Jariatu was found in a house surrounded by nine of her family members. All of them, except her, had died from Ebola. She was just 14 months old and barely alive.
When Jariatu arrived at Maforki, an Ebola treatment unit in Port Loko, Sierra Leone, she was too dehydrated for the doctors and nurses to start an IV, but without one she wouldn't have lasted more than a day. So the team chose a dangerous and difficult option, an intraosseous infusion -- a technique that injects fluids directly into the bone marrow. In a few short hours, they were able to rehydrate her enough to start an IV, and she began the slow process of healing.
Although Ebola survival rates for children under 5 are just 25%, Jariatu recovered.
She is the patient that Marc Rosenthal, a Madison nurse who spent months in Sierra Leone helping fight Ebola, remembers most.
"All of us have a particular person or child.... She's one that I really go back to and think about a lot," says Rosenthal. "The story about Jariatu just lifts your spirits because this baby was suddenly surviving, and you really wanted to hope for that."
Rosenthal is the first and only Wisconsin resident to return from Africa after working directly with Ebola patients. He recently completed his 21-day quarantine after returning to the States and shared his experiences with Isthmus.
Ebola was first identified in 1976. Dr. Greg DeMuri, associate professor in the division of pediatric infectious diseases and part of UW Hospital's Ebola preparedness team, says that what makes Ebola unique is its infectivity.
"It requires very few infectious particles to be transmitted to another human being," DeMuri says. "As the patient gets sicker the amount of virus they have in their fluids goes up; when they start to develop severe diarrhea and vomiting there are tons of Ebola particles in the stool making it really contagious."
Symptoms begin with body aches, loss of appetite and abdominal pain. Patients then develop a fever and often a rash. After "dry" symptoms, patients usually get "wet" symptoms including diarrhea and vomiting. If the virus hasn't been treated, or if the patient isn't responding to treatment, he or she will develop confusion and bleeding, which are followed rapidly by death.
Once the virus gets into the body, it attacks the cells of the immune system, spreading throughout the body's organs.
"Because Ebola infects immune cells it severely dampens the immune system's response to itself," DeMuri says. "That allows it to really propagate and divide unchecked, and that's why it makes people so sick."
'If not me?'
The recent Ebola epidemic was first detected in Guinea in December 2013; it spread to Liberia in March 2014 and entered Sierra Leone in May of the same year. Throughout that time, Rosenthal and his wife, Julie Derwinski, followed news about the epidemic.v
When the World Health Organization declared it a global emergency in August 2014, they both knew Rosenthal had to go help.
"The level of pain and suffering in West Africa was overwhelming," Rosenthal says. "I had a history of doing emergency response. I worked in shelters around Hurricane Katrina, I did work in war zones in El Salvador, I had emergency room experience. It was very odd; we looked at each other and almost simultaneously, I said, 'if not me, who?' and she said, 'if not you, who?'"
As Rosenthal began the process of connecting with Partners in Health, an aid organization committed to improving the health of poor and marginalized people, the epicenter of the Ebola epidemic began to shift to the Sierra Leone town of Port Loko. With 1,200 to 1,300 new cases of Ebola per week, Partners in Health agreed to enter immediately, opening up a treatment unit on Nov. 1 called Maforki.
Rosenthal was in the fourth group to arrive. When they got there on Dec. 3, Maforki, had been open for just one month.
For the next four weeks, Rosenthal spent every day except for one working in the treatment unit. He knew the dangers of getting Ebola himself were very real.
To prevent infection, Rosenthal and other health workers wore heavy boots, a full body suit, a respirator, a hood and three pairs of gloves. The only visible part of his body were his eyes.
The amount of time they could be in the unit was limited. "You only enter for about an hour and a half at most," says Rosenthal. "Because of the heat, from the moment you put the suit on you start to sweat; you lose about a liter and a half of fluid per hour."
Once in the unit, Rosenthal and his team would go about treating patients as best they could.
"It was a nonstop process of having to improvise and figure things out," Rosenthal says. "How do you treat Ebola? Well, how do you treat Ebola with the materials that we have?"
Most of the time, Rosenthal and his colleagues didn't have basic supplies like IV poles, tourniquets, even toilets. Patients never received painkillers, even though Ebola causes a tremendous amount of pain. The work had other risks as well--during his time there, Rosenthal contracted chemical pneumonitis from the heavy use of chlorine as a disinfectant.
Despite the daunting conditions, by the time he left, Rosenthal and his co-workers managed to increase the survival rate in Port Loko from 10% to 40%. After spending four weeks in a treatment unit, Rosenthal also traveled around Sierra Leone, helping to set up other clinics.
A lot of the time, Rosenthal's job was just to be there for the patients. The virus removes the ability for family members to care for the sick; often people were left alone and terrified.
"My last patient was a 9-year-old boy whose 7-year-old sister had just died," says Rosenthal. "I spent the last 20 minutes of my time there just sitting with him. Sometimes that's just what you did."
It wasn't until Rosenthal got home and entered his mandated 21-day quarantine -- which he chose to spend alone in a cabin along the Wisconsin River -- that the gravity of his experiences in Sierra Leone hit him.
"Suddenly all those emotions were there; I cried a lot. I didn't feel okay, but I didn't feel like I should feel okay," Rosenthal says. "It felt right to cry, it felt right to just be in pain."
While the trip was emotionally taxing, he has no regrets about going.
"I felt better about this than anything I've ever done," he says. "I never felt prouder to be a nurse, I never felt so clear about my mission, and I've also never done anything this difficult, mentally and physically."
Rosenthal may be home, but his head is still in West Africa with his colleagues and survivors like Jariatu.
"The truth is, I don't go a day without thinking about being there, and part of me wants to return."
For Rosenthal, it's just a matter of when.
Marc Rosenthal will give a talk about his experiences fighting Ebola in Africa, titled "The Chlorine Blues: An Eyewitness Report From an Ebola Treatment Unit in Sierra Leone," on Tuesday, March 10, 7-8:30 pm, at Edgewood College's Anderson Auditorium.