In the Company of Men

by Véronique Tadjo

  Next on the agenda are the tasks for the day: a female patient is refusing to eat and take her malaria medication. Only three days ago, she lost both her husband and her baby. It’s a case that needs to be closely monitored. A young man who was still very communicative on admission started going rapidly downhill and is now completely unresponsive. Several patients are in an advanced stage of the illness and require urgent rehydration. A little girl’s arm has swelled up enormously, most probably due to septicemia. She has received a dose of antibiotics. One of the doctors says that special attention must be paid when giving injections, since the thickness of the gloves makes these procedures risky for both patients and staff. One of the nurses reports that a patient has vomited in the courtyard. A knife has been found under his pillow. He says he’d rather kill himself than succumb to Ebola. The team leader wants to know how this knife could possibly have stayed hidden. The nurse doesn’t know. The occupant of bed number six will be allowed to go home. Five patients seem to be getting better.

  I go to the changing room, where I’m helped with getting dressed. I pull on my plastic suit. The strong synthetic fabric is thick, waterproof, and sealed at the wrists and ankles. Once my body is safely wrapped, I am given a transparent plastic apron as an additional protective layer. I pull on two pairs of gloves, slide my feet into rubber slippers, heavy but comfortable, and easy to put on and take off. In front of the mirror, I check that my face mask is properly in place and my goggles fit tightly. I’m ready. Patients who are already seriously ill are brought in on stretchers. The others walk, with difficulty. Their faces are like death masks already. Their eyes bulge, their bodies are emaciated.

  Bending over a patient, I’m trying to find a vein. Then the needle prick, and I can insert the catheter, gently, very gently, for the skin is dry and brittle, and the pulse practically nonexistent. I’m focused, working with precision. The gloves are definitely a hindrance; one second’s distraction, and the needle may pierce my flesh. Inside my suit, sweat pours from me. I can’t talk, my voice is stifled. I gesticulate to the nurse to let her know what to bring me, pointing to the instruments with my fingers. My visor is blurred from condensation. Forty minutes like this, that’s the maximum. Any longer, and you may faint, you may simply collapse. Forty minutes of inhaling my own breath. Sweat trickles down my arms, my torso and legs. It’s boiling hot under the torrid metal roof. The rainy season should have started by now, the rays of the sun seem to be getting more and more intense. I look up, thinking of my wife and children. When will I see them again? Why expose myself to such dangers? Ebola pushes us to our very limits, presses our backs against the wall. I refuse to let the virus win the day. I can’t let the disease take control, spread, and threaten my family. We must fight it. That’s the price we have to pay as long as we share the same planet.

  The task before us is immense—I’m aware of that. All we can do for our patients is to try to keep them going. There are no effective medicines against the virus. So the main thing is to rehydrate the patients. We give them lots of liquids, as often as possible. They also receive nutrition by mouth, but if that doesn’t work, they’re fed intravenously. Then they get tablets to bring down their temperature, and they’re constantly monitored for any signs of gastrointestinal problems. We also give them painkillers and try to reduce their anxiety. In their weakened state, such patients easily succumb to secondary illnesses: bacterial infections, malaria, typhoid, tuberculosis. This means we’re obliged to go on treating them, even if they’re already at death’s door. We have to do our utmost at all times. Any personal attachment is out of the question, for that would mean making myself so susceptible to my patients’ suffering that I wouldn’t be able to care for them anymore. All I can really do is carry on with my work, hoping that this horror will soon be over, hoping that the day will come when I can go home to forget and start my life again.

