By Dr. James Appel - September 3, 2014

We’ve been seeing so many kids with severe malaria and anemia that I let my guard down. Because of the Ebola epidemic, parents are waiting till the last minute to bring in their children. Fortunately, so far we’ve been able to save most of them with blood transfusions and Quinine drips. So, when I go out to see this 10 year old girl, in my mind I’ve already decided she has malaria. I go through the motions of asking all the screening questions and she sounds like she has malaria: headache, fever, loss of appetite, no vomiting or diarrhea. Instinctively, I check her eyelids to see if she has anemia like everyone else. Most of the kids have had very pale palpebral conjunctiva, but this girl’s are bright red. It sets of warning bells in my head, but I ignore my instinct. It’s probably malaria I tell myself. I don’t want to send her to certain death of malaria by refusing her, so I let her come in against my gut feeling.

I hope the mistake doesn’t turn out to be too costly.

We bring her into the ER and the nurses find an IV. As the nurse is taping the catheter in place she asks me if I’ve noticed the rash. She has a raised rash all over her arms and trunk and face. It doesn’t look like anything I’ve seen before. I just gave her an Artemether shot in her muscle. There was no bleeding. Now I look back and some blood is pooling over the injection site. Jeff from the lab is right there. I ask him to go get a rapid malaria test and do it here at bedside. Meanwhile, we start the Quinine drip. I look again at her conjunctiva…they really are more red then normal. I’m starting to get a suspicious feeling. Sure enough the malaria smear is normal. And where Jeff pricked her finger is also bleeding more than normal. And she has a high fever. There’s a reason they call it Ebola Hemorrhagic fever. Of all the suspicious cases we’ve had here, this is the first I’ve seen with bleeding. Of all the cases, this has to be the most suspicious for Ebola I’ve seen yet. 

I call in the mother. She’s dressed in some kind of police or security uniform. I explain that I’m suspicious of Ebola and they should take her immediately to either of the Ebola Centers: JFK government hospital or EWLA Hospital where Doctors Without Borders has set up shop. They leave immediately. We wash down everything and through away anything that we may have touched. I run home, take a shower and wash my scrubs and put on new clothes. I feel this is my closest contact with Ebola yet.

A few hours later, the mother is back with the girl in the back of the car. 

“Dey look at de IV and say to take her back to where she bein’ treated…”

Are you kidding me!? It turns out that neither place would take her. Both are overrun. Dr. Martin comes out and tries to call some colleagues who work at the Ebola treatment centers. No one is picking up. There just aren’t enough isolation beds or tents or personnel or supplies or anything. They are turning away patients left and right. But to not even test? And to use the excuse that she is being treated elsewhere and turn her away because we left the IV in to help them out so they could treat her without the risks of starting another IV?

I admit, some NON-MISSIONARY WORDS not only came to mind, but a few slipped out at high volume as being the only words worthy of expressing my feelings about the ridiculousness of the situation.

I do what I should’ve done before: I write out a referral explaining why we think she has Ebola. I tell them to go back and persist and don’t let themselves be turned away. Dr. Martin also suggests a third hospital, Redemption which is supposed to be opening or already open as an Ebola treatment center.

Obviously—and rightfully so—the family is frustrated and turns away sorrowfully. Who knows? No one probably ever will. She will probably die without us ever knowing if she had Ebola or some treatable disease. If there were only the resources to isolate all the suspicious cases and test them. Then if they are negative, get them referred to a hospital such as our own which is treating non-Ebola cases and get them the malaria or other treatment they need. And if they have Ebola, there should be personnel, protective gear and IV fluids to treat them, not to mention the availability of experimental drugs known to help certain Ebola patients.

Instead, chaos, fear, suspicion, lies and death abounds in Liberia.

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