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Last Updated: Wednesday, 13 April 2005, 17:56 GMT 18:56 UK
Diary from Angola's virus frontline
MSF team  (photo: MSF)
Health teams covered from head to toe to avoid contamination
Zoe Young of the medical NGO, Medecins Sans Frontieres (MSF), is keeping a web diary for the BBC News Website from Angola as she helps with the emergency response to an outbreak of the deadly Marburg virus.

Here she describes her first two days of work in the town of Uige in the north-east of the country, which has so far been the town worst hit by the epidemic.

Sunday 10 April

I am absolutely exhausted. Today I went into the isolation centre in Uige hospital for the first time. There are two zones, the low risk and the high risk. In the low-risk zone I changed into a medical scrub suit and put on some white boots and thin blue gloves. Then I put on the next layer of protective clothing.

You do it using a kind of buddy system where you check your partner has everything on correctly and hasn't forgotten anything. It took us ages to put our kit on and I was completely covered from top to toe. Not an inch of skin could be seen - just my eyes.

Zoe Young
Zoe is a water and sanitation specialist
We walked into the high-risk area where the patients are kept. My specs and mask immediately fogged up so much that I couldn't really see.

I found that if I tilted my head and looked down my nose I could see through a small band at the bottom of my mask.

It was a horrible feeling being completely encased, crinkly sounds in my ears from the head protection, hot sticky hands under two pairs of gloves, tripping along because of my long rubber apron and not being able to see.

Body bag

Three people died yesterday and the only patient still left in the ward died this morning. Everyone was really sad as we had been hoping that she would survive.

Marburg is a viral hemorrhagic fever rather like the infamous Ebola. Most people seem to die within about two days of coming into the ward, but this patient had been here for a week. She was lying on her side on the bed in the ward for confirmed cases, covered up by various pieces of clothing.

We needed to put her in a body bag so that she could be buried. Body bags are used because even though the patient is dead they are still extremely infectious. To protect the burial teams who have to transport the body, it is really important that it is safely wrapped up.

There was quite a lot of blood so we kept spraying our hands with the chlorine
Zoe Young

We went back into the low-risk area for a while to cool down and rest before dressing up again from scratch. I was really dreading trying to move the patient since I was scared of what I might see.

We went into her ward with a spray machine filled with a very strong chlorine solution. There was a plastic fitted sheet on the mattress underneath her so we carefully undid it from underneath and wrapped her in it.

There was quite a lot of blood so we kept spraying our hands with the chlorine and moved very slowly and deliberately to avoid splashing. We laid out a body bag on the mattress next to her and then lifted her into it using the plastic sheet. It wasn't nearly as difficult as I was expecting: The body bag opened very wide so we didn't have to do lots of fiddling and pushing to get her into it.

I was down at the foot-end trying to avoid seeing too much, but when she was inside we wanted to make sure that she looked OK for when her family looked at her. She was curled on her side and looked like she was sleeping.

Patients

There have been quite a few cases that have been linked to the maternity ward of the hospital so we went in there this afternoon to spray everything. The virus is very sensitive to chlorine and soap, so spraying with chlorine solution is an effective way of cleaning.

All the nurses were wearing face masks and long plastic bags around their feet to make boots. We sprayed the floors, the walls and all the beds, and even the director's desk and papers - that was one of the spray men being a bit overzealous!

With everyone dressed up in full length gowns, aprons, masks, goggles, gloves and hoods, it is impossible to see who anyone is, so everyone has their names written on their aprons. We must have been in there for two hours at least, absolutely sweltering and breathing in the chlorine.

We are worried that no more patients are coming to the hospital because people are really frightened. I think that they are terrified of letting their loved one go into this place surrounded by plastic sheeting only for them to come out in a bag. So people are staying at home to die and being cared for by their relatives.

Most of the cases in the isolation ward so far have been women: Maybe this is because they are the carers and have taken care of a family member who was dying of the disease.

Monday 11 April

This afternoon we started training some new teams of local people to work on disinfecting and burial. We have a team that collects patients; a team that goes to the cemetery with the bodies and a team that goes to people's houses to disinfect the area where the patient was.

We explained the tasks of each team to the new recruits. I am not sure how they managed to persuade people to be on the burial team - I think that it must be the worst thing - going to people's houses and collecting the bodies, which are probably in a fairly poor way, with all the family members wailing and mourning. Then we gave a demonstration of how to put on the protective gear.

I did the putting on and taking off. It was like being an air stewardess, as I pointed to my mask and goggles and put everything on. Then we got them to try on the clothes themselves. I hope that they understood. They looked OK at the end, so they should be ready to start working tomorrow.

Training
Locals are given training to do specific jobs
At about six o'clock we were told that there were two new patients coming in. Everyone bustled around getting things ready.

Finally the patients came in on stretchers and were carefully installed in the 'suspect' ward. It had been worrying us that patients hadn't been coming. On Saturday, the governor of Uige province was on the radio explaining about Marburg disease and what MSF is trying to do in the isolation centre.

One of today's patients came in with an attendant, who said that they had come to the hospital because they had heard the radio broadcast. This was really good news.

I am staying in a house with the rest of the MSF team. The house is fairly full as there are 17 of us. Everyone sleeps on the floor on mattresses, three or four to a room. I was lucky to get a space. There is no touching among us, so no good morning kisses or handshakes and everyone takes care not to sit too close to each other.

At the entrance is a drum of chlorine solution that we can use to wash our hands as we come in. All the plates and cups are washed first with soap and then with chlorine solution. It's strict but comforting.

MSF is sending more people out to help contain the outbreak. Soon we will go to Songo, north of Uige, where there have so far been nine confirmed cases.




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