Doctor hesitates, then returns to Ebola front line

JOHANNESBURG — Returning last month to Sierra Leone to treat Ebola victims after a break, volunteer doctor Juli Switala was shocked to see the obituaries and photographs of colleagues who had died of the disease in her absence, pinned to a board in the treatment center.

"That was quite terrible, to realize that people you met a few weeks ago, who were happy, helping you with this fight, have now died because of what they were treating," Switala, a South African who works for Doctors Without Borders, told The Associated Press in a telephone interview from Sierra Leone.

Ebola has killed more than 5,000 people in the west African countries of Sierra Leone, Liberia and Guinea. Many were health workers, and cases of American and other foreign medical staff who got the virus generated widespread international attention. Doctors Without Borders said 24 of their staff have been infected by the disease, with nine surviving.

Switala believes the local staffers are the unsung heroes who have carried out desperately needed but dangerous work while risking rejection in their homes and communities. Many are under increased pressure at home to quit their jobs. Some have been left by partners who worried that they might catch Ebola from their health-worker partners, according to the South African.

"What makes it incredibly difficult is that they are not only dealing with this at work, they are going home with the same fear," she said.

On her return last month, Switala noted that the local staffers' wariness of making contact with patients is increasing while their determination is faltering under Ebola's relentless attack on people close to them.

Switala, 33, trained in South Africa at the height of the country's AIDS pandemic, spending many nights of her internship filling out death certificates. She has also worked in the northern Kunduz region of Afghanistan.

The doctor is where she wants to be, working nine-hour shifts, most of them in a sweaty protective suit, in a tent hospital. The facility was recently erected in what was a cassava field in Bo, Sierra Leone's second-largest city.

As a child, Switala watched news reports about Sierra Leone's civil war. And now she is there fighting in another war, against a deadly and invisible foe.

In May, on her first trip, she tended to patients in a pediatric hospital that is struggling to function in a country overwhelmed by the pandemic. There, she had worried that the disease might be hiding in a patient in the ward. If she suspected Ebola she could put on a protective outfit, but handling each patient felt like a gamble to her.

She went as a pediatrician, landing in Sierra Leone just days after the virus claimed its first victim, and had to change her focus to Ebola. She found herself making hard decisions to help some victims and turn others away because resources are stretched.

"So much of what we're doing is going completely against your gut," she said. "It's almost like being in a war, where you're picking which one has the best chance of survival and that's who you need to spend your time on."

Switala recalled how she once did her rounds with a 3-year-old boy on her hip, eight layers of protective gear separating them. It was the only affection the recently orphaned child had received because most other people were too afraid to pick him up, fearing he might have the Ebola virus. The boy was discharged after he was declared Ebola free, only to be admitted with malnutrition to a government hospital days later.

Doctors have devised mock hugs or high-fives that don't involve physical contact but let them share lighter moments.

European Union officials said yesterday that thousands more health professionals like Switala are needed to eradicate the Ebola epidemic.

Help is required "today, not tomorrow — it's very crucial," the EU's Ebola coordinator, Christos Stylianides, said in Brussels after visiting Sierra Leone, Liberia and Guinea.

Switala said her mother struggled to understand her decision to return to Sierra Leone, and says she considered remaining in Johannesburg when she learned that a friend had fallen ill with Ebola.

"The gut feeling was 'Oh no, I don't know if I want to go back there,'" she said. "That lasted for about a minute and then I thought, 'Now I have to go back even more because this time it's personal.'"