluids from an infected patient.

More than 2,800 people have died over the past six months in West Africa. Five countries have reported Ebola cases, but Liberia, Guinea and Sierra Leone have carried the largest burden.

Deadliest outbreak: What you need to know

Island Clinic is supported by the government of Liberia and the World Health Organization. When shown CNN’s video of the patients collapsing, a WHO representative was horrified, but said the patients shouldn’t have waited until they were so sick to seek help.

“I think the lesson here is that people come too late,” said Peter Graaff.

But many Ebola patients don’t wait by choice — there’s an estimated shortage of 700 Ebola beds in Monrovia alone, and patients often wander from hospital to hospital, only to be turned away.

“I know, I know,” said Graaff, WHO’s country representative in Liberia. “That’s why we need to increase capacity.”

Graaff said he would try to find out why hospital workers didn’t come help the patients. He said he hopes any opening-day difficulties won’t discourage patients from seeking help — he doesn’t want them to stay home.

“It’s shocking,” he said. “This is exactly what we should try to avoid in the future. It’s horrible.”

***

John Bonifield, Orlind Cooper, Orlando Ruiz and Jacque Wilson contributed to this story.

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Life under Ebola in Lagos, Freetown, Monrovia

As we headed toward the gate, a young boy passing by glanced at us and said: “That’s the Ebola house.”The doctor pushed the rusty gate open with the sole of her shoe, warning me not to touch anyone or anything. “Not the walls, not the doors, nothing.”An eerie silence filled the empty courtyard that leads to the Lagos house where a nurse died of Ebola. The five families – 26 people in all – who shared the house with her were being monitored for possible signs of the dreaded disease.

I wasn’t sure what to expect and I must admit that my apprehension was high as I accompanied the doctor who had been visiting the house on a daily basis to monitor the health of the 26 people listed as contacts – meaning they had contact with a person who had Ebola.

Each family has its own separate room, but the bathroom is shared by all the compound’s residents. The doctor called out someone’s name and people began to emerge from the doorway. Within a few minutes about a dozen people, young and old, had gathered. Greetings were made, but we remained a couple of yards (meters) away from the contact persons.

All of them had brought along their digital thermometers so their temperature could be recorded. One of the first symptoms that Ebola patients tend to exhibit is a fever. All the contacts were given a thermometer and told to take their temperature daily for 21 days, the incubation period of the Ebola virus.

Entrance to the Lagos Ebola treatment center. (c) UNICEF Nigeria/2014/Terry Howard

The contact monitoring teams meet every contact person daily to make sure temperatures are properly taken and recorded. Anyone who develops a fever or shows any of the other Ebola symptoms, such as vomiting, diarrhea, headache, or a rash, is taken to the treatment facility for testing. There is no known cure for Ebola, but proper clinical care, if started early, can greatly increase chances of survival. In Nigeria, 12 of the 19 cases confirmed by September 16, survived.

But survivors face another battle after fighting off the disease – stigmatization – which also affects their families and anyone they had contact with. In the compound, I asked what life has been like since the nurse had taken ill and passed away. Everyone wanted to talk at once, and all said they had been contending with stigmatization in one form or another.

Three of the men living in the house had lost their jobs – two of them had just been informed that morning. Both of them worked as security guards for a nearby church that they attended. The third was a private driver.

Community members who used to come into the compound to draw water from the well now stayed away, even though the house was decontaminated the day that the nurse was taken to the hospital.

Terry Howard

“If we go out onto the street, people run away from us. They are afraid,” one of the contact persons said.

“We’re hungry-o,” an older man said, pointing to his stomach. “People won’t sell us food, they won’t take our money. It’s three days now since we’ve eaten and we’re hungry.” All of those standing around nodded in agreement. .

The families in the compound were not receiving any assistance. When they told me that they had not eaten anything for three days because nobody would sell them any food…that really tugged at my heartstrings.

As we drove away the man’s words “We’re hungry-o” kept ringing in my head. The children, the adults…they’d done nothing wrong. They were simply being monitored for their own safety and that of their community.

