On the night of Sunday July 20, 2014, Patrick Sawyer was wheeled into the Emergency Room at First Consultants Medical Centre, Obalende, Lagos, with complaints of fever and body weakness. The male doctor on call admitted him as a case of malaria and took a full history. Knowing that Mr Sawyer had recently arrived from Liberia, the doctor asked if he had been in contact with an Ebola patient in the last couple of weeks, and Mr. Sawyer denied any such contact. He also denied attending any funeral ceremony recently. Blood samples were taken for full blood count, malaria parasites, liver function test and other baseline investigations. He was admitted into a private room and started on anti-malarial drugs and analgesics. That night, the full blood count result came back as normal and not indicative of infection. The following day however, his condition worsened. He barely ate any of his meals. His liver function test result showed his liver enzymes were markedly elevated. We then took samples for HIV and hepatitis screening. At about 5.00pm, he requested to see a doctor. I was the doctor on call that night so I went in to see him. He was lying in bed with his intravenous (I.V.) fluid bag removed from its metal stand and placed beside him. He complained that he had stooled about five times that evening and that he wanted to use the bathroom again. I picked up the I.V. bag from his bed and hung it back on the stand. I told him I would inform a nurse to come and disconnect the I.V. so he could conveniently go to the bathroom. I walked out of his room and went straight to the nurses’ station where I told the nurse on duty to disconnect his I.V. I then informed my Consultant, Dr. Ameyo Adadevoh, about the patient’s condition and she asked that he be placed on some medications. The following day, the results for HIV and hepatitis screening came out negative. As we were preparing for the early-morning ward rounds, I was approached by an ECOWAS official who informed me that Patrick Sawyer had to catch an 11 o’clock flight to Calabar for a retreat that morning. He wanted to know if it would be possible. I told him it wasn’t, as he was acutely ill. Dr. Adadevoh also told him the patient could certainly not leave the hospital in his condition. She then instructed me to write very boldly on his chart that on no account should Patrick Sawyer be allowed out of the hospital premises without the permission of Dr. Ohiaeri, our chief medical consultant. All nurses and doctors were duly informed. During our early-morning ward round with Dr. Adadevoh, we concluded that this was not malaria and that the patient needed to be screened for Ebola Virus Disease (EVD). She immediately started calling laboratories to find out where the test could be carried out. She was eventually referred to Professor Omilabu of the LUTH Virology Reference Lab in Idi-Araba, whom she called immediately. Prof. Omilabu told her to send blood and urine samples to LUTH straight away. She tried to reach the lagos state commissioner for health but was unable to contact him at the time. She also put calls across to officials of the federal ministry of health and national centre for disease control. Dr. Adadevoh at this time was in a pensive mood. Patrick Sawyer was now a suspected case of Ebola, perhaps the first in the country. He was quarantined, and strict barrier nursing was applied with all the precautionary measures we could muster. Dr. Adadevoh went online, downloaded information on Ebola and printed copies, which were distributed to the nurses, doctors and ward maids. Blood and urine samples were sent to LUTH that morning. Protective gear, gloves, shoe covers and facemasks were provided for the staff. A wooden barricade was placed at the entrance of the door to keep visitors and unauthorised personnel away from the patient. Despite the medications prescribed earlier, the vomiting and diarrhoea persisted. The fever escalated from 38c to 40c. On the morning of Wednesday July 23, the tests carried out at LUTH showed a signal for Ebola. Samples were then sent to Dakar, Senegal for a confirmatory test. Dr. Adadevoh went for several meetings with the Lagos state ministry of health. Thereafter, officials from Lagos state came to inspect the hospital and the protective measures we had put in place. The following day, Thursday July 24, I was again on call. At about 10.00pm, Mr. Sawyer requested to see me. I went into the newly-created dressing room, donned my protective gear and went in to see him. He had not been cooperating with the nurses and had refused any additional treatment. He sounded confused and said he received a call from Liberia asking for a detailed medical report to be sent to them. He also said he had to travel back to Liberia on a 5.00am flight the following morning and that he didn’t want to miss his flight. I told him that I would inform Dr. Adadevoh. As I was leaving the room, I met Dr. Adadevoh dressed in her protective gear along with a nurse and another doctor. They went into his room to have a discussion with him and as I heard later to reset his I.V. line, which he had deliberately removed after my visit to his room. At 6:30am, Friday July 25, I got a call from the nurse that Patrick Sawyer was completely unresponsive. Again I put on the protective gear and headed to his room. I found him slumped in the bathroom. I examined him and observed that there was no respiratory movement. I felt for his pulse; it was absent. We had lost him. It was I who certified Patrick Sawyer dead. I informed Dr. Adadevoh immediately and she instructed that no one was to be allowed to go into his room for any reason at all. Later that day, officials from W.H.O came and took his