Dr. Maria Barstch spends her days in the small house that serves as the Doctors Without Borders/Médecins Sans Frontières (MSF) Ebola survivor clinic in Freetown, Sierra Leone. The peak of the epidemic may have passed in Sierra Leone, but new cases continue to emerge almost every day, and with new cases come new survivors. While they are relieved to have defeated the deadly virus, some survivors are facing other debilitating symptoms of the so-called “post-Ebola syndrome.”
Across from Dr. Barstch sits Mamadou, a young boy who looks no more than 11 years old. He’s 15, he says; he had his birthday in December, the same month he lost his mother to Ebola and just before he fell ill himself. He had never seen a doctor before contracting Ebola, but now makes sure to see Dr. Barstch every week.
MSF has also opened a survivor clinic in Liberia, housed at the site of the organization’s new pediatric hospital in Monrovia. In both Liberia and Sierra Leone, many survivors had previously sought treatment at local public or private hospitals and clinics, but were refused care as soon as staff learned they had recovered from Ebola.
“They are afraid of us,” says Jestina Dorley, one of the patients who survived Ebola at MSF’s ELWA 3 Ebola treatment center in Monrovia. “Even when you show your survival certificate, people take a step back and say they cannot do anything for you.” For other survivors, money is another constraint, with Ebola having left them without jobs and support systems. Even obtaining basics like food and shelter, let alone health care, can be a real struggle.
Dr. Barstch flicks through Mamadou’s files to remind herself of the health issues she helped him with during his previous visit: inflammation in his left eye; nondescript itching all over his body; body aches and weakness.
“I see a lot of people with severe joint pain,” says Dr. Barstch. “I also see a lot of rashes and skin infections, eye problems, general fatigue and weakness, and genito-urinary tract infections. Many issues can be treated very easily here in our clinic, but without treatment some of the complications can be very severe and can cause irreversible damage.”
One of the most common and serious complications seen in Ebola survivors like Mamadou is an inflammation of the eye called uveitis. It is a complication also seen after other severe viral illnesses, and the results can be debilitating. “This is where we, at the MSF survivor clinic, can have a huge impact,” says Dr. Barstch. “Most patients suffering from uveitis can be treated with eye drops by an ophthalmologist, but, if left untreated, uveitis can lead to blindness. We refer patients to the specialist before the damage becomes irreversible and the success rate is high.”
The mental health impact of surviving Ebola cannot be underestimated. “For many of us, surviving Ebola means coming back to an empty house where most of our loved ones passed away; to a job that is no longer there; to a neighborhood where old friends are now avoiding you,” says Tony Henry, an Ebola survivor from Monrovia.
MSF psychologists see patients like Tony every day. “Our initial observations indicate that, three months after discharge, around one-quarter of the survivors followed up by MSF showed signs of post-traumatic stress disorder, and a similar proportion presented signs of depression,” says Dr. Richard Bedell, MSF project medical referent in Liberia. “Some also suffered from memory loss and recurrent nightmares.”
But there is hope: “It is very nice to see how open patients are to receiving mental health care,” says Dr. Sylvia Wamser, an MSF psychologist in Freetown. “We listen to them and explain that what they are experiencing is actually a very normal reaction to an abnormal situation. We help them unlock coping mechanisms and also teach some easy breathing exercises [that help] deal with anxiety. For many patients we see improvements within four or five sessions.”
Integrated Care is Crucial
MSF’s two survivor clinics—one in Freetown, and one in Monrovia—have so far provided more than 1,000 outpatient consultations. This two-pronged approach, combining adequate medical and mental health care, is essential to providing the support required after surviving Ebola. As the epidemic continues, and as more patients survive the disease, MSF will continue its efforts to ensure patients are not left to cope alone once they leave an Ebola management center.