I just had to get them some provisions – bread, rice, and ground cassava. I re-entered the courtyard after pushing the door open with the sole of my shoe. They seemed surprised to see me return so quickly, and their eyes lit up as I put the plastic bags filled with food down on the small bench. Everyone reassembled and thanked me. Such a small gesture…but one that made a big difference to these hungry children, women and men.

The following day, I was told that, somehow, news of me giving them food reached the local government authorities, who then provided some more supplies.

Terry Howard is a Staff Counsellor at UNICEF Nigeria. Since the Ebola outbreak started in Nigeria, he has been providing psycho-social counselling to people affected by the disease in Lagos and Port Harcourt. UNICEF is playing a key role in sensitizing people about Ebola, to help contain the spread of the disease and to combat stigmatization.

Life under the three-day lockdown in Freetown

Source: KSN via Associated Press – Sep 20, 2014

(AP Photo/ Michael Duff)
(AP Photo/ Michael Duff)
A health worker volunteer marks a home with chalk to identify that it has been visited.(AP Photo/Michael Duff)
A health worker volunteer marks a home with chalk to identify that it has been visited.(AP Photo/Michael Duff)

FREETOWN, Sierra Leone (AP) — Some in Sierra Leone ran away from their homes Saturday and others clashed with health workers trying to bury dead Ebola victims as the country struggled through the second day of an unprecedented lockdown to combat the deadly disease.

Despite these setbacks, officials said most of Sierra Leone’s 6 million people were complying with orders to stay at home as nearly 30,000 volunteers and health care workers fanned out across the country to distribute soap and information on how to prevent Ebola.

The virus, spread by contact with bodily fluids, has killed than 560 people in Sierra Leone and more than 2,600 in West Africa since the outbreak began last December, according to the World Health Organization. It is killing about half of the people it infects.

The streets of the capital, Freetown, were empty Saturday except for the four-person teams going door to door with kits bearing soap, cards listing Ebola symptoms, stickers to mark houses visited and a tally to record suspected cases.

Among the volunteers was Idrissa Kargbo, a well-known marathoner who has qualified for races on three continents but whose training and career have been stymied by the outbreak.

(AP Photo/Michael Duff)
(AP Photo/Michael Duff)

Although early responses to the disease have been marred by suspicion of health workers, Freetown residents on Saturday seemed grateful for any information they could get, Kargbo told The Associated Press.

“Some people are still denying, but now when you go to almost any house they say, ‘Come inside, come and teach us what we need to do to prevent,’” Kargbo said. “Nobody is annoyed by us.”

Sierra Leone’s government is clearly hoping the lockdown will help turn the tide against the disease which the U.N. health agency estimates will take many months to eradicate in the country. In a speech before the lockdown, President Ernest Bai Koroma said “the survival and dignity of each and every Sierra Leonean” was at stake.

The strategy has drawn criticism, however. The charity group Doctors Without Borders warned it would be “extremely difficult for health workers to accurately identify cases through door-to-door screening.”

Even if suspected cases are identified during the lockdown, the group said Sierra Leone doesn’t have enough beds to treat them.

In a district 20 kilometers (12 miles) east of Freetown, police were called in Saturday to help a burial team that came under attack by residents as they were trying to bury the bodies of five Ebola victims, Sgt. Edward Momoh Brima Lahai said.

A witness told state television the burial team initially had to abandon the five bodies in the street and flee. Lahai said later the burials were successfully completed after police reinforcements arrived. The bodies of Ebola victims are very contagious and must be buried by special teams.

In northern Sierra Leone, health worker Lamin Unisa Camara said Saturday he had received reports that some residents had run away from their homes to avoid being trapped inside during the lockdown.

Police guard a roadblock as Sierra Leone government enforces a three day lock down. (AP Photo/Michael Duff)
Police guard a roadblock as Sierra Leone government enforces a three day lock down. (AP Photo/Michael Duff)

“People were running from their houses to the bush. Without wasting time, I informed the chief in charge of the area,” said Camara, who was working in the town of Kambia.

Several health care workers and volunteers complained that supply kits were delivered late, preventing their teams from starting on time.

But Kargbo, the marathoner, said his team was on track to meet its goal of visiting 60 households by the end of the lockdown Sunday. He said the effort would be worth it if the outbreak is shortened even a little.

