Do what you can

     Patients are often admitted to an ETU when they are sick with something other than Ebola.  Among the general population in West Africa, a myriad of conditions can cause fever, body aches, stomach pain and headache.  However in the setting of an Ebola outbreak, those symptoms meet the criteria for a diagnosis of 'Ebola suspect'.    First, you have to rule out Ebola and then you can get the patient to somewhere where they can be more thoroughly evaluated and treated.  You just hope that they don't get worse while you are evaluating them in the ETU.  

     We had a patient admitted to the ETU after having a cesarean section in the neighboring hospital.  Initially, she had been doing well then she suddenly turned worse.  The hospital staff became concerned about a possible Ebola infection and unfortunately, she meet the case definition and we had to admit her.  We quickly tested her, found her to be negative and we returned her to the hospital.  Over the next day, she did better, but then she suddenly turned worse and died.  To make sure, we tested her again for Ebola which was again negative.  She had probably died of a pulmonary embolus, but she left a 6 day old baby girl.

     This is a problem.  The baby's father isn't married to the mother and there is no tradition of wet nursing in Liberia.  A baby's chance for survival in Tappita is somewhat compromised anyway with the poverty and disease prevalence, even with an intact family.  The situation is so much worse with a baby is so young and without support.  We have no technical obligation to help the baby.  She wasn't our patient and there was no diagnosis of Ebola.  There was even some question about what we could officially do for her.  But we couldn't just not do anything.  We passed the hat and collected enough money for formula and will continue to provide that for as long as we are here. The sister of the baby's father agreed to watch her since she has no girls.  We arraigned for multiple 'community outreach' visits to the home to weigh and check on her every week or two.  Yes, we will only be able to help for the next three or four months.  Yes, we are well aware that even this effort is Quixotic and that the child still faces long odds of making it to her first birthday.  But despite the odds, we are called to care and we are called to at least try.