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Back On Its Feet, A Liberian Hospital Aims To Keep Ebola Out

Dr. Wvennie MacDonald, the administrator of the JFK Memorial Hospital, has helped put new procedures in place to keep Ebola out, including a triage station to identify possible Ebola patients at the front gate. (NPR)

John F. Kennedy Memorial Hospital is the largest public hospital in Liberia. It has a trauma unit, a maternity ward and an outpatient clinic that serves hundreds a day.

But there's one illness that the facility won't treat: Ebola. JFK is not equipped to treat or contain it if it gets inside their wards. A new triage unit in the driveway detects patients with the virus and sends them to a dedicated Ebola center.

Like most hospitals in the capital Monrovia, the government-run JFK shut down in July after several of its prominent doctors died of Ebola. The hospital reopened in August — with major changes to keep the virus out.

"If we miss and a patient get up here and it's real Ebola, it's helter-skelter," says Dr. Wvennie MacDonald, the general administrator. "The staff panic, they run, we got close down. We got to spray. It's an economic cost. You got to rebuild morale."

All patients now come through one gate, says MacDonald.

Those who arrive on foot or motorcycle are sent to a triage station under an awning to the left of the driveway. Anyone in a car or ambulance is screened by a nurse at the vehicle. If there's any suspicion that someone is sick with Ebola, a doctor is called immediately.

Even when patients make it past the initial triage, they're still treated as possible carriers of Ebola. The cleaning staff wears impermeable raincoats, face masks, hoods and thick rubber gloves even in the tropical heat.

The midwives don full protective gowns — some even wear goggles — just to take vital signs during routine checkups.

The neonatal ward has been split, with babies from women who are known to the hospital staff in one area and those who are unknown, and thus suspect, in another. MacDonald says in this time of Ebola the staff have to be incredibly careful — all the time.

Keeping staff vigilant is one of the challenges as this epidemic drags on.

"It's very tough because you forget," says Helena Gbalzeh-Suah, a nurse at the hospital. "You easily forget."

Health care workers need to constantly check their protective gear and make sure they don't come in contact with the bodily fluids of anyone. "It's not something you say, 'OK, I got to go back and correct it,'" Gbalzeh-Suah says. "You're dead. That's what we are dealing with."

This hospital knows this all too well. Last week the head of the obstetrics and gynecology department died of Ebola. Earlier JFK also lost three others to the disease, including the hospital's top HIV physician, the director of the emergency unit and a physician's assistant.

Everyone who works at the facility is terrified of Ebola, says Gbalazeh-Suah. But she views this as a good thing because it keeps them on their toes.

MacDonald says screening patients rigorously before they can enter the hospital remains the institution's best defense. But she says the screening needs to be more than just taking patients' temperature. They may not have a fever because they've taken over-the-counter medication.

So the hospital has come up with a different strategy.

"Listen to the story," MacDonald says. "What I've told my staff is let them tell you their story in the Liberian vernacular. You empathize: What's wrong? How can I help you?"

She knows that if health workers simply go through a checklist, asking patients if they have a fever or if they've been vomiting, "everything is denied."

If the person is coming from an area that's had a lot of Ebola cases, or if they've had several deaths in their family recently those are red flags for MacDonald. She says sometimes that information can identify an Ebola suspect better than a thermometer or any checklist of self-reported symptoms.

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Transcript

AUDIE CORNISH, HOST:

The U.S. Centers for Disease Control and Prevention is setting up an Ebola response team for American hospitals. CDC Chief Tom Frieden explained today how the team will work.

(SOUNDBITE OF ARCHIVED RECORDING)

THOMAS FRIEDEN: For any hospital, anywhere in the country, that has a confirmed case of Ebola, we will put a team on the ground within hours with some of the world's leading experts in how to take care of and protect healthcare workers from Ebola infection.