  But all this is incomparably harder when the patient is a child. I remember the baby who came in one afternoon. Her mother was holding her in her arms, tightly wrapped in a blue blanket. Nothing but the tiny face was visible: closed eyelids, a fine layer of soft hair covering the forehead, the lips slightly parted, the skin as flimsy as tissue paper. The woman had to be supported by two male nurses in protective clothing. Since we were obliged to separate the baby girl from her mother, a confirmed case, we took turns feeding the infant with a syringe. Her minuscule body was fighting, resisting. At first, she was digesting the food we gave her and seemed to be gaining strength. But after a few days, she started whimpering. She didn’t sleep that night, and the following morning, the milk wouldn’t go down, she couldn’t swallow anymore. She vomited. Not long afterward, she took a deep breath, and then she died.

  Was there something we could have done to save her?

  That’s the question I’ve asked myself so often, the question that still obsesses me. The mortality rate among children is devastating, and we have no separate room for pediatric cases. They are just as contagious as adults, and the same rules apply. Yes, by the time they’re dying, they’re no longer children.

  Was there something we could have done to save her?

  The Ebola center was put up in haste to enable us to deal with the outbreak quickly. Huge trucks arrived, piled high with wooden planks, metal sheets, and plastic tarpaulins. Then technicians set to work. They built the center—a cluster of prefabricated rooms and tents—and within a few weeks, everything was ready and working. Two generators that operate nonstop provide electricity. The noise they make is an integral part of our working day. The camp is subdivided into two different zones: one zone for suspected cases only, and the other for confirmed cases. One side of the center is reserved for medical staff rooms and offices, unauthorized entry prohibited. In the absence of security guards, an orange plastic ribbon forms a barrier around the center. The entire area is so well lit, one might say it was a prison. The patients inside feel like convicts. The ground all around the place has been bulldozed to create a perimeter that no one approaches without trepidation. Triage takes place under the big tent. Two possible directions: suspected cases and confirmed cases. People waiting for their test results have to stay in the transit zone. They pray, weep, make promises to their god, and remember the important events in their lives.

  The test results take at least four hours to come in. Four hours, followed by a return to normal life or isolation in the treatment zone, which is shut off from the outside world. Formerly, getting the results took four to five days. A new mobile laboratory provided by the U.S. Army has shortened the wait.

  What are we doing here on earth? Why have we been put here if our existence is nothing but suffering? Some lives seem as worthless and irrelevant as the bruised fruit left over at the end of a market day. Left to rot in wooden crates, or just thrown away, it’s fruit nobody wanted, and yet, only a few hours before, it was adorning the stalls.

  I’m a trespasser in the kingdom of Death. This is his private domain, his empire, where he rules with absolute power. I feel like an astronaut floating in space, a thousand miles from earth. The slightest tear in his spacesuit and he’s lost. The slightest tear in mine, and, just like him, I’m lost too.

  Only a few of these patients are going to make it. The rest are never going to leave their beds or the treatment tent.

  Who will survive? Although they all receive the same level of care, within the span of two weeks, one patient is about to pass away, while another’s getting ready to go home. Another will feel better, get stronger, start to smile again, but then, suddenly, he’ll give up and die. It’s impossible to know. Despite our efforts, all too often, the virus wins.

  In reality, the final outcome isn’t up to us. How hard the sick are able to fight against Ebola depends on the natural defenses they have at their disposal, that is, it depends on their immune system, or on the virulence of the virus infecting their organism. Were the survivors in better health than the rest before they becam
e infected? This is something of a mystery. And suppose they recovered simply because their survival instinct was stronger than the disease? The will to survive defeats the virus, it concedes, and they have the freedom to go on living a little longer. None of us knows what we have in our bellies. I myself, though I’m a doctor, have no idea how my body would react if I came down with Ebola. Chances are, I wouldn’t fare any better than my patients. A woman can survive, an old man can survive, a teenager can survive. And what about me? The virus respects nobody, makes no exceptions. Incapable of rational thought, it’s the kind of enemy that instinctively wants to crush its opponent. The human race itself wouldn’t be enough for it.

  Even in death, Ebola doesn’t want to let go. Like bombs, its corpses sow destruction.