Other Freetown residents, however, were having trouble making it through the three days.

“The fact is that we were not happy with the three days, but the president declared that we must sit home,” said Abdul Koroma, the father of nine children in Freetown.

“I want to go and find (something) for my children eat, but I do not have the chance,” he said.

Coco’s journey, losing 10 of her family in Monrovia

Source: Pastor Garrett

Can you imagine the feeling of defeat and despair that one who has lost 10 family members to the Ebola virus could sense? We recently sat down with Coco Dahn and her husband, Peter, as she talked about the pain of having ten close family members pass away due to the Ebola virus over in Monrovia, Liberia. And if that pain isn’t enough, she still has three teen-aged children there who are trapped in isolation inside Liberia and whom she hasn’t seen in months (although she has spoken with them on the phone.) Their names are Bernice, Luther, and Nelson. Luther and Nelson are 15-year-old twins.Coco3

As you have probably already heard, the CDC is currently urging everyone to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of the unprecedented outbreak of Ebola in those countries. The CDC further recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola.

There are reports of civil unrest and violence against aid workers all over West Africa as a result of this outbreak. In fact, the public health infrastructure of Liberia is being severely strained as the outbreak grows.

Coco1

Of course, the Liberian government has responded by recently implementing enhanced measures to combat the spread of Ebola. These measures will affect travel in, out, and within Liberia. This creates another aspect of Coco’s Challenge. movement of her children within and without the country. Here are the five-point measures that the Liberian government is taking.

  • All Liberian borders are closed except for major entry points.
  • There are new and stringent measures of screening for the virus to be implemented at those major entry points. Again, this affects ALL incoming and outgoing travelers.
  • There are new restrictions concerning public gatherings.
  • Quarantine measures have been established for communities heavily affected by Ebola; travel in and out of those communities will be restricted.
  • Authorized military personnel have been placed to help enforce these and other prevention and control measures.[1]

Coco2All of these situation make Coco’s story even more difficult. She wants to get her teen-aged children out of Liberia to a place where they can be reasonably safe. But they are trapped within their own city. Because of the quarantine measures there in the city of Monrovia, they are essentially confined to their house … even though they are not sick nor show any signs of the sickness.

So ISOH/IMPACT is trying to help Coco by getting her children out of Liberia. Phone calls are being made to immigration attorneys, emails are being sent to embassies, questions are being researched concerning medical and health screenings, and finances are being raised to support this massive project.

We are aware that there are many who are in a similar situation to the one that Coco is in. And we know we can’t help them all BUT … together, we can help one or two.

Would you consider making a gift of love to help us with this project? We are not sure what the final price tag will be because we are only in the initial stages. But we promise to be good stewards of the gifts that God gives us through you.

If you want to donate, please go to the following website and click on the “Donate” button under “Where Needed Most”: http://isohimpact.org/make-an-impact-with-hope/ Be sure to let us know that this gift is for “Coco’s Challenge.

Ebola headlines and local report wrap up, Sep 8 2014

African Union says efforts to stop Ebola are creating sense of siege

MONROVIA, Liberia – The United States and Britain will send medical equipment and military personnel to help contain West Africa’s Ebola outbreak, as the World Health Organization warned Monday that many thousands of new infections are expected in Liberia in the coming weeks.

The current Ebola outbreak is the largest on record. It has spread from Guinea to Sierra Leone, Liberia, Nigeria and Senegal and killed more than 2,000 people. An “exponential increase” in new cases is expected in the hardest-hit countries in coming weeks, the U.N. health agency warned.

“As soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload,” WHO said in a statement about the situation in Liberia. “Many thousands of new cases are expected in Liberia over the coming three weeks.”

Military personnel will set up a 25-bed field hospital in the Liberian capital, Col. Steven Warren, a Pentagon spokesman, said Monday. The clinic will be used to treat health care workers, a high number of whom have become infected in this outbreak.

Once set up, the centre will be turned over to the Liberian government. There is no plan to staff it with U.S. military personnel, Warren said.

Liberia welcomed the news.

“This is not Liberia’s particular fight; it is a fight that the international community must engage very, very seriously and bring all possible resources to bear,” said Information Minister Lewis Brown.

