Gomathinayagam, part of Doctors Without Borders who served Ebola victims in Liberia, speaks about her experiences

Vidya Krishnan in http://www.livemint.com

Gomathinayagam says they had to win the trust of the community first—they suddenly see foreigners giving them instructions. Photo: Ramesh Pathania/Mint

Kalyani Gomathinayagam is a general physician based in Madurai, Tamil Nadu, who has just returned from Liberia, the epicentre of the Ebola outbreak, after spending six weeks caring for patients in the West African nation. She is already talking about going back.

Gomathinayagam, 46, joined Médecins Sans Frontières, or MSF (Doctors Without Borders) after the Haiti earthquake in 2010. She has served as an emergency doctor in the Ivory Coast, Chad and the Democratic Republic of Congo before her stint in Liberia, from where she returned to Delhi on 20 October after being quarantined for 21 days in Geneva, Switzerland.

Working in Foya district of Lofa county in Liberia, the doctors operated in small hutments, plastic-sheeted from inside to prevent infections—much like the ‘kill room’ in the popular television series Dexter. The doctors worked in temperatures touching 40 degrees Celsius, swathed in protective gear including face shields, goggles and boots, that made even simple tasks like placing an intravenous (IV) line or giving an injection seem like hard labour.

Health workers have been the most critical resource at the frontline of the battle against the latest outbreak of Ebola, which has so far claimed 4,919 lives—2,413 in Liberia alone, according to the World Health Organization.

Gomathinayagam spoke about her experiences in Liberia and other disaster-struck regions in an interview during a visit to New Delhi. Edited excerpts:

You have seen people suffer earthquakes, civil wars and medical emergencies. Which one has been the most challenging?

Ebola. Without a doubt. This outbreak is unprecedented in so many ways. The disease threatens doctors and health workers, severely limiting our capacity to treat patients. And this is happening in countries where the health infrastructure is not robust to begin with. Additionally, we had a few scares with some of our colleagues falling sick, but thankfully, it was not Ebola.

We had to win the trust of the community first—they suddenly see foreigners giving them instructions. The families see their loved ones taken to the hospital and coming back dead. Even burial is not under their control. So, it was a very challenging experience.

Working with the nurses was the trickiest bit. The nursing staff was given clinical information without passing over pieces of paper from inside the quarantine zone. So everything was dictated. This takes a lot of time when you have over 100 patients and just four doctors. It was a tremendous amount of work to get the data collected.

How difficult is it to care for an Ebola victim with basic health infrastructure?

The most difficult part was to administer any kind of treatment without coming in physical contact with the patient. (In treating) this disease, everything is complicated. The patients can only see my eyes and recognize my voice, and I have to shout through a perimeter to be heard. Everything has to be done from across the ‘perimeter fencing’. It was challenging to gain the community’s trust because all they (see) is a hazmat suit (protective gear).

In this setting, I had little or no access to the patient. I had to figure out how to put the IV fluid, but my goggles were getting foggy and I was no longer able to properly place an IV. If I cannot see, there are chances of me pricking myself with the injection instead. I was sweating a lot because of the protective gear. And somehow you manage everything and within minutes the patient is lying in a pool of faeces or vomit—and you have to do this all over again.

Do you choose these assignments for an adrenaline rush? Because this must have been difficult for your family.

Their first reaction was “Are you crazy?” But they know I work for a humanitarian aid agency, which responds to acute medical emergencies for the most vulnerable population—civil wars, epidemics, natural disasters.

Ebola has had a huge impact on me as a person. One cannot imagine the magnitude of this epidemic unless you go there. I have never seen or felt such helplessness. I could also, like normal doctors, set up a regular practice. My patients would have a choice of going to another doctor if they didn’t like me. But I serve in places where people cannot go to another doctor. There is no other doctor.

It is stressful moving from one suffering to another, but we also have a rest period in between. I don’t know about the adrenaline rush, but this gives me tremendous satisfaction. I do what is needed. My family and friends understand I chose this profession. They have adapted so I can keep going back.

Is there a ‘good day at the office’ in situations like these?

Well, not often. I had one which made me very happy. I had skipped the morning rounds one day and when I went in the evening, a patient came up to me and asked me why I didn’t turn up in the morning. And I realized he knew me. By my voice. He could still identify me despite the hazmat suit and face shield, and it was heartening.

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Natarajan