Dr Ada Igonoh was part of the medical team that treated Nigeria’s index case of Ebola, Patrick Sawyer. Photograph: Ada Igonoh
Doctor who contracted Ebola while caring for Patrick Sawyer, the first patient diagnosed with the virus in Nigeria, gives a powerful account of her treatment and recovery.
I was the one who certified Patrick Sawyer dead. I informed the consultant immediately and she said that no one was to be allowed in his room. Later that day, officials from WHO came and took his body away. The test in Dakar came back positive for the Zaire strain of the Ebola virus. We now had the first official case of Ebola 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 and decontamination began. We were now managing a crisis situation.
The next day, Saturday 26 July, all staff of First Consultants medical centre in Lagos attended a meeting with infectious disease experts. They said we were going to be grouped into high-risk and low-risk categories based on our individual levels of exposure to Patrick Sawyer, the “index” case.
Every day I would try to recall the period Patrick Sawyer was on admission – just how much direct and indirect contact did I have with him?
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 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, 29 July. I could not contain my anxiety. People were talking about 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 try 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 the 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, 1 August, my temperature read a high 38.7°C. 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 were using.
I stayed away from my family. I started washing my plates and spoons myself
On Saturday, 2 August, the fever worsened. It was now at 39°C 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 WHO 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, 3 August, 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 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.
A man opened the ambulance door for me and moved away from me rather swiftly. Strange behaviour, I thought
I asked if they would bring me back. He said “yes”. Even with my symptoms, I did not believe I had Ebola. After all, my contact with Sawyer was minimal. I only touched his IV 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 I 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.
I have to inform you that your blood tested positive for Ebola. I am sorry.
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 typical Ebola tongue. I took out my mirror from my bag and took a look and 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.
I was taken to the female ward. I was shocked at the environment. It looked like an abandoned building. I suspected it had not been in use for quite a while. As I walked in, I immediately recognized one of the ward maids from our hospital. She always had a smile for me but not this time. She was ill and looked it.
She had been stooling a lot, too. I soon settled into the corner and looked around the room. It smelled of faeces and vomit. It also had a characteristic Ebola smell to which I became accustomed. Dinner was served – rice and stew. The pepper stung my mouth and tongue. I dropped the spoon. No dinner that night.
Dr David, the Caucasian man who had met me at the ambulance on my arrival, came in wearing his full protective hazmat suit and goggles. It was fascinating seeing the suit live. I had only seen them online. He brought bottles of water and ORS, the oral fluid therapy, which he dropped by my bedside.
He told me that 90% of the treatment depended on me. He said I had to drink at least 4.5 litres of ORS daily to replace fluids lost in stooling and vomiting. I told him I had stooled three times earlier and taken Imodium tablets. He said this was not advisable, as the virus would replicate the more inside of me. It was better, he said, to let it out. He said good night and left.
My parents called. My uncle called. My husband called crying. He could not believe the news. My parents had informed him, as I didn’t even know how to break the news to him.
As I lay on my bed in that isolation ward, strangely, I did not fear for my life. I was confident that I would leave that ward some day. There was an inner sense of calm. I did not for a second think that I would be consumed by the disease.
That evening, the symptoms fully kicked in. I was stooling almost every two hours. The toilets did not flush, so I had to fetch water in a bucket from the bathroom each time I used the toilet. I then placed another bucket beneath my bed for the vomiting. On occasion, I would run to the toilet with a bottle of ORS, so that as I was stooling, I was drinking.
This was a battle for my life but I was determined I would not die
The next day, Monday, 4 August, I began to notice red rashes on my skin, particularly on my arms. I had developed sores all over my mouth. My head was pounding so badly. The sore throat was so severe I could not eat. I could only drink ORS. I took paracetamol for the pain. The ward maid across from me wasn’t doing so well. She had stopped speaking. I couldn’t even brush my teeth; the sores in my mouth were so bad. This was a battle for my life but I was determined I would not die.
Every morning, I began the day with reading and meditating on Psalm 91. The sanitary condition in the ward left much to be desired. The whole Ebola thing had caught everyone by surprise. Lagos state ministry of health was doing its best to contain the situation but competent hands were few. The sheets were not changed for days. The floor was stained with greenish vomitus and excrement.
The matrons would leave our food outside the door. They hardly entered in the initial days
Dr David would come in once or twice a day and help clean up the ward after chatting with us. He was the only doctor who attended to us. There was no one else at that time. The matrons would leave our food outside the door. They hardly entered in the initial days. Everyone was being careful. This was all so new. I could understand, was this not how we ourselves had contracted the disease? Mosquitoes were in our room until they brought us mosquito nets.
