Goats and Soda
3:38 am
Wed August 27, 2014

Why Patients Aren't Coming To Liberia's Redemption Hospital

Originally published on Wed August 27, 2014 1:00 pm

Redemption Hospital is a government-run facility in Liberia's capital city of Monrovia.

It offers care to all who come, free of charge.

Only now, patients aren't coming. It's rainy season — and malaria season. Tita Horace, head nurse of the pediatric ward, says her department usually sees 25 patients a day this time of year. Today, there are only five.

The sick are staying away, she explains, because they are afraid. "Some of them are afraid that maybe when they come they will get in contact with [an] Ebola patient. So they don't want to come to the hospital."

The hospital itself is a cluster of one-story cement block rooms connected by open-air passageways. Water stains scar the ceilings. Rust covers metal doors.

Walk into a narrow, dimly lit hallway and the first thing you see is a crib. A tiny boy is curled up inside, his spine curved like a sickle. His mother abandoned him here a year ago. The nurses take turns looking after him.

A few steps farther is the pediatric ward, a room with high ceilings, packed with steel cribs and scuffed-up wooden tables where several kids stretch out, their arms hooked up to IV drips. They may have malaria, they may be anemic, Horace explains.

People are especially afraid of Redemption because a doctor and several nurses on staff became infected with Ebola and died as the outbreak was beginning in Liberia. After that, scores of nurses and staffers stopped coming to work. And the number of new patients slowed to a trickle.

But some people still come. A father is waiting for doctors to check his 12-year-old son. The boy has a fever and hasn't been eating.

The man says his neighbors urged him not to bring his son to Redemption. There are rumors that the government has made up Ebola to get funds from international donors, and that hospital workers secretly kill patients and then claim they died of Ebola.

But the father didn't listen: "I say no, that ... can't happen."

Nearby a woman in a T-shirt and a red print skirt watches intently as nurses hover over a girl lying on one of the tables.

The mother says her daughter has malaria: "She get fever, her skin get hot, she just weak."

But Horace, the head nurse, has just heard otherwise. She beckons urgently from the corridor. "We are getting information that two of [the woman's] family members have died," she whispers. Someone in the hospital saw the woman at an Ebola treatment center not long ago, crying over the death of a different daughter.

Now Horace can't help but wonder about this child, "so probably maybe that child might be having, I don't know ... maybe it might be ... "

Horace can't bring herself to say the word: Ebola.

And Horace says this kind of thing happens all the time at Redemption. People don't want to admit their child may have Ebola because to them this disease is tantamount to a death sentence. The way they see it, their kid will be taken from them, put in isolation to die. They won't even get the body back.

But when parents hold back information about their child's exposure to Ebola, they put other patients, and the hospital staff, at risk. Ebola is spread through direct contact with an infected person's bodily fluids — blood, vomit and stool.

The nurses put on protective gear — white plastic suits, goggles, masks and gloves — to examine the girl. If she does have Ebola, there's a limit to what they can do. This hospital is not equipped to care for patients with this disease.

Yet they keep seeing people who may be infected. The latest case is a man who is now dead. His body lies on a metal cot, in the room next door, just visible through the doorway.

A team of men covered from head to toe in protective suits arrive for the corpse. They lay a plastic tarp on the floor, and heave the body onto it. They wrap it carefully. If this man did have Ebola, his body and any fluids that leak out are extremely infectious.

"It's a scary job that you have," I say to Horace.

She answers: "Of course! Very scary!"

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Dr. Tom Frieden is director of the Centers for Disease Control and Prevention in Atlanta. He has been touring West Africa, assessing the spread and reach of the deadly Ebola virus there. In an interview with ALL THINGS CONSIDERED yesterday, he said there are urgent health care needs going unmet in the midst of this outbreak. That's partly because people are afraid of catching the disease and are staying away from hospitals.

(SOUNDBITE OF ARCHIVED RECORDING)

TOM FRIEDEN: For every Ebola death, there are other people who are ill or potentially dying who are getting care. And the fears have, at times, been justified because there has been spread among patients in health care facilities.

INSKEEP: One of those health care facilities is called Redemption Hospital. It is in a northern neighborhood of Monrovia, Liberia's capital. NPR's Nurith Aizenman went there and sent this report.

NURITH AIZENMAN, BYLINE: Redemption Hospital is a cluster of one-story cement block rooms connected by open-air passageways. Water stains unfurl over the ceilings. Rust covers metal doors.

