Daily Life in an Ebola Treatment Unit

Karin Huster has spent months battling Ebola in West Africa. The 48-year-old nurse trained Ebola responders in Liberia in September and October. And after Partners In Health pledged to fight the epidemic, she became one of the organization’s first short-term clinicians, in Port Loko, Sierra Leone, in November and December. When Ebola is beaten, it will be in no small part thanks to people like her.

Huster has written long, thoughtful pieces about her experiences in The New York Times, on NPR.org, and elsewhere. We asked if she’d share something simpler: a view of day-to-day life in a West African Ebola Treatment Unit, or ETU.

She was happy to oblige. We caught up with Huster in Seattle, Washington, where she lives with her husband. They have a 20-year-old son, an 18-year-old daughter, and two cats, Lulu and Fly. If all goes according to plan, she’ll be back in Sierra Leone in early spring, she says.

What’s a typical day like for a nurse in the ETU?

I would wake up around 6 or 6:30. Take a bucket shower. Have a breakfast of sandwich with tuna. We had decided not to take cars to the ETU, but to walk, because that was one of our only relaxation modes, and it gave us a window on what was happening in our community. That was a really nice thing.

Then you get to the ETU. And from then on the energy is 100,000 volts, day in and day out, every second of the day.

What do you do?

We start, sadly, by acknowledging who our deaths are from the night before. We have a bunch of white boards in the wards labeled “suspect” and “confirmed,” and all the patients listed. We quickly go over everyone’s case and make a high-level plan for what we’re going to do—lab tests, etc. Then we break into teams. (We always have international staff—Americans with PIH, Cubans with the World Health Organization, locals with the Ministry of Health and Sanitation—which is a lot of fun.)

If you’re doing clinical stuff, which most people are, then that means two trips a day inside the red zone, sometimes three trips—dressed in full protective gear, treating patients. The trips usually last one and a half hours. Sometimes people extend to two hours, but that’s not recommended because it’s hot, so you’re just not feeling so good.

When not in the red zone, you work on projects—maybe a psycho-social project, or clinical protocols, or infection prevention.

How do you spend your free time?

As we were one of the earlier teams, we felt really strongly that we were there to work, and we had so much work, and we really didn’t want to take a day off. That was a mistake. Working every day, you burn out at the end of five or six weeks. Now people are much more on the ball with that.

What’s readjustment like?

You go from a place where it’s work, work, work, 24-7, where you’re living and dreaming Ebola, and then you come home and—because of local quarantine policies—you have 21 days of doing nothing. It’s bizarre, surreal. You feel useless.

What’s your one-sentence answer to the cocktail-party question, “Why do you do it?”

It’s the right thing to do.

What does your family say?

They’ve always been supportive, even though sometimes they’re worried. My husband has to man the fort at home, so it’s not always easy for him.

What do your kids say?

They say, “Just don’t die.” It’s simple and it’s nice. Because I think about it regularly. This is my mantra: I need to come home alive and healthy. It keeps me on my toes every day.

What kind of tips do you have for first-time short-term clinicians?

Find things that relieve your stress. It’s healthy to go to bed on time, have a glass of wine, go surfing, take pictures. If something really stressful happens, I like to write. I also like to walk. You can buy wine or beer at the gas station near the ETU. And I think there is a tiki bar at the International Humanitarian Partnership Base Camp.

If people know how to play an instrument, they should bring it. We had Mark. He was an incredible harmonica player. Dylan also had a little Hawaiian guitar, a ukulele, that was a lot of fun. It relaxed people, forced us to move away from talking about work the whole day long.

Fatality rates are dropping, but even now, 40 to 50 percent isn’t atypical. How do you deal with so many deaths?

Last time I handled it pretty well until I reached Freetown and was on my way out, and then it all rushed in. Not one memory, just emotions in general. You see so much death every day, you think you become blind to it, but you’re not. You’re just accumulating it.

I think a way to handle it is not to focus on those negative moments, but to focus on the people who survive, who become healthier. We do these celebrations for survivors. They come out, get food, a certificate. They tie a ribbon to this tree. Sometimes we start singing. It doesn’t erase the sadness, but it makes the sad moments more tolerable.

The other thing, for the kids or patients that were healthy, I’d sometimes do some silly dancing.

In a plastic-y suit?

Oh yeah. I remember one day, a colleague and I were coming out of the confirmed ward on our way to doffing. We passed a bunch of kids—they were super healthy—waiting for their final lab results. We started the chicken dance. They followed behind, stomping and clapping and laughing and flapping their arms. This makes your day.

In The Washington Post recently, Dr. Farmer pledged to drop case-fatality rates to less than 10 percent. You were with him in Port Loko when the idea surfaced. How did you and the other clinicians react?

We all embraced it. We knew very well that this was a very aggressive number. It probably is not going to be done in a month or two months. But every step in that direction is a step toward less than 10 percent. It’s something to strive for. You wake up every day and you know that you want to bring the mortality rate to less than 10 percent.