Later that evening, Dr David brought another lady into the ward. I recognised her immediately as Justina Ejelonu, a nurse who had started working at First Consultants on the 21 July, the day after Patrick Sawyer was admitted. She was on duty the day he reported that he was stooling. While she was attending to him that night, he had yanked off his drip, letting his blood flow almost like a tap onto her hands.
Justina was devastated and wept profusely – she had contracted Ebola on her first day at work
Ejelonu was pregnant and was brought into our ward bleeding from a suspected miscarriage. She had been told she was there only on observation. The news that she had contacted Ebola was broken to her the following day after results of her blood test came out positive. Justina was devastated and wept profusely – she had contracted Ebola on her first day at work.
My husband started visiting but was not allowed to come close to me. He could only see me from a window at a distance. He visited so many times. It was he who brought me a change of clothes and toiletries and other things I needed because I had not even packed a bag. I was grateful I was not with him at home when I fell ill or he would most certainly have contracted the disease. My retreat at my parents’ home turned out to be the instrumentality God used to shield and save him.
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I drank the ORS fluid like my life depended on it. Then I got a call from my pastor. He had been informed about my predicament. He called me every single day, morning and night, and he would pray with me over the phone. He later sent me a CD player, CDs of messages on faith and healing, and Holy Communion packs through my husband.
My pastor, who also happens to be a medical doctor, encouraged me to monitor how many times I had stooled and vomited each day and how many bottles of ORS I had consumed. We would then discuss the disease and pray together. He asked me to do my research on Ebola since I had my iPad with me, and told me that he was also doing his study. He wanted us to use all relevant information on Ebola to our advantage. So I researched and found out all I could about the strange disease that had been in existence for 38 years. My research, my faith, and my positive view of life, the extended times of prayer, study and listening to encouraging messages boosted my belief that I would survive the Ebola scourge.
There are five strains of the virus, and the deadliest of them is the Zaire strain, which was what I had. But that did not matter. I believed I would overcome even the deadliest of strains. Infected patients who succumb to the disease usually die between six to 16 days after the onset of the disease from multiple organ failure and shock caused by dehydration. I was counting the days and keeping myself well-hydrated. I didn’t intend to die in that ward.
My research gave me ammunition. I read that as soon as the virus gets into the body, it begins to replicate really fast. It enters the blood cells, destroys them and uses those same blood cells to aggressively invade other organs where they further multiply. Ideally, the body’s immune system should immediately mount up a response by producing antibodies to fight the virus.
If the person is strong enough, and that strength is sustained long enough for the immune system to kill off the viruses, the patient is likely to survive. If the virus replicates faster than the antibodies can handle, however, further damage is done to the organs. Ebola can be likened to multi-level, multi-organ attack, but I had no intention of letting the deadly virus destroy my system. I drank more ORS. I remember saying to myself repeatedly, “I am a survivor, I am a survivor”.
The ward had become the house of death
I also found out that a patient with Ebola cannot be re-infected and they cannot relapse back into the disease as there is some immunity conferred on survivors. My pastor and I would discuss these findings, interpret them as it related to my situation and pray together. I looked forward to his calls. They were times of encouragement and strengthening. I continued to meditate on the word of God. It was my daily bread.
Shortly after Justina Ejelonu came into the ward, the ward maid, Mrs Ukoh, passed on. The disease had gotten into her central nervous system. We stared at her lifeless body in shock. It was a whole 12 hours before officials of WHO came and took her body away. The ward had become the house of death. The whole area surrounding her bed was disinfected with bleach. Her mattress was taken and burned.
To contain the frequent diarrhea, I had started wearing adult diapers as running to the toilet was no longer convenient for me. The indignity was quite overwhelming, but I did not have a choice. My faith was being severely tested. The situation was desperate enough to break anyone psychologically. Dr Ohiaeri, our chief medical consultant, also called us day and night, inquiring about our health and the progress we were making. He sent provisions, extra drugs, vitamins, Lucozade, towels, tissue paper; everything we needed to be more comfortable in that dark hole we found ourselves.
Some of my male colleagues also had been admitted to the male ward two rooms away, but there was no interaction with them. We were saddened by the news that Jato, an official from Ecowas who worked with Patrick Sawyer, who had also tested positive, had passed on days after he was admitted.
