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A human touch despite layers of gear

A human touch despite layers of gear

Caregivers in West Africa must restrain nurturing impulses that may be unsafe

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A human touch despite layers of gear

A medical worker clad in protective gear sprays people leaving an Ebola clinic in Monrovia, Liberia. At the clinic where Dr. Steven Hatch works, monitors observe each other put on the gear, which can be difficult to work in. At top, a caregiver shown in full face protection.

SUAKOKO, Liberia — The first time Dr. Steven Hatch suited up at an Ebola treatment center in Liberia, he was confronted with the weight of his decision to volunteer. A patient had collapsed. "Literally every surface of his body was covered in billions of particles of Ebola," he recalled. • Dr. Pranav Shetty said they needed to get the man back to bed. Shetty focused on calming the patient, who would not live through the night. He diluted a Valium tablet and cut some tubing into a crude straw for him to sip. • "It was a beautiful moment because I was like, he's a doctor he was taking care of his patients," said Hatch, an American. "That's what we do here."

Much of West Africa is following a no-hands rule to avoid contagion from the deadly virus, but doctors and nurses here, protected by layers of plastic and rubber armor, routinely touch the sick. Without a drug that can cure the disease, they offer patients fluids and medications to treat symptoms, but also the simplest of comforts, like feeding them or cleaning them up. They follow their instincts — Hatch turned out to be right that an elderly man suffered from a chronic illness, not Ebola, as a lab test mix-up showed — but they try to restrain their impulses, because old habits might not be safe.

Hatch's journey to Liberia began last month at a training course run by the Centers for Disease Control and Prevention at a former Army base in Anniston, Alabama. An infectious disease specialist in Worcester, Massachusetts, Hatch, 45, joined about two dozen other medical workers heading to West Africa.

Outside a battered warehouse at the base, mannequins were sprawled on the ground. Hatch and Bridget Anne Mulrooney, an American nurse who was volunteering with the same charity, spent nearly 20 minutes putting on gear: two to three pairs of gloves, aprons, head coverings, goggles, masks and chemical protection suits that were hot and crinkled when they walked. Hatch had trouble tying a knot with the double gloves. "I was never good at surgery," he confessed.

As Mulrooney, Hatch and two others lifted the first mannequin onto a stretcher, an instructor watched. She warned Hatch that the edge of his mask had come out from under his goggles, leaving part of his face exposed.

"We put him down, and we go straight out," Hatch told the team, his voice muffled by the mask. "Second time in two days I've breached here. Is it because I'm 6-foot-2?"

Last year, in the Liberian capital, Monrovia, Hatch had helped teach medical residents with one of the country's top physicians, Dr. Abraham Borbor. "We laughed for two weeks," Hatch said. "I just loved him."

Borbor died from Ebola in August, which spurred Hatch to join the effort his friend had begun. He signed on for a four-week rotation with International Medical Corps, a Los Angeles-based relief group that was starting its first Ebola treatment unit, with funding from the U.S. Agency for International Development.

Mulrooney, 36, was already on the charity's emergency roster. She had volunteered in other crises and had worked four years in Haiti. After the Ebola epidemic erupted, she put off a plan to move in with her boyfriend near London. "I feel like I have something to offer," she said.

In the unit — about 20 international medical volunteers work alongside 175 Liberian nurses, physician assistants, aides and others in three shifts — the workers look out for one another. Monitors observe every time someone suits up to make sure steps are followed properly. (The center uses protocols established by Doctors Without Borders.) Dr. Colin Bucks, an emergency physician from Stanford, urged his colleagues to limit visits to the wards to an hour at a time; if someone passed out, safe removal of their garb would be nearly impossible. He switched his shifts to overlap with Hatch.

Mulrooney serves as a motivator. "Welcome to afternoon!" she said one day, doing a little dance for a nurse who had come in on her day off. Hatch amused his Liberian colleagues by learning to sing one of their devotionals. A Liberian physician assistant, A. Welehyou Duo, rescued him from a botched blood draw; like many American doctors, Hatch had rarely done that task since medical training.

"It's teamwork," said Duo, who previously supervised a primary health center. Love Fassama, 30, a nurse assistant, said she felt compelled to help her fellow Liberians. "I can't have these skills and sit at home," she noted.

Hatch, married with 13-year-old twins, says he is at peace with his decision to treat Ebola patients. "I just don't worry about my life," he said. "When you're scared, you get jumpy. When you get jumpy, you make bad decisions."

Last Friday, he carried a malnourished 9-year-old girl, Blessing Gea, into the unit. The next night, Mulrooney, clad in full protective gear, tended to the little girl. She let her lean against her as she squeezed a packet of peanut butter-based supplement into the child's mouth. She changed her clothing and wrapped her in a fuzzy blanket for the chilly night, stroking her head. Three days later, a blood test showed the girl had recovered from Ebola.

"I cant have these skills and sit at home".

Love Fassama, 30, nurse assistant in Liberia

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