Yesterday, Dr. Darin Portnoy, a family physician from the Bronx, completed his first rounds—60 patients, five of them children—in an Ebola ward of a treatment center in Paynesville, about 250 miles southeast of Monrovia, Liberia. He’s been impressed from the start by the efficiency of the clinic, but what struck him the most was watching as an Ebola survivor, a man he describes as looking a little like Mike Tyson, scooped up an 11-year-old boy in the infectious stages of the disease, carried him to a washbasin, and gave him a sponge bath, before carefully returning him to his cot.
Survivors, Portnoy says, are playing an increasing role in caring for the sick and the effort outside the wards to halt the epidemic. Ebola survivors are immune to the virus for as long as three months–or longer. Research indicates an immunity to re-infection by the same strain of Ebola virus could last 10 years, according to the Centers for Disease Control and Prevention. This means they can risk getting close to those with symptoms, and even touch them—something that’s especially helpful with children, a number of whom are separated from their families. “It’s kind of like a superpower,” Portnoy says of the survivor’s immunity. “Even those who are not fully recovered, but that you can tell are going to clear the virus, they’ll help other patients before they’ve finished convalescing,” he adds.
This is Week One of Portnoy’s four-week stint at ELWA3, an Ebola treatment center with 250 beds in Paynesville. ELWA3 is operated by Médecins Sans Frontières/Doctors Without Borders, the privately funded relief organization often known simply as MSF. The center’s staff totals around 700, about 100 of whom are from outside West Africa. MSF has similar, smaller facilities in the neighboring countries of Sierra Leone and Guinea, where Ebola remains out of control.
Portnoy has just arrived as a volunteer. On his rounds, he isn’t working solo, of course. A nurse and sanitation aide, also suited head-to-toe in personal protection equipment (PPE), accompany him; assistants are available, as well, to help clean patients and disinfect around them. “I had a couple of dry runs, where we put on the PPEs, took off the PPEs,” the 52-year-old doctor says. “Then I did one round where I only spoke to patients.”
There is no cure for Ebola, but Portnoy provides his patients with anti-malaria and anti-nausea medicines, generic Tylenol and antibiotics, and hydration salts. Severe dehydration is the underlying, grave danger with hemorrhagic fevers. “Sometimes we prescribe morphine, too,” he says. “It can be very painful.”
Via phone, Portnoy confirmed the press reports and World Health Organization figures showing that, for the first time in weeks, there are fewer new cases of Ebola in Liberia. At ELWA3, empty beds outnumber the patients, and only about 80 to 85 confirmed cases remain. Did this decline strike those who’d been there all summer as cause for optimism that there won’t be, as the Centers for Disease Control and Prevention warned, as many as 5,000 new cases a week by January?
“It would be great to think so. It’s the best news,” Portnoy says, but no one at ELWA3 believes it’s over yet. “For us, it’s more a chance to prepare, build capacity, train as many people as we can, and be ready.” To hear him tell it, ELWA3 is becoming the world’s first Ebola-treatment teaching hospital.
The reason it was too soon to declare victory, he says, is that “a lot of things that should be working are not. Contact tracing”—tracking those who may have been exposed—“is not working. The ambulances are not functioning. It’s hard to tell if safe burial practices are really being observed. So we are keeping an eye on it and staying vigilant.”
“Some [survivors] want to return to their communities kind of anonymously, because there’s still a lot of stigma,” says Athena Viscusi, a New Yorker who ran the mental health intervention center at ELWA3 until last week. (MSF mental health workers provide grief counseling to families and help to caregivers, too, as the work is often traumatic.) “Usually, though, Ebola’s affected several members of the family, and the neighbors know there’s been an infection in the house, so they can’t return quietly,” Viscusi says. “And they find they’re more comfortable coming back to the Ebola centers, because we’re very welcoming of them.” MSF hires some of these returning survivors to work with patients.
Of the man who helped the child, says Portnoy: “You know you hear about things like that, but when you see it—that whatever someone is going through, their humanity remains intact. It’s magnificent.”