In addition, Britain will open a 62-bed treatment centre in Sierra Leone in the coming weeks. It will be operated by military engineers and medical staff with help from the charity Save the Children, Britain’s Department for International Development said Monday.

The clinic will also include a special section for treating health care workers, offering them high-quality, specialist care, the statement said.

Currently, there are about 570 beds in Ebola treatment centres in Guinea, Sierra Leone and Liberia, the hardest-hit countries, and the World Health Organization says nearly 1,000 more are needed, the vast majority of those in Liberia.

Doctors Without Borders welcomed both the American and British announcements, but warned even the latest surge in efforts may not be enough, saying the disease was moving “catastrophically through the population much faster than new facilities are being created.”

And experts say it’s not just beds, but that more international and local health workers that are needed. Doctors Without Borders also urged Washington to not simply set up clinics but also to staff them.

Many health workers, however, have been reluctant to respond to the crisis out of concern that there isn’t enough protective equipment to keep them safe.

A fourth American who contracted Ebola in West Africa was expected to arrive in the U.S. for care Tuesday, Emory University Hospital — where two other aid workers successfully recovered from the disease — said Monday in a news release.

Ebola is spread through the bodily fluids of people who show symptoms, and doctors and nurses are at high risk of infection because they work closely with the sick. The WHO doctor whose infection was announced Monday is the second health care worker with the agency to catch Ebola. The doctor is in stable condition and will shortly be evacuated, the agency said.

In Liberia alone, 152 health care workers have been infected with Ebola and 79 have died, WHO said, noting that country had too few doctors and nurses even before the crisis.

“Every infection or death of a doctor or nurse depletes response capacity significantly,” it said.

U.N. Secretary-General Ban Ki-moon called several world leaders over the weekend, including the British prime minister and French president, to urge them to send more medical teams and money to fight the outbreak.

Officials have said flight bans and border closures — meant to stop the disease’s spread — are slowing the flow of aid and protective gear for doctors and nurses to the region.

At an emergency African Union meeting Monday, members agreed to open borders that have been closed and lift bans on flights to and from affected countries, according to Nkosazana Dlamini Zuma, chair of the AU’s Commission. But it was unclear how quickly those promises would be kept.

Earlier, Senegal, which has shut its borders and blocked flights, said it was planning to open a “humanitarian corridor” to the affected countries.

Liberia: Govt. Suspends Poro, Sande Activities

The Ministry of Internal Affairs through its Bureau of Customs and Culture and in collaboration with the National Council of Chiefs and Elders has announced the immediate suspension of all Poro and Sande activities throughout Liberia.

Sande, also known as zadεgi, bundu, bundo and bondo, is a women’s association found in Liberia, Sierra Leone andGuinea that initiates girls into adulthood, confers fertility, instills notions of morality and proper sexual comportment, and maintains an interest in the well-being of its members throughout their lives. In addition, Sande champions women’s social and political interests and promotes their solidarity vis-a-vis the Poro, a complementary institution for men. The Sande society masquerade is a rare and perhaps unique African example of a wooden face mask controlled exclusively by women – a feature that highlights the extraordinary social position of women in this geographical region.

The ministry says its attention has been drawn to reports of the continued operation of Poro and Sande societies in several parts of the country in violation of the moratorium placed on the operation of Poro and Sande Societies on June 2, 2014.

In a press release issued here, it said the decision then, and now, was intended to ensure that there is no outbreak of the Ebola virus in any Poro or Sande grove in Liberia.“This would be a disaster and it must be prevented in the interest of saving additional lives of our fellow citizens”, the release read. However, the ministry notes that in spite of its demonstration of understanding and accommodation, some individuals have continued to operate Poro and Sande Groves and conduct cultural festivals.

According to the press release signed by Minister Morris Dukuly, such practices in the face of the Ebola epidemic exposes citizens to increased incidents of the virus and untimely death. The ministry therefore directs that all such practices must cease and be seen to have ceased by September 17, 2014.

MIA warns that any grove which operates or reopens its doors to initiate persons will be seen to be in defiance of its General Circular No. 13 and its most recent statement, reaffirming the provisions of the General Circular.

