As part of Sierra Leone's broader effort to contain the deadly Ebola virus, the country
opened a new ambulance dispatch centre in September in the capital,
Freetown. Along with a new Ebola hotline, the centre is considered an
important step forward in the war on Ebola.
But on the centre's second day of operation, a series of errors put the life of an apparently healthy 14-year-old boy at risk.
The
dispatch centre is situated in a meeting room at the Cline Town
hospital just north of downtown Freetown. Inside the room, a group of
men and women are huddled around a table full of laptops. Safa Koruma, a
technician, points at a message on a screen. It describes a possible
Ebola patient, reported through the hotline, with the words "vomiting
and very pale."
Koruma forwards this message — along with
hundreds of others — to the nearest health official. A community health
worker is then supposed to evaluate the patient and assess the
likelihood of Ebola.
"Probable" Ebola cases end up on a large
whiteboard on the other side of the meeting room. It's the master list
for ambulance pickups.
Victoria Parkinson, of the
Tony Blair African Governance Initiative,
is one of the directors of the center. She points at a name on the
board with the number five written next to it, indicating the number of
cohabiting family members.
"We want to get that [person] quickly, because there's many people in the home that could be infected by," she says.
One
of Parkinson's colleagues, Ama Deepkabos, writes down an address and
hands it to an ambulance driver. "It's 7 Hannah Street, 555 Junction. Do
you understand?" she says, imitating the local Krio accent. "Go
directly to the patient. No other stops!"
The driver nods and
hustles out to the dirt parking lot, along with a nurse. I attempt to
speak with the driver and nurse, but neither speaks good English. They
step into a white Toyota SUV with the word "Ambulance" in large red
letters, and pull out of the parking lot.
Sierra Leone is in the midst of a three-day national lockdown,
intended to slow the spread of Ebola, so the roads are clear. The
ambulance speeds across town and is waved through multiple police
checkpoints.
After two wrong turns and several stops for
directions, it eventually bounces down a long dirt road in Waterloo, a
rural suburb 15 miles southeast of Freetown.
The driver and
nurse spot the person they believe to be the patient: a 14-year-old boy
in a blue T-shirt slouched on a white lawn chair.
They get out
and put on glimmering white protective suits, surgical masks and rubber
gloves. They walk over and escort the boy, who is able to walk on his
own, into the back of the ambulance without touching him. They kick the
door closed behind him.
The boy's guardian, Suleiman Espangura,
is the principal of a nearby high school. He recently took the boy,
Ngaima, into his custody because his family was moving to a rural part
of Sierra Leone, and Ngaima wanted to stay at his current high school
near Freetown.
"He likes to play football," Espangura says of the boy. "And he's very clever. We [teachers] like children who are clever."
Espangura
says he's unclear why Ngaima is being taken away in an Ebola ambulance.
He says the boy doesn't have any signs of Ebola — no fever, no
vomiting, no diarrhea. He just has a headache and a slight loss of
appetite.
But because Espangura had heard multiple public
service announcements encouraging people to report any signs of illness,
he contacted a health official and was told a community health worker
would come to evaluate Ngaima. Instead, an Ebola ambulance showed up.
Espangura
says the ambulance driver and nurse asked him if Ngaima was "the
patient." Espangura said yes, thinking the men were here to evaluate
him. Instead, they ushered the boy into the ambulance and whisked him
away.
The ambulance rushes across town to a military hospital
with an Ebola isolation unit set up outside — a series of white plastic
tents with a blue tarp stretched around the perimeter.
The
hospital guards, in military fatigues, tell the ambulance driver and
nurse that Ngaima is not on their list of expected patients. A heated
argument ensues. The driver insists that he is merely following
instructions, and that this is the correct patient.
One of the
guards eventually calls the head of the hospital, who consents to
admitting Ngaima. The driver and nurse spray the back of the ambulance
with chlorine and open the door to let him out. Ngaima steps out of the
vehicle and disappears behind the blue tarp fence, into the Ebola ward.
A
few minutes later, another Ebola ambulance arrives. The military guards
are expecting this patient. But they say the beds beds are now
completely full — Ngaima has taken the last one. The new patient is
admitted anyway.
It's not clear exactly what went wrong here.
But now, a 14-year-old boy with a headache is sitting inside an Ebola
isolation center.
REPORTER'S NOTE: Peter Breslow, my
producer, and I didn't realize what had happened until the following
day, when we were reviewing recordings of the event. We noticed that the
names given to the ambulance driver did not match the names of Ngaima
or his guardian, Suleiman Espangura. We immediately contacted the
ambulance dispatch center and Espangura to explain what we thought had
happened. The ambulance dispatch center neither confirmed nor denied
having made an error.
Ngaima was kept at the isolation
unit for the next six days, despite being told that he would get his
Ebola test results within 24 hours. Ngaima eventually tested negative
for Ebola and was discharged. But it was possible that, between the time
his blood was taken and the time he was discharged, he could have been
infected by another patient.
Since we returned to the U.S. in late September, I have been unable to reach Espangura for further updates.
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