Garmai Sayon endured more than anyone should have to bear. First, her husband died at the Ebola treatment center here, falling ill after rushing to help a stranger who had collapsed in their village. Five days later, their child — a 1-year-old boy whose two older siblings had been lost earlier to illness and accident — died in her arms while she was delirious from the disease.
Doctors and nurses tended to the young woman as she had fevers, suffered pains all over her body and lay listless, confused. “I just gave my heart to God,” Ms. Sayon recalled.
As her symptoms began to abate, her arm grew hot and swelled to twice its size, prompting fears of sepsis, an often deadly complication of infection. It most likely stemmed from where her intravenous line had been inserted but not changed as often as desirable because of risks, both to her and to the medical workers. Ms. Sayon had survived Ebola, but it was not yet certain that she would survive the treatment.
What level of care is possible for a disease with no cure being treated in wooden huts in the middle of a forest? How do medical workers prioritize which patients and tasks to focus on when they cannot do everything they were trained to do? Will their decisions determine who lives and who dies? And how would they even know?
“You always want to do more, but it has to be balanced with what’s possible, with what makes sense for the context you’re working in,” said Dr. Pranav Shetty, the medical director at the center operated here by International Medical Corps.
Because of the limited time they can spend in the sick wards in their stifling protective suits, the risks of certain procedures and even the amount of medicines available, health workers here and elsewhere in West Africa ration care, operating under constraints they often find frustrating. The mainstays of fighting the Ebola epidemic — isolation and basic treatment — have resulted in more dead than survivors among those infected, just like with Ms. Sayon’s family.