This is a government-run facility, with care offered free of charge. And even before Ebola hit, the staff here faced a lot of challenges.

UNIDENTIFIED CHILD: (Crying).

AIZENMAN: Walk into a narrow, dimly lit hallway and the first thing you see is a crib. A tiny boy is curled up inside, his spine curved like a sickle. His mother abandoned him here a year ago. The nurses take turns looking after him.

A few steps further and you reach the pediatric ward. It's a high-ceiled room, packed with steel cribs and scuffed-up wood tables that several kids are stretched out on. Their arms are hooked up to IV drips.

UNIDENTIFIED NURSE: Most of them are anemic, malaria, anemic.

AIZENMAN: Normally, this place would be teeming with children. It's the rainy season - malaria season. And the head nurse, Tita Horace, says that usually brings in 25 patients a day. But right now there are only five. Horace says people are staying away because they're afraid of catching Ebola.

TITA HORACE: Some of them are afraid maybe when they come they will get in contact with another Ebola patient. And so they don't want to come to the hospital.

AIZENMAN: And Horace says they don't want to come to this hospital in particular. When Ebola first started spreading through Liberia, a doctor and several nurses here got infected and died. After that, scores of other nurses and staffers stopped coming to work. And the number of new patients coming to Redemption slowed to a trickle.

UNIDENTIFIED FATHER: He can't eat. He get weak. So I just had to bring him here.

AIZENMAN: A father is waiting for doctors to check out his 12-year-old son. The boy has a fever and he hasn't been eating, but the man says his neighbors urged him not to take his son here.

UNIDENTIFIED FATHER: They say when you come here, they will say you're Ebola patients.

AIZENMAN: It's a pervasive rumor. People say Ebola's not real; that the government has made up this disease to get funding from international donors and that hospital workers secretly kill patients, then claim they died of Ebola.

UNIDENTIFIED FATHER: They say, when you come here sometimes they'll inject you - you die. I say, no, that one can't happen.

AIZENMAN: Nearby, a woman in a T-shirt and a red print skirt watches intently as nurses hover over a girl lying on one of the tables.

AIZENMAN: This is your daughter here?

UNIDENTIFIED MOTHER: Yes, that's my daughter. She's 6 years old.

AIZENMAN: The mother says her daughter has malaria.

UNIDENTIFIED MOTHER: She get fever, her skin get hot, she get weak.

AIZENMAN: But Horace, the head nurse, has just heard otherwise. She beckons urgently from the corridor and speaks in a whisper.

HORACE: We are getting information that two of her family members have died.

AIZENMAN: Horace says they just learned that two of this woman's family members have died. She says someone in the hospital recognized the woman; they saw her at a nearby Ebola treatment center not long ago, crying over the death of a different daughter. Now Horace can't help but wonder about this child.

HORACE: Because the child is weak now from a fever, maybe it might be.

AIZENMAN: Because of the fever, maybe it might be - she can't even bring herself to say the word - Ebola. And Horace says this kind of thing happens all the time at Redemption Hospital. People don't want to admit their child may have Ebola because to them, this disease is tantamount to a death sentence. The way they see it, their kid will be taken from them, put in isolation to die. They wouldn't even get the body back.

HORACE: Because of the crisis, people will not come and say the truth.

AIZENMAN: This puts her other patients and her staff at risk. Ebola is spread through direct contact with an infected person's bodily fluids - blood, vomit and stool.

AIZENMAN: It's a scary job that you have.

HORACE: Of course, very scary.

AIZENMAN: The nurses put on protective gear - white plastic suits, goggles, masks and gloves - to examine the girl. But if she does have Ebola, there's a limit to what they can do. This hospital is not equipped to care for patients with the disease. And yet, they keep seeing people who may be infected. The latest case? A man who's now dead - his body is lying on a metal cot in the room next door, just visible through the doorway.

AIZENMAN: So what we're seeing there is a man lying on a bed who was suspected to have Ebola. When did he die?

UNIDENTIFIED MAN: Died just last night.

AIZENMAN: A team of men, covered from head to toe in protective suits, arrives for the corpse. They lay a plastic tarp on the floor and heave the body onto it. They wrap it carefully. If this man did have Ebola, his body and any fluids that leak out of it are extremely infectious.

Nurith Aizenman. NPR News, Monrovia. Transcript provided by NPR, Copyright NPR.