Delivering Babies in Ebola Land

Tuesday, December 1, 2015

The Princess Christian Maternity Hospital in Freetown, Sierra Leone, is the only maternity referral hospital in that West African country. It does not take patients who screen positive for Ebola. Sierra Leone also is short on physicians, with just one obstetrician in the country during the Ebola epidemic.

Theresa Cullen, MD, a Tucson family doctor who has spent most of the last 30 years caring for underserved populations,was part of the Partners in Health volunteer team in Sierra Leone. She initially was based at the Ebola Treatment Unit in Port Loko, one of the hardest-hit areas, until she was asked to move to the maternity Ebola holding unit in Freetown.

“To be honest, I was frightened,” Cullen says. “We know that obstetrics is the most dangerous work you can do in Ebola. Amniotic fluid has the highest concentration of the Ebola virus. Women admitted to the Ebola holding unit are there until their Ebola test results are available, but at that time, test results could take days, while women stayed in the unit, waiting.

“So I said, ‘I can’t go. I haven’t delivered a baby in 10 years.’ And the response was, ‘Well, if you don’t go, we will have to send someone else to work there and that will be someone who has never done a delivery."

So Cullen, who holds that when you have skills, and can use them to help another person, that’s what you do, that’s why you became a doctor, said, “Ok, I’ll go.”

Ebola Holding Units (EHUs) have dry rooms and wet rooms. Wet rooms are for people who are throwing up, bleeding, or have diarrhea. The