CORNISH: In West Africa, the Ebola virus has proven deadly to doctors and nurses. Healthcare systems in Liberia and Sierra Leone collapsed this summer. Most hospitals in the Liberian capital, Monrovia, shut down. That city's JFK Hospital remained closed for a month after several doctors died. We're going to hear now about the facilities new start. It's reopened, but as NPR's Jason Beaubien reports, it is not treating Ebola patients. In fact, the staff is taking extraordinary measures to keep the virus out.

JASON BEAUBIEN, BYLINE: The JFK Hospital is the largest public hospital in Liberia. It has a trauma unit and a large maternity ward and an outpatient clinic that serves hundreds of patients a day. It now also has a triage unit in its driveway to detect patients with Ebola and divert them to another facility.

(SOUNDBITE OF ARCHIVED RECORDING)

WYENNIE MACDONALD: They look like they may have a patient in their car. Is that a patient?

BEAUBIEN: Dr. Wvennie MacDonald is the general administrator of JFK. She's standing just inside the hospital fence.

MACDONALD: Right now, for infection control and just trying to contain this, we have all patients coming through this gate now.

BEAUBIEN: People who arrive on foot or motorcycle are sent to a triage station under an awning to the left of the driveway. Anyone who arrives in car or an ambulance is screened by a nurse right at the vehicle. If there's any suspicion that someone is sick with Ebola, the nurses immediately call a doctor.

MACDONALD: The chief makes the decision for the next move. Do they enter this hospital, the women's hospital, or do they go this way or do they make a U-turn to go to a treatment center?

BEAUBIEN: By treatment center she means an Ebola treatment center. The policy at JFK is that if there's any suspicion that the patient could have the virus, they turn them around at the gate and send them to one of the dedicated Ebola hospitals. Dr. MacDonald says the epidemic has forced this general hospital to completely change how it operates. Even once the patients get past the initial triage, they're still treated as possible carriers of Ebola. The cleaning staff wear impermeable raincoats, facemasks, hoods and thick rubber gloves, even in the tropical heat. The midwives don full protective gowns, some even with goggles, just to take women's vital signs during routine checkups. The neonatal ward has been split with babies from women who are known to the hospital staff in one area and those who are unknown, and thus suspect, in another. Dr. MacDonald says in this time of Ebola the staff have to be incredibly careful all the time.

MACDONALD: 'Cause if we miss and the patient gets up here and then it's real Ebola, it's helter-skelter. Staff panic, they run. We've got to close down. We've got to spray. It's an economic cost and you're trying to rebuild morale.

BEAUBIEN: Keeping staff vigilant is one of the challenges as this epidemic drags on.

HELENA GBALZEH-SUAH: And it's very tough because you forget, you know? You easily forget.

BEAUBIEN: Helena Gbalzeh-Suah, a nurse at the hospital, says healthcare workers need to constantly check their protective gear and make sure they don't come in contact with the bodily fluids of anyone.

GBALZEH-SUAH: It's not something that's OK I've got to go back and correct it. You're dead. OK. That's what we are dealing with.

BEAUBIEN: This hospital knows this all too well. Last week, the head of the obstetrics and gynecology department died of Ebola. Earlier, JFK also lost its top HIV position, the director of the emergency unit and a physician's assistant to the disease. Gbalzeh-Suah says everyone who works at the facility is terrified of Ebola. She views this as a good thing because it keeps them on their toes. Dr. MacDonald says screening patients rigorously before they can enter the hospital remains the institution's best defense. But she says the screening needs to be more than just taking patient's temperatures. They may not have a fever because they've taken over-the-counter medication.

MACDONALD: One of the strategies now we have employed is to listen to the story. You know, what I've told my staff is that let them tell you the story in our Liberian vernacular. You empathize - what's wrong? How can we help you? What - you know, because if you go by that checklist - do you have fever, are you vomiting - everything is deny.

BEAUBIEN: If the person is coming from an area that's had a lot of Ebola cases or if they've had several deaths in their family recently, those are red flags for MacDonald. She says sometimes that information can identify an Ebola suspect better than a thermometer or any checklist of self-reported symptoms. Jason Beaubien, NPR News, Monrovia. Transcript provided by NPR, Copyright NPR.

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