The Ministry says, the two-week extension it is granted under this statement is to allow the smooth closure of all Poro and Sande Societies operating in the country, and should not be viewed as an extension of the term of existing graves.

It said any grove or society found operating beyond the September 17, 2014, date would be ordered immediately closed in keeping with cultural, traditional practices, and its guidelines and regulations, while persons operating such groves will be prosecuted under the laws of Liberia.

Meanwhile, the Minister of Internal Affairs is authorizing all county Superintendents, District Commissioners, County Inspectors, and other appropriate local government officers ensure full compliance with this directive, and to close uncooperative Sande and Poro Societies upon the expiration of the two-week extension period.

The release said the Minister of Internal Affairs has written to inform Chief Zanzan Karwor, Chairman of the National Council of Chiefs and Elders, of the directive, and requested the full cooperation of the council.

Monrovia – The deadly Ebola virus is spreading in Monrovia and beyond, touching the security sector as 18 Police officers have been quarantined in Bloc C at the Police Barracks in Monrovia.

According to sources, one Police officer serving the Police Support Unit (PSU) contracted the virus and is currently undergoing treatment at the ELWA Ebola center.

One senior Police source confirmed to FrontPageAfrica that the officer is in critical condition at the Ebola treatment center. The Police officer is said to have contracted the virus from his wife who is a nurse, who transferred the virus to her husband after also getting infested from work.

The health of the PSU officer prompted the quarantining of Bloc C of the Police barracks where accordingly the 18 Police officers are residing. Located at the intersection of Camp Johnson Road and Capitol By-pass the Police Barracks is home to several Police officers and their dependents.

According to one member of the Ebola Task Force, several items have been supplied the quarantined Police officers including chlorine, biscuits and other materials. Police officers are used in protecting clinics and other medical facilities also accompanying various medical teams, including burial, collection of sick patients and others.

The officers are usually not seen wearing protective gears including gloves and other PPEs while providing protection in medical facilities and carrying out other duties closely related to Ebola. Police officers are also used to implement quarantine in several communities as they were recently deployed to ensure the quarantine of the West Point community and some are now in Dolo’s Town, Margibi County performing similar duty.

United States based Centers for Disease Control has warned that up to 20,000 people will get infested with the virus before it is brought under control, but it seems the Liberian government does not agree with such prediction as President Ellen Johnson Sirleaf has publicly declared disagreement with the CDC’s prediction.

Despite disbursement of funding from the Ebola fund to the security sector including the Police, Police officers are not adequately catered for as some officers have complained that they do not receive daily per diems and other protective materials, thus making vulnerable to contracting the virus.

Why the ebola drama remains compelling

Ebola-victims

Originally posted July 26, 2014 and edited by me.

Ebola battling sadness, fear and disgust on the frontline

An MSF psychologist reveals the trauma of dealing with the Ebola outbreak for medics, cleaners and the families of the dead.
MDG : Ebola Treatment Center in Kailahun, Sierra Leone

MSF’s Ebola treatment centre in Kailahun, Sierra Leone. A pair of brothers, 11 and four, draw pictures with a psychologist. Their mother continues to receive treatment. Photograph: MSF

Ane Bjøru Fjeldsæter is a 31-year-old psychologist from Trondheim, Norway. For the past month, she has been working for Médecins sans Frontières (MSF) in Kailahun, Sierra Leone, helping to fight the largest ever outbreak of Ebola, which has killed more than 600 people in three countries. She provides support and counselling to patients and their families, as well as to the staff whose job it is to deal with the dead bodies.

I was expecting the Ebola epidemic to be quite gruesome and unlike anything I had seen before. But I really didn’t expect its magnitude – this outbreak is enormous. In Sierra Leone, it killed off a lot of health workers before MSF even arrived. Not surprisingly, medical staff were reluctant to work with us at first. They’d never come across Ebola before – but at least they had previous experience of people suffering and people dying. But for the non-medical staff, like the hygienists – our hospital cleaners – it’s been a new and disturbing experience, and a large part of my work involves helping them with counselling and support.

