MIDDLEBURY — Another scorching day in the West African Republic of Sierra Leone, where the air hangs heavy with humidity and death.
Another day of misery for the latest group of patients filing into the Lunsar Ebola Treatment Center.
For those flagged with the vicious disease, there’s a 60-percent chance they’ll leave the center in a body bag — especially if they’re children.
Among this latest group is an eight-year-old girl named N’yandewah. She enters with her parents and a sister, all of whom are confirmed to have Ebola. N’yandewah spends the next several days battling a raging fever, jarring spells of vomiting blood, and intense pain, before beating the odds.
Her reward is watching her parents and sister die.
It is the second time that N’yandewah has been orphaned; her biological parents were buried several years ago.
“It is just unfathomable,” Dr. Jean Andersson-Swayze said of the girl’s suffering.
N’yandewah’s story is but a chapter in the six-week saga of Andersson-Swayze’s service in Sierra Leone’s Lunsar Ebola Treatment Center, where the Middlebury family physician helped care for scores of suffering patients earlier this year.
This was not Andersson-Swayze’s first experience in Africa.
She and her family lived in Johannesburg, South Africa, while she was in high school. Andersson-Swayze’s dad was a diplomat in that country, and she chose to live there rather than attend a boarding school.
“I leapt at that opportunity,” Andersson-Swayze recalled.
She would reside in seven different countries before attending Middlebury College. She received her medical training at the University of Vermont College of Medicine, and joined Middlebury Family Health in 2009.
DR. JEAN ANDERSSON-SWAYZE, a Middlebury physician, recently spent six weeks in Sierra Leone treating Ebola patients. She is now raising funds to help an Ebola survivor who has been orphaned twice.
Independent photo/Trent Campbell
Though firmly rooted in Middlebury with a medical practice, husband and three children, Andersson-Swayze has maintained an interest in Africa and its people. Her early outreach has included collecting used books and shipping them to Africa for distribution to children in rural towns. During medical school, she spent almost two months in parts of Nigeria and South Africa providing medical services.
Late last year, she made the decision to take her aid to Africa to the next level. After getting a thumbs-up from her family and her partners at Middlebury Family Health, Andersson-Swayze signed up for a six-week deployment with International Medical Corps, a non-governmental organization currently providing medical and development assistance in the West African Republic of Sierra Leone. Sierra Leone until recently was a hotbed for Ebola cases.
“When Ebola hit the headlines last August, I began thinking almost immediately about how I could help,” Andersson-Swayze said. “One of the images that really galvanized my response to this was seeing the pictures of children lying in the streets and people standing around them, but unable to touch them,” Andersson-Swayze recalled. “Realizing that that could be any of the kids I know, it’s just a terrible position to be in.”
She arrived in Sierra Leone in mid-January and was stationed at the Lunsar Ebola Treatment Center, located in the Loko District, around two hours from the Sierra Leone capital of Freetown.
“It was one of the most heavily affected areas,” she said.
To make matters worse, most people in Sierra Leone were afraid to go to the hospitals for fear of contracting Ebola from confirmed cases, Andersson-Swayze noted.
“The hospitals were shut down, and are only now slowly reopening,” she said. “The other thing is, a lot of the health care workers died, so a lot of the expertise evaporated, killed by Ebola. They have an even greater need for health care workers to help out for the next few years.”
EBOLA SYMPTOMS
Ebola is a virus that causes initial symptoms of fever, sore throat, muscular pain and headaches, followed by vomiting, diarrhea and rash. The virus attacks the kidneys and liver while it lowers the patient’s blood pressure to dangerous levels.
“(Patients) go into massive shock,” Andersson-Swayze explained. “It causes the capillaries to become very leaky, so it’s accompanied by hemorrhaging. There are copious amounts of bloody vomit and bloody diarrhea … along with a lot of pain.”
Since there is no cure for Ebola, physicians and nurses provide “supportive care,” according to Andersson-Swayze.
“We can give intravenous fluids and medications to treat symptoms only,” she said. “We had morphine for pain, medication to help prevent throwing up, and Tylenol for headaches. Very, very basic treatment.”
Unfortunately, Andersson-Swayze and her colleagues had no diagnostic equipment at their disposal.
“It was very challenging and frustrating, from a caregiver’s point of view,” she explained. “There was a lot of ‘educated guessing’ going on and a little praying at times. We did the best we could. It was really tough.”
After receiving some training, Andersson-Swayze began her work in what could literally and figuratively be called the “hot zone.” The center had a capacity to serve 80 patients and featured three wards — one for suspected Ebola cases, another for probable cases, and the third for confirmed cases.
Andersson-Swayze described her first glimpse of the center’s Ebola ward as being akin to “stepping back into a medieval era. The beds didn’t have sheets. There were no pillows. Often there were no IV poles and we had to hold the IV bag up. We had the most basic of medications, and there was a lot of suffering and a lot of pain.”