  At the start of the epidemic, there was the danger that panic might spread. The army had not yet been mobilized. Soldiers were not yet ready to fire on the sick if they tried to escape. But how do you get used to the idea that your body will end up in a plastic bag, doused with disinfectant and interred in a communal grave by men in masks? Buried without any sort of ancestral ritual to prepare the deceased for entry into the next world, and without any kind of funeral to honor their memory. No time for contemplation or human affection. Some people went home in spite of their diagnosis. They “absconded,” with all the consequences doing so entailed: bringing the virus back to their family, to their village, to their town.

  My shift over, I return to the changing room. This time, I get help with the long, complicated process of taking off my protective suit. First, to ensure my bootsoles are free of debris or contaminated fluids, I have to step into a container filled with chlorine solution. Then I’m doused with a disinfectant. I extend my arms so that the solution can reach every part of me. Any physical contact is to be avoided. Next, I take a chlorinated shower. All the clothing I’ve worn must also be washed in chlorinated water and then dried in the sun. What can’t be disinfected gets burned.

  When a patient is allowed to go home, it makes me happy. He or she receives new clothes, since everything worn on arrival at the center has been incinerated. The patient is also given some food, vitamins, a small amount of money, and a certificate of good health, which should help with restarting a normal life. When I see a smile on a patient’s face, I tell myself that I’ve done my duty. The things I go through in the Ebola center are extremely distressing, but I’ve never known anything more gratifying than alleviating human suffering.

  My thoughts are with my children and what we’ll do when we’re together again. I’m going to buy them bicycles, one red, one blue. I’m going to teach them bicycle racing. They’ll love that; it will make them happy. All I really want is to spend time with them. To stay home, play in the garden, watch television. I miss their mother. To me, she’s the most beautiful woman in the world.

  V

  The nurse’s courage is a jewel she wears on her chest with benevolence and pride.

  I care for my patients with compassion, trying to put myself in their place, to understand what they suffer. There’s no difference between them and me, except for the circumstances that separate us. I’m on the other side of the barrier. But they’ve done nothing to deserve what’s happening to them. We waste so much time. Our lives are frittered away with trivialities. And now that our normal, everyday routine is in turmoil, we should all go back to the beginning and start again. Looking to the past for answers is no longer an option.

  It’s the women who are the worst affected by the epidemic. Maybe because it usually falls on them to care for the sick. Maybe because they’re the last to leave home and seek treatment. And maybe because, until the very end, they try to keep things going, they try to make things right.

  When the first infected patients started arriving at the government hospitals before the outbreak was officially declared, we members of the medical staff, out of ignorance, treated them with our bare hands. Our white cotton lab coats were our only protection. It was only afterward that we were informed. Many of us took the infection home and didn’t survive. I was terrified. Now that the Ebola virus has been identified, I know how careful we must be: following the hygiene rules to the letter is not negotiable, underestimating the danger can be deadly, and staying alert at all times is imperative.

  I saw a very close colleague of mine become contaminated right in front of my eyes. A child arrived in a very bad state. The boy was bleeding from every orifice, he had diarrhea, and his chest was racked by spasms of deep, painful hiccups. My colleague cleaned him up and bent over him, trying to make him drink. Suddenly, he vomited all over her shoulder. Her white coat was soaked and stuck to her skin. That’s how she caught Ebola. A few weeks later, she died.

  When people on the outside learned you were working with Ebola patients, they didn’t want to come near you anymore. You lost all your friends. When you went home, you were alone with your family. My daughter had problems at school; no one wanted to play with her during recess. Her fellow students had heard the rumors circulating in the neighborhood: the medical staff was behind all these deaths; the President of the Republic had supposedly paid them large sums of money to reduce the local population and thus get rid of the poor. Ebola, they said, didn’t exist.

  Despite all this, we continued fighting the disease. Watching my colleagues die, abandoned by the authorities and without any form of qualified help, was terribly hard.