The hygienists have the hardest job of all because they are the ones dealing with the dead bodies. Since our Ebola centre opened two weeks ago, we’ve had 37 deaths: an average of two or three a day. A lot of the cleaners are young, unskilled workers. In an area with an unemployment rate of 95%, they jumped at this opportunity to get a job.

They are the ones who mop up the vomit, the stools and the blood. And when there’s a death, they are the ones who retrieve the body from the isolation ward, put it in the morgue and disinfect it. In the final stages of the disease, the viral load increases massively, which means the dead bodies are extremely contagious and very dangerous to deal with.

MDG : MSF Ebola Treatment Centre in Kailahun, Sierra LeoneDoctors try to feed a girl in the centre’s high-contamination-risk zone. Photograph: Sylvain Cherkaoui/Cosmos for MSFDealing with the dead bodies is disturbing: the hygienists experience feelings of sadness and fear, but also disgust. When Ebola patients die, there’s bleeding, vomiting and diarrhoea. The cleaners tell me they have flashbacks of the things they have seen and of things they have smelled. Even wearing a mask, you can’t shut out all the smells.

Traditionally, in Sierra Leone, dead bodies are taken care of by the tribal elders. A lot of the hygienists feel they are too young to be dealing with the dead, so worry they’re being disrespectful of their culture’s traditions. We make sure that on each shift there is always one man and one woman, so that when someone dies, there will always be someone of the same sex to tend to them.

The local staff experience huge stigma from the community. The son of one of our workers recently died from malaria. People in his village immediately said he had caused his son’s death because he was working with Ebola. It was very distressing for him.

The stigma makes it hard for the hygienists. We tell them: “You are heroes, you’re doing a very important service for your community – it’s absolutely vital that someone is doing this job.” But although we see them as heroes, that isn’t always how they are perceived by their families, their friends or their villages.

MDG : MSF Ebola Treatment Centre in Kailahun. Sierra LeoneA patient attempts to rehydrate himself under the watchful eye of a nurse. Photograph: Sylvain Cherkaoui/Cosmos for MSFWhen we discharge a patient who has survived Ebola, it makes an enormous difference to them. On Tuesday, three people who had been cured were discharged from the isolation ward, and all the cleaners were dancing, deliriously happy and taking photographs. They find ways to manage the stress: they take good care of each other; when someone is upset, they talk about it, and they are very open about voicing their concerns and difficulties.

Still, the local staff have had their lives turned upside down. But then throughout the entire district everything is upside down. Here in Kailahun, the banks are shut, the schools have been closed for more than a month, and the students are very upset that they are missing their exams. A lot of people are isolated by the fear that if they go near other people, they will get the disease. People are at a loss to understand what is happening to them.

Last week, a girl came out of the isolation ward. Her name was Bintu and she was almost two. Both her parents had tested positive for Ebola, but she tested negative, so we had to take her out of the ward because the risk of contamination was too high. That was a horrible day.

MDG : MSF psychologist Ane Bjøru Fjeldsæter at Ebola Treatment Centre in Kailahun, Sierra Leone Psychologist Ane Bjøru Fjeldsæter welcomes Tamba James, who has been tested negative for Ebola. Photograph: Sylvain Cherkaoui/Cosmos for MSFThe nurses told me she didn’t know how to speak. For the two days she’d been in the ward, she’d been so shocked that she hadn’t uttered a word. This can happen to children – it’s called elective mutism. When she came out, she was in shock: she didn’t make eye contact; she didn’t speak to anyone. We put her in a chair and she turned around, with her back to the world.

It must have been a terribly disturbing experience for a child: to see someone come into the ward in a spacesuit; to hear them speaking to her mother in words she didn’t understand; to see her mother start crying; and then to be handed over to the stranger in the spacesuit and carried off.

I sat with her for four hours, trying to talk to her in a calm and normal voice and singing her songs, to see if the shock would pass. By the end of the four hours she had turned around and was facing me. She made eye contact, she put her hand out for me to touch her, she tried to start a conversation with me. You could see that she was starting to warm up to me, and that she wasn’t in the same condition.

Bintu became an orphan that day. She is in the care of our child protection partner and they will locate other family members who can take care of her. She will need to be monitored for 21 days to see that she does not develop the disease herself.

Originally from The Guardian, July 17, 2014.