Two more females joined us in the ward; a nurse from our hospital and a patient from another hospital. The mood in the ward was solemn. There were times we would be awakened by the sudden, loud cry from one of the women. It was either from fear, pain mixed with the distress, or just the sheer oppression of the isolation.
I kept encouraging myself. This could not be the end for me. Five days after I was admitted, the vomiting stopped. A day after that, the diarrhea ceased. I was overwhelmed with joy. It happened at a time I thought I could no longer stand the ORS. Drinking that fluid had stretched my endurance greatly.
I knew countless numbers of people were praying for me. Prayer meetings were being held on my behalf. My family was praying day and night. Text messages of prayers flooded my phone from family members and friends. I was encouraged to press on. With the encouragement I was receiving, I began to encourage the others in the ward. We decided to speak life and focus on the positive.
Dr Fadipe, one of the doctors at Lagos’s First Consultant Hospital who survived Ebola, with the Oral Rehydration Solution he credits for his recovery. Photograph: WHO/Andrew Esiebo/AP
I then graduated from drinking only the ORS fluid to eating only bananas, to drinking pap and then bland foods. Just when I thought I had the victory, I suddenly developed a severe fever. The initial fever had subsided four days after I was admitted, and then suddenly it showed up again. I thought it was the Ebola. I inquired from Dr David, who said fever was sometimes the last thing to go. But he expressed surprise that it had stopped only to come back on again. I was perplexed.
I discussed it with my pastor, who said it could be a separate pathology and possibly a symptom of malaria. He promised he would research if indeed this was Ebola or something else. That night as I stared at the dirty ceiling, I felt a strong impression that the new fever I had developed was not as a result of Ebola but malaria. I was relieved. The following morning, Dr Ohiaeri sent me an antimalarial medication, which I took for three days. Before the end of the treatment, the fever had disappeared.
I was not prepared to deal with a member of my family contracting it from me
I began to think about my mother. She was under surveillance along with my other family members. I was worried. She had touched my sweat. I couldn’t get the thought off my mind. I came across a tweet by WHO saying that the sweat of an Ebola patient cannot transmit the virus at the early stage of the infection. The sweat could only transmit it at the late stage.
That settled it for me. It calmed the storms that were raging with me concerning my parents. I knew right away it was divine guidance that caused me to see that tweet. I could cope with having Ebola, but I was not prepared to deal with a member of my family contracting it from me.
Soon, volunteer doctors started coming to help Dr David take care of us. They had learned how to protect themselves. Among the volunteer doctors was Dr. Badmus, my consultant during my housemanship days. It was good to see a familiar face among the care-givers. I soon understood the important role these brave volunteers were playing.
As they increased in number, so did the number of shifts increase and subsequently the number of times the patients could access a doctor in one day. That allowed for more frequent patient monitoring and treatment. It also reduced care-giver fatigue. It was clear that Lagos State was working hard to contain the crisis.
Sadly, Justina succumbed to the disease on 12 August. It was a great blow and my faith was greatly shaken as a result. I commenced daily Bible study with the other two female patients and we would encourage one another to stay positive in our outlook, though in the natural it was grim and very depressing. My communion sessions with the other women were very special moments for us all.
On the 10th day in the ward, the doctors having noted that I had stopped vomiting and stooling and was no longer running a fever, decided it was time to take my blood sample to test if the virus had cleared from my system. They took the sample and told me that I shouldn’t be worried if it comes out positive as the virus takes a while before it is cleared completely. I prayed that I didn’t want any more samples collected from me. I wanted that to be the first and last sample to be tested for the absence of the virus in my system. I called my pastor. He encouraged me and we prayed again about the test.
On the evening of the day Justina passed on we were moved to the new isolation centre. We felt like we were leaving hell and going to heaven. We were conveyed to the new place in an ambulance. It was just behind the old building. Time would not permit me to recount the drama involved with the dynamics of our relocation. It was like a script from a science fiction movie. The new building was cleaner and much better than the old building. Towels and nightwear were provided on each bed. The environment was serene.
The following night, my consultant Dr Ameyo Adadevoh was moved to our isolation ward from her private room where she had previously been receiving treatment. She had also tested positive for Ebola and was now in a coma. She was receiving IV fluids and oxygen support and was being monitored closely by the WHO doctors. We all hoped and prayed that she would come out of it. It was so difficult seeing her in that state. I could not bear it. She was my consultant and my mentor. She was the imperial lady of First Consultants, full of passion, energy and competence. I imagined she would wake up soon and see that she was surrounded by her First Consultants family but sadly it was not to be.