  * * *

  —

  In the morning, before going to see the patients, we pray. We get together and we pray. We close our eyes, stretch out our arms toward heaven, and sing hymns. We beseech God to have pity on us. Lord, give us the wisdom to know what we should do. Give us the will and the ability to accomplish it. Give us the courage to go on.

  The patients are in pain, they need care and reassurance. If they believe in God, we tell them to keep their faith, but above all else, we urge them to continue eating and drinking, even when their strength is gone. We rub their backs, we hold their hands. We talk to them in their mother tongue, in words familiar to them. I would like to take off my mask to let them see who I am, to let them look into my eyes and know that I share their suffering. But that simply isn’t possible.

  Where should we focus our efforts amid this uninterrupted stream of patients? Will the decisions we make in the heat of the moment determine whether they’re going to live or die? There’s no one to tell us.

  Even inside the hospital, the sick occasionally express doubts about us. They think we want to poison them with the needles we stick into their arms, or with the concoctions we make them drink. If not, why aren’t they getting better? Why else would there be so many deaths among them? So they want me to take a sip of the liquid I’m holding out to them. Why not try a little bit yourself, they say, if it’s really that beneficial? And then they also ask why they’re not allowed to have masks and protective suits, whereas all those who come near them are wearing them. I suppose they have a point. How can we earn their trust when our equipment alienates us from them? The distance between us is the distance between life from death. To tell them otherwise would be lying.

  Our hospitals have always been run on a shoestring budget. Getting by without the essentials, making do without even the minimum, is common. Poorly managed budgets, insufficient budgets, deplorable working conditions, underpaid staff: we’re used to all that. Our long working hours are spent in buildings with peeling paint, where the mattresses on the iron bedsteads are filthy and all the furnishings either damaged or broken. Out-of-order machinery is just left in a storeroom. The place reeks of open wounds. We’re used to all that. But this time, things are worse than ever; the lack of supplies has taken on gigantic proportions.

  One day, I heard a young guy plucking the strings of his guitar and singing in a bleak, cynical voice:

  Come along with me!

  Let’s go to the University Hospital in the capital,

  T
he global disease market.

  Let’s go buy some cholera

  From soiled, overflowing toilets!

  Let’s go buy some malaria

  From the stagnant puddles in the courtyard!

  Let’s go buy some AIDS

  From all that medical waste!

  Let’s go buy some madness

  From sacks of corruption and arrogance!

  Come along with me!

  Let’s go to the University Hospital in the capital,

  The arena of capsized values,

  Let’s go treat the doctors, who’ve been

  Infected with administrative negligence!

  Let’s go vaccinate the nurses, who’ve been

  Laid low by poverty and squalor!

  Let’s go save the pregnant women

  Giving birth on broken beds without mattresses or sheets!

  Let’s go pacify the workers, who are

  Striking for better working conditions!

  Can you see the University Hospital?

  That’s where you’ll find the global disease market!

  That’s where the sick treat the doctors!

  That’s where the sick get even sicker!

  That’s where you can learn to cultivate

  Unhealthy habits!*1

  I still remember the day when I “came home,” armed with my certificate in specialist nursing. I was the first woman in my village to have achieved that. After two years of training abroad, with internships in some of the top hospitals, I came back to be of service, to practice my profession. I was ready to pick up the baton, to take over from the expat staff. It was the way the entire country was going. At Independence, the international banks were handing out loans, meaning we suddenly had fully equipped hospitals in our biggest cities. Education and health were at the top of the agenda. Our machines were very sophisticated, too sophisticated, in fact. If they broke down, technicians had to be called in from abroad. Local training courses were lagging behind; it was as if the planners in charge of the health system hadn’t taken any of these eventualities into account. From one health minister to the next, we encountered the same problems, the same broken promises. Yes, yes, the technical instruments would be fixed as soon as possible. Yes, a rehabilitation program would be put in place, and yes, of course, medical treatment would still be free.