Physicians and nurses took strict precautions to make sure they didn’t become patients themselves. Before entering the Ebola ward, all workers had to don a special outfit that covered everything except the eyes, which were protected by goggles.
“Now imagine doing this in 100-plus-degree heat with greater than 80-percent humidity,” Andersson-Swayze said. As a result, personnel worked in short shifts. When they took off their suits, their bodies were drenched with perspiration, she recalled.
Andersson-Swayze noted upon her arrival at the center that morphine was being infrequently used to help control pain in Ebola patients. She explained that center officials feared the drug might hasten the patients’ demise. But Andersson-Swayze was able to convince them that morphine, when used properly, would help patients weather pain episodes and live longer.
“The idea is that the longer you live, the more chance you have of mounting an immune response and actually survive Ebola,” she said.
One of most appreciated medications proved to be human contact — even if it was somewhat muted through a protective suit.
“There was sitting next to someone and holding their hand,” said Andersson-Swayze, who learned and repeated some comforting phrases in the native languages of Temne and Mende. “I watched a lot of amazing nurses and doctors take care of people with words and touch.”
HELPLESS & FRUSTRATED
But there were times when the crew felt the odds were stacked against it.
There was a period during which the mortality rate was close to 60 percent at the center, which is no better than the rate out in the communities, according to Andersson-Swayze. And most of the casualties were children, whose small bodies simply couldn’t defend against the mysterious viral scourge.
“Sadly, we treated a lot of pediatric patients, but we didn’t discharge anyone that was less than the age of five,” Andersson-Swayze said.
Many children who weren’t infected or survived infection, nonetheless lost family members. Ebola has left approximately 25,000 orphans so far in West Africa.
“Imagine … stepping into a series of tents where the air is so thick with chlorine it burns the back of your doubled-masked throat, and the sick and dying lie sweltering with no sheets, pillows and, of course, no air conditioning,” she added. “Kids are watching their parents die, and parents are helpless as their kids die — day in and day out, shift after shift.
“I have never felt so helpless and frustrated in my life,” she added.
Every patient recovery was cause for celebration.
“On those occasions, we would gather together and, as they emerged from a chlorine shower, sing songs of encouragement to the beat of the djembe,” Andersson-Swayze said. The djembe is a favorite conga-like percussion instrument in Sierra Leone.
AN EBOLA SURVIVOR holds a certificate as aid workers celebrate her recovery from Ebola at a treatment center in Sierra Leone. Middlebury’s Jean Andersson-Swayze is third from right.
Courtesy photo
But surviving Ebola was not the end of suffering for many of the patients, however. Most, if not all, of the survivors’ families had already been decimated by Ebola, Andersson-Swayze noted.
Along with providing direct care to patients, Andersson-Swayze helped train nurses and doctors. She worked in some of the surrounding clinics to strengthen their ability to recognize Ebola patients earlier and send them to centers for specialized care. She was pleased to report last week that the Lunsar Ebola Treatment Center had not seen a new Ebola case in two weeks. The focus now in Sierra Leone is turning to more long-term development projects for what remains an extremely poor country.
RETURNING TO VERMONT
When Andersson-Swayze returned home in late February, she made sure to comply with the requisite quarantining regulations.
“It pretty much started when I landed in Washington, D.C.,” she said. “I was taken aside, put in a room for several hours, questioned and interviewed by the Centers for Disease Control.”
She was cleared to go back to Vermont and spent 21 days inside her home before returning to her practice.
“It was strange to have such vigilance,” Andersson-Swayze said. “The great irony is, there is more fear of Ebola here than there is in Sierra Leone.
“The Vermont Department of Health checked in with me every day,” she added. “They were great.”
She shrugged off mention of the personal sacrifice and danger she faced during her medical mission to Sierra Leone.
“The personal sacrifice had more to do with leaving my kids; it was the hardest thing I’ve ever had to do,” Andersson-Swayze said. “I had every bit of faith in my personal protective gear and the training we received. I realize people in the military do this all the time. I have been lucky to have this skill-set which I thought would be able to make a difference in this circumstance.”
The comforts of Vermont life have not wiped away the searing memories of the clinic. And one of her most vivid memories is of N’yandewah, for whom Andersson-Swayze has created a gofundme site to raise money for the Sierra Leonean youngster. She is confident that the funds will be used on N’yandewah’s behalf, as the young girl has a cousin who is a driver for International Medical Corps. A nurse at the center will also help disburse the funds. N’yandewah has returned to her hometown to be with her six surviving siblings, who were — and still are — in the care of neighbors, according to Andersson-Swayze.
The gofundme site for N’yandewah and her siblings is at gofundme.com/Nyandewafund.
But Andersson-Swayze also knows that, tragically, for every N’yandewah there were several other children at the clinic  who didn’t make it.
“I am haunted by the many deaths,” she said. “The experience simply can’t be summed up in the few sentences that people seem to have the time for. And the many comforts of our life here sit uneasily with the knowledge that so many have so little and are still suffering.”
Reporter John Flowers is at [email protected].