I continued listening to my healing messages. They gave me life. I literally played them hours on end. Two days later, on Saturday the 16 August, the WHO doctors came with some papers. I was informed that the result of my blood test was negative for the Ebola virus. If I could somersault, I would have, but my joints were still painful. I was free to go home after being in isolation for exactly 14 days. I called my mother to get fresh clothes and slippers and come pick me up. My husband couldn’t stop shouting when I called him. He was completely overwhelmed with joy.
It felt like I was being baptised into a new life as Dr Carolina, a WHO doctor from Argentina, poured the bucket of chlorinated water all over me
I was told however that I could not leave the ward with anything I came in with. I glanced one last time at my CD player, my valuable messages, my research assistant - my iPad, my phones and other items. I remember saying to myself, “I have life; I can always replace these items.”
I went for a chlorine bath, which was necessary to disinfect my skin from my head to my toes. It felt like I was being baptised into a new life as Dr Carolina, a WHO doctor from Argentina, poured the bucket of chlorinated water all over me. I wore a new set of clothes, following the strict instructions that no part of the clothes must touch the floor and the walls. Dr Carolina looked on, making sure I did as instructed.
I was led out of the bathroom and straight to the lawn to be united with my family, but first I had to cut the red ribbon that served as a barrier. It was a symbolic expression of my freedom. Everyone cheered and clapped. It was a little but very important ceremony for me. I was free from Ebola! I hugged my family as one who had been liberated after many years of incarceration. I was like someone who had fought death face to face and come back to the land of the living.
We had to pass through several stations of disinfection before we reached the car. Bleach and chlorinated water were sprayed on everyone’s legs at each station. As we made our way to the car, we walked past the old isolation building. I could hardly recognise it. I could not believe I slept in that building for 10 days. I was free! Free of Ebola. Free to live again. Free to interact with humanity again. Free from the sentence of death.
My parents and two brothers were under surveillance for 21 days and they completed the surveillance successfully. None of them came down with a fever. The house had been disinfected soon after I was taken to the isolation centre. I thank God for shielding them from the plague.
My recovery after discharge has been gradual but progressive. I thank God for the support of family and friends. I remember my colleagues who we lost in this battle. Dr Adadevoh, my boss; nurse Justina Ejelonu and the ward maid, Mrs Ukoh were heroines who lost their lives in the cause to protect Nigeria. They will never be forgotten.
I commend the dedication of the WHO doctors, Dr David from Virginia in the US, who tried several times to convince me to specialise in infectious diseases; Dr Carolina from Argentina who spoke so calmly and encouragingly; Mr. Mauricio from Italy who always offered me apples and gave us novels to read. I especially thank the volunteer Nigerian doctors, matrons and cleaners who risked their lives to take care of us. I must also commend the Lagos state government and the state and federal ministries of health for their swift efforts to contain the virus.
To all those who prayed for me, I cannot thank you enough. And to my First Consultants family, I say a heartfelt thank you for your dedication and for your support throughout this very difficult period.
I still believe in miracles. None of us in the isolation ward was given any experimental drugs or so-called immune boosters. I was full of faith, yet pragmatic enough to consume as much ORS as I could – even when I wanted to give up and throw the bottles away. I researched the disease extensively and read accounts of the survivors. I believed that even if the mortality rate was 99% I would be part of the one percent who would survive.
Why do some die and some survive? Why do bad things happen to good people? Where is God in the midst of pain and suffering?
Early detection and reporting to hospital is key to patient survival. Please do not hide yourself if you have been in contact with an Ebola patient and have developed the symptoms. Regardless of any grim stories one may have heard about the treatment of patients in the isolation centre, it is still better to be in the isolation ward with specialist care than at home where you and others will be at risk.
I read that Dr Kent Brantly, the American doctor who contracted Ebola in Liberia and was flown out to the US for treatment, was being criticised for attributing his healing to God when he was given the experimental drug Zmapp. I don’t claim to have all the answers to the nagging questions of life. Why do some die and some survive? Why do bad things happen to good people? Where is God in the midst of pain and suffering? Where does science end and God begin? These are issues we may never fully comprehend on this side of eternity. All I know is that I walked through the valley of the shadow of death and came out unscathed.
Ada Igonoh is a doctor, public health advocate and motivational speaker. She graduated from the University of Ghana Medical School in 2011
By Dr Ada Igonoh
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