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THE EXPOSURE

Patient zero presented to the hospital where I work, at about 4pm, on Friday, the 12th of January 2018. She had been on admission in a clinic some 10km away.

She presented as a known RVD on HAART with complaints of Fever [even though on presentation, temperature was normal: 36.7°C], cough with occasional blood-stained sputum [hemoptysis], pleuritic chest pain, oral sores, joint pains, all of 4 days duration; irrational talk, that progressed rapidly to an altered level of consciousness, of 3 days duration; and jaundice [yellowness of the eyes], passage of coke-colored urine, and slight abdominal swelling, of a day duration. No leg swelling, nor swelling around the eyes.

After reviewing the systems, and carrying out a full examination, which included a VE [!]; I noticed a nose bleed, which the relatives claimed was the first incident of such. Based on the findings, I made an assessment of "Multi Organ Failure, query cause." This means that her organs were already failing-- that much I knew; but I was not yet sure what was the cause. Hence the "query cause." My list of possiblities, however, included:

 1. Pneumonic Sepsis [for obvious reasons]
 
 2. Acute Fulminant Hepatitis [because of the quartet of jaundice, encephalopathy, coagulopathy, and abdominal distention]
 
 3. SLE [making a case for this here is beyond the scope of this write up]
 
 4. And finally, Viral Hemorrhagic Fever, in this instance Lassa Fever [this was only included for the sake of completion, because at this point, I honestly wasn't thinking of Lassa Fever].

The plan was to resuscitate, and refer-- a decision I would later regret.

ATTEMPTS AT CONTROLLING AN OUTBREAK FROM THE SUSPECTED CASE

At this point, everyone was yelling "discharge and refer," but I couldn't, for the following reasons:

 1. This people didn't have money. So, if I referred them at that point, they were definitely going home. And that would mean exposing everyone around them: the family, relatives, and friends, who'd come visiting!

 2.  If they found money, by whatever stroke of luck [oh, I forgot to mention that they had lied about having money in the bank] , and went to a new Hospital, that would mean exposing another set of doctors, and nurses!

The best way to prevent these two scenarios, I reckoned, was to keep her [since we were already exposed anyway], and then inform the authorities. They would know exactly what to do, and how to do it, without risking other lives. STUPID ME!

While we were waiting for that, I put the following measures in place:

 1. I had the woman transferred to an isolation ward. Thankfully, throughout her admission, she'd been alone in the particular ward section she was admitted in before we started suspecting VHF.

 2. We stopped admitting new patients into the ward she was admitted before.

 3. The two relatives taking care of her were advised to be using hand gloves, and face masks; and also not to leave the hospital premises.

 4.  No visitors were allowed into her isolation room.

 5. I saw to it that provision for hand washing, under running water, was made at the entrance to her room. The water was always fortified with Jik.

6. We minimized care to the essentials: changing her drip, and administering her IV drugs. No more taking of vital signs, changing of beddings, doing reviews, and all what not.

7. Any staff who MUST GO IN, must do so with elbow length gloves, and face mask, and try as much as possible to minimize contact.
 
8. All the vital signs equipments used on the patient were marked as potentially hazardous, not to be used on other patients, at least until we become sure of what we are dealing with.

.

The plan was to do this for few hours, at most a day, as we were expecting the authorities to sweep in, and take the huge burden of KEEPING HER ALIVE off our shoulders.

DEATH OF "PATIENT ZERO, " AND CONTINUED NONCHALANCE OF THE PUBLIC HEALTH DEPARTMENT

The following morning, the patient was still in a bad shape. We had transfused [yes, STUPID ME; I was still trying to save her life] with fresh whole blood, to correct the Thrombocytopenia shown in the FBC, and she was no longer bleeding. But she was still in a terrible condition.

We waited for the team that was promised to come and take her, but saw no one. A little after midday, about 72 hours after the Public Health department had been notified; she gave up the ghost.

I called the PH department again, to inform them of the development, and to remind them that the corpse needed to be disposed professionally, to avoid putting others at risk. They said I should get a body bag, put the patient in it, make sure the patient is buried ASAP, and what more, that I should supervise the burial. Yes; they actually said all that!

Question is, since when did it become the duty of a doctor to supervise the burial of a corpse suspected to be contaminated with a highly virulent virus such as Lassa Fever? Even if it was my duty, is it not meant to be done with the "undertakers" wearing PPEs, and someone following them, decontaminating the environment as they go? So, where was I meant to get PPEs, the whatever they use in decontamination, and the damned body bag?

Clearly, not just were this people running from their responsibilities, they also don't know what their responsibility is!

When I asked about the sample I risked my life to collect the previous day, they said they were yet to send it to Irrua; that they planned on doing so the following day!

