As I type, Paula Cafferkey lies in a specialised plastic bed in a critical condition in hospital. She is suffering from the previously unknown after effects of the Ebola virus. These have now been well publicised and can include serious central nervous system complications as the virus insidiously strikes again.
I travelled to Sierra Leone in May 2015 to help carry out one of the much needed drug treatment trials. I had signed up to UK-Med in the November after hearing a horrendous story about a man and his father. The father was diabetic and probably on the cusp of a diabetic coma. He had run out of insulin and was waiting outside the hospital in his son’s car. But the son had been told that because his father had vomited, he was not allowed into the hospital, because it might be Ebola. It was literally unimaginable.
Being a pharmacist, I was not expecting to hear anything from UK-Med. They were calling out for nurses and doctors. But I was contacted by a clinical trial coordinator to discuss my suitability. I would have to be able to leave at the drop of a hat. I couldn’t have a complicated domestic life.
“It’s tough out there,” she said, “it can take its toll on your personal life”.
I was pretty shocked when she offered me the post because I had only been qualified nine months, was working as a hospital locum and had no aseptic or clinical trials experience other than during preregistration — but I had a pretty tame personal life.
I wracked my brain for my aseptic contacts and frantically arranged to complete some training in their isolators to prepare me. I had to revalidate my Good Clinical Practice (GCP) certificate but other than that I was, in theory, ready to go.
As a trial pharmacist I was compounding the investigational product in a portable, aseptic dome, which was placed in one of the corners of the pharmacy. Each dose took 45 minutes to make up from start to finish so it was a race against time to get the drugs to the patients early enough in the mornings so the clinical team would have enough time to complete all the follow up monitoring.
Most patients died. Even the ones we thought were improving. They were just coming to us too late and they were so ill. One patient who was not placed on the trial but had Ebola was brought to the treatment centre by ambulance. The rumours of what happened to patients who came to the treatment centre were vast and people were terrified. As the ambulance doors were opened, she fled and carnage ensued.
The atmosphere was intense. There were rumours that we were harvesting organs and killing patients. There was concern amongst the staff about their job security if the epidemic ended. I once watched as the clinical staff had their wellington boots checked for stolen patient property on their exit from the red zone. Apparently mobile phones and money had been going missing. Tensions were palpable, people were exhausted from the relentlessness. It had become difficult to maintain focus.
I was only seeing the action from the green zone. The red zone workers understandably hated the physical barriers placed between themselves and the patients. It was impersonal, they wanted to comfort their patients. I was a little more detached, in the white and green zones, where the pharmacy and donning areas were. At times, I wished I could spend time with the patients; I imagined it would feel much more personal than never meeting the people you are trying to save.
Then we managed to save one. We were told that when it happens, everyone celebrates with drums and singing and clapping — that everyone gathers to welcome the survivors into the green zone. We were waiting for it for days. Each day she got a tiny bit better so we were excited for her return. But, when it happened, I was sitting about ten feet away and a little commotion caught my attention. A half-hearted teetering of drums and voices. I looked around me to alert and share the moment with my colleagues, but they were all elsewhere, otherwise occupied.
And then she was back. Just like that. I had never seen her so close before, always separated by metres of fencing. She was given new clothes by the social worker. Amusingly, I thought, she was given copious helpings of aqueous cream that she smothered all over herself. She casually chatted to the social worker as though she had just hopped off a bus. I think by this point I was the only person watching. I began to feel as though I was imposing on a personal exchange. Then, just as casually, she left the treatment centre.
I don’t know why she got better. I don’t know if she knows that she represents a little bit of a triumph. But that doesn’t really matter.