body away. The test in Dakar later came out positive for Zaire strain of the Ebola virus. We now had the first official case of Ebola virus disease in Nigeria. It was a sobering day. We all began to go over all that happened in the last few days, wondering just how much physical contact we had individually made with Patrick Sawyer. Every patient on admission was discharged that day and decontamination began in the hospital. We were now managing a crisis situation. The next day, Saturday July 26, all staff of First Consultants attended a meeting with Prof. Nasidi of the national centre for disease control, Prof Omilabu of LUTH Virology Reference Lab, and some officials of W.H.O. They congratulated us on the actions we had taken and enlightened us further about the Ebola Virus Disease. They said we were going to be grouped into high-risk and low-risk categories based on our individual level of exposure to Patrick Sawyer, the “index” case. Each person would receive a temperature chart and a thermometer to record temperatures in the morning and night for the next 21 days. We were all officially under surveillance. We were asked to report to them at the first sign of a fever for further blood tests to be done. We were reassured that we would all be given adequate care. The anxiety in the air was palpable. The frenetic pace of life in Lagos, coupled with the demanding nature of my job as a doctor, means that I occasionally need a change of environment. As such, one week before Patrick Sawyer died, I had gone to my parents’ home for a retreat. I was still staying with them when I received my temperature chart and thermometer on Tuesday July 29. I could not contain my anxiety. People were talking Ebola everywhere – on television, online, everywhere. I soon started experiencing joint and muscle aches and a sore throat, which I quickly attributed to stress and anxiety. I decided to take malaria tablets. I also started taking antibiotics for the sore throat. The first couple of temperature readings were normal. Every day, I would attempt to recall the period Patrick Sawyer was on admission – just how much direct and indirect contact did I have with him? I reassured myself that my contact with him was quite minimal. I completed the anti-malarials but the aches and pains persisted. I had loss of appetite and felt very tired. On Friday August 1, my temperature read a high 38.7c. As I type this, I recall the anxiety I felt that morning. I could not believe what I saw on the thermometer. I ran to my mother’s room and told her. I did not go to work that day. I cautiously started using a separate set of utensils and cups from the ones my family members were using. On Saturday August 2, the fever worsened. It was now at 39c and would not be reduced by taking paracetamol. This was now my second day of fever. I couldn’t eat. The sore throat was getting worse. That was when I called the helpline and an ambulance was sent with W.H.O doctors who came and took a sample of my blood. Later that day, I started stooling and vomiting. I stayed away from my family. I started washing my plates and spoons myself. My parents, meanwhile, were convinced that I could not have Ebola. The following day, Sunday August 3, I got a call from one of the doctors who came to take my sample the day before. He told me that the sample which was they had taken was not confirmatory, and that they needed another sample. He did not sound very coherent and I became worried. They came with the ambulance that afternoon and told me that I had to go with them to Yaba. I was confused. Couldn’t the second sample be taken in the ambulance like the previous one? He said a better-qualified person at the Yaba centre would take the sample. I asked if they would bring me back. He said “yes”. Even with the symptoms, I did not believe I had Ebola. After all, my contact with Sawyer was minimal. I only touched his I.V. fluid bag just that once without gloves. The only time I actually touched him was when I checked his pulse and confirmed him dead, and I wore double gloves and felt adequately protected. I told my parents I had to go with the officials to Yaba and that I would be back that evening. I wore a white top and a pair of jeans, and I put my iPad and phones in my bag. A man opened the ambulance door for me and moved away from me rather swiftly. Strange behaviour, I thought. They were friendly with me the day before, but that day, not so. No pleasantries, no smiles. I looked up and saw my mother watching through her bedroom window. We soon got to Yaba. I really had no clue where I was. I knew it was a hospital. I was left alone in the back of the ambulance for over four hours. My mind was in a whirl. I didn’t know what to think. I was offered food to eat but I could barely eat the rice. The ambulance door opened and a Caucasian gentleman approached me but kept a little distance. He said to me, “I have to inform you that your blood tested positive for Ebola. I am sorry.” I had no reaction. I think I must have been in shock. He then told me to open my mouth and he looked at my tongue. He said it was the typical Ebola tongue. I took out my mirror from my bag and took a look and I was shocked at what I saw. My whole tongue had a white coating, looked furry and had a long, deep ridge right in the middle. I then started to look at my whole body, searching for Ebola rashes and other signs as we had been recently instructed. I called my mother immediately and said, “Mummy, they said I have Ebola, but don’t worry, I will survive it. Please, go and lock my room now; don’t let anyone inside and don’t touch anything.” She was silent. I cut the line.
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