REJECTED BY THE TEACHING HOSPITAL

Before I left, I had contacted the Public Health department again, to let them in on the new development, and the fact that we should seriously start making plans of tracing other people that patient zero may have contacted, and exposed unknowingly. Stupid me! But that's how I am wired; I am never really the type who looks out for himself alone.

The Department of Public Health gave me a contact to call in the Teaching Hospital, and convinced me not to embark on a 9 hour journey to Irrua, since I was sick and unstable, and they have an infection control unit in the Teaching Hospital that is well equipped to handle the case. I called the contact, and he said that they've been informed, and that they are READY and waiting for me. By being "ready," they meant Ribavirin, PPEs, and all that. So, I took a detour, and embarked on a 2 hour journey to the Teaching Hospital instead.

When I got there, I got a cold reception. I was kept in the ambulance for 2 hours, from 6.30pm to around 8.45pm, on the pretext that they were "looking for the keys to the isolation ward." I was left out there unattended to, sick, tired from a long journey, and apprehensive. My friends were calling, yelling that I should leave and start going to Irrua. But I reasoned it was already late, and I didn't want to take that risk.

At around 9pm, they finally "found the keys," and I was taken to an isolation ward, in a huge deserted complex.

After one hour of waiting, and of having the clinical staff peer at me through the window, like I was some alien; someone fully kitted with a PPE, came in to see me.

After asking a few questions, he told me outrightly that I was on my own. That the PPE he was wearing was the last in the hospital, and that no one would agree to touch me without it.  He went further to say that as it stood then, neither him, nor the hospital, was "officially aware" that I was in there. Talk about "plausible deniability!"

I was shocked to the marrow. The irony of it--  the fact that I risked my own life to take care of someone I didn't know, who wasn't even from the same state as me, without PPEs, and in a Community Hospital, in a remote village! And right there were people, who were meant to be my professional colleagues, my "Hippocratic" and "Nightingalean" brethren, working in a tertiary institution-- supposedly the most equipped hospital in the state, and yet they couldn't do same for me.

I wasn't mad at them though, as I realized that they were as much victims of a shitty system, as I was; for in their eyes, I saw pity, empathy, and shame. Perhaps if they had PPEs they would have done something. Perhaps not. Truth is, we'll never know.

" Okay," I said; "now that you're still wearing PPE, can you at least help me site an IV line, and put me on IV fluids?"

No, can't do; you're not on admission, and like I said, the hospital is not "aware" you're here.

" What of Ribvirin; can I get it and start treating myself?"

No, we can't give you that; we can't give you drugs without a definitive diagnosis.

"Excuse me? You're saying that in the setting of a potentially life-threatening ailment, you'd rather wait for a confirmatory diagnosis that may take days, possibly risking the patient's life, instead of starting life-saving treatment?"

And he said something I considered condescending about the drugs having numerous side effects.

I scoffed. Drug side effects my foot! As if we were not taught about what to do when benefits outweighs risk in medical school.

At this point, there was no need engaging further; it was obvious this people were playing "political correctness" with my life.

Before they left, they said I should continue self-medicating with  the ORS  and Zinc, that I CAME WITH, to stay hydrated;  and that I should be monitoring MY OWN vital signs, and let them know if "something" happens. Right; like if I enter into shock, my ghost would pick up my phone and start making calls, abi?

That was how I was left ALONE in a vast one storey complex, sick, with a thousand thoughts running through my head.

At around 11pm, I decided it was best to check myself out, and go to find a hotel, spend the night, and then continue my journey to Irrua the following day. And no, I didn't care if I was going to be putting the hotel staff at risk; whatever selflessness, and misguided sense of patriotism, I had died in that Hospital where I was left to my fate. If their government didn't care enough to protect them, even when I had tried to make it easier for them, why should I care? Besides, if I was dying, I would rather spend the remaining of my days in luxury, and comfort, and not  in a deserted building where my only companions would be my thoughts, and the elements.

Old habits die hard. As I went to that hotel room, I still went with Dettol, and Jik, and made sure I was washing my hands regularly, to minimize the risk of putting anyone at risk. Lol. Stupid me.

DISCLAIMER

I deliberately left out the name of any state on this write up, so "Ministry of Health," "Department of Public Health," and "Teaching Hospital," as used here, could be that of any of the 36 states. This was deliberate, and was done so for legal reasons, in case anyone wants to get funny, as I don't have any evidence to prove all I've written here.

But we know every bit of information written here is the TRUTH, our truth; and we know where all these happened. Don't we?

Shhh, don't tell.

There you have it, people; your NIGERIA!

And you, the medics; just know this: YOU ARE ON YOUR OWN!