A doctor from America who treats children in eastern Democratic Republic of Congo describes the present Ebola outbreak as the most severe situation she has ever seen.
Doctors Without Borders brought Dr. Rupa Narra to Butembo in August. She runs a treatment unit with 30 beds, all of which are currently occupied.
“I don’t know how this is going to slow down,” Narra says. “It’s the most devastating thing I’ve ever seen in my life.”
Butembo’s Overwhelmed Ebola Unit
Since May, the DRC has seen an ongoing Ebola outbreak with at least 6,800 confirmed cases and over 3,310 deaths. The situation appears set to become the most severe Ebola outbreak ever recorded.
Over the past seven days, Narra’s unit saw eight patients die. Every single one of them was still a child, all under the age of 5.
The epidemic is being caused by the Bundibugyo strain of ebolavirus, a pathogen that has not received an approved antiviral drug or vaccine. Because there are no such treatments available, roughly 30% of adults who receive a diagnosis pass away within two weeks. Children suffer a worse fate, since their undeveloped immune systems leave them more vulnerable. Newborns fare worst of all, with the virus almost always proving fatal to them.
Children make up 1 in 4 confirmed cases in this outbreak, but they represent 1 in 3 overall deaths.
The unit has divided its beds into two groups: 15 for patients who are ill while awaiting test results, and 15 for those whose Ebola infection has been confirmed. Now, according to Narra, the clinic is receiving so many visitors that they have begun assigning quarantine beds to confirmed cases as well.
“It’s still not enough,” Narra says. “I know everyone is trying to scale up as fast as possible, but it’s moving at a rapidity that never was the case.”
Treating Children Without a Vaccine
Narra and her team devote their days to giving supportive care instead of treating the virus directly. Their duties include:
- Running fluids through an IV
- Giving oxygen or blood transfusions
- Treating hypothermia, fever and secondary infections
- Training about a dozen Congolese doctors and nurses on pediatric and newborn care
Narra also helps local staff adapt adult-focused Ebola care to fit younger patients. This work has led her to change what she considers a successful outcome.
“I had to change my mindset, that we were going to save kids,” Narra says. “Now, it’s — we’re going to minimize suffering, and we’re going to let the Congolese staff know that they did everything they could to save that baby’s life.”
Caring for children in an Ebola unit presents a specific challenge. Since there is no approved vaccine, finding someone with natural immunity — from a previous infection — to care for the youngest patients is difficult. Narra and her colleagues can spend only about an hour at a time in protective gear, because of how hard and risky it is to work in it.
A Baby Left Alone
A short time after Narra made it to Butembo, a young woman who had just given birth passed away in the Ebola unit. Her infant daughter was left without anyone caring for her.
“I didn’t know what we were going to do with this baby, because there were no other family members who had been exposed, and there was a high likelihood for this child to have Ebola,” Narra says.
Upon entering the infant’s chamber, she found a woman standing within it, clasping the child to her bosom.
“Actually, she was an Ebola survivor,” Narra says. “She did not know the family and agreed to take care of this baby.”
The child survived for 10 days before finally falling victim to the virus. Throughout that time, her caregiver never abandoned her bedside.
A Career Built for Crisis
Narra is no stranger to emergency response. She worked as an epidemiologist in 2014, responding to the West Africa Ebola outbreak that killed 11,310 people. She was a pediatrician in an emergency department in Brooklyn when COVID-19 hit the United States. She also worked for Doctors Without Borders in Haiti.
None of that prepared her for this.
“I’ve never seen anything like this,” she says. “The speed of transmission, along with other aspects of a fragile healthcare system.”
Families have fled to cities like Butembo for safety after fighting broke out between the Congolese army and Rwandan-backed paramilitary forces in the eastern border region shared by the DRC, Rwanda and Uganda. The region’s healthcare system is already overburdened, caring for children suffering from malnutrition while also managing regular outbreaks of malaria and measles. The conflict, combined with reductions in foreign aid, has interrupted routine vaccinations and other assistance.
The Spacesuit Problem
A pediatrician cannot do much to make a child feel less afraid.
Each morning, prior to treating her patients, she dons a thoroughly sterilized hazmat suit. Her eyes alone remain uncovered.
“You’re 5 years old, and these people walk in with what looks like a spacesuit. Of course you’re going to scream!” she says.
A toy brought in to distract them is not an option, nor is a funny hat, or picking them up and showing them around the clinic while she bounces them on her hip. Neither can she hold their hand through the night when they get really sick.
“That’s been the very difficult part for me — is I can’t be at the bedside of this critical child,” she says.
A Bollywood Moment
A single case comes to mind: a young patient, just 5 years old, held in quarantine while awaiting test results. Her father remained beside her throughout, offering comfort by letting her watch Bollywood films on his smartphone.
One of the songs was recognized by Narra, who hails from a family in southern India. It was a number from the romantic comedy Desi Boyz.
That evening, after finishing her shift, Narra removed her gear and hurried outside to stand beneath her patient’s window. She rapped on it, presenting a face free of mask, and performed her own version of the dance moves from the film, doing her very best.
“And then, she was smiling, laughing and clapping,” Narra laughs. “I was like –- I don’t even know these moves but I will make them up for you!”
Several days after the test was administered to the young girl, the results arrived: negative.
One bright spot, in Narra’s painful summer.
The Numbers Behind the Outbreak
The numbers from this outbreak are striking, and they reveal how disproportionately the youngest patients are being affected.
| Group | Share of confirmed cases | Share of deaths |
|---|---|---|
| Children | 1 in 4 | 1 in 3 |
Within two weeks of diagnosis, about 30% of adults with the Bundibugyo strain pass away. Children face a higher death rate than adults do. Newborns nearly always succumb to the virus.
More than 3,310 people have died from the disease since May, with at least 6,800 confirmed cases reported. The death toll is on course to exceed that of every prior Ebola outbreak recorded.
The Response Is Falling Behind
Narra says the reaction is failing to keep pace with how far the virus is spreading. She admits that everyone is working to scale up as fast as they can, but the rate at which it moves from person to person is unlike anything she has ever seen before.
A war, a weak healthcare system, and a sickness without any approved medicine to fight it have combined into a crisis that Narra says she cannot see ending.
“I don’t know how this is going to slow down,” she repeats.
She and her colleagues keep going round by round, putting on their hazmat suits, offering whatever comfort they can, while holding out hope for more bright spots such as the little girl who smiled, laughed and clapped for her through a window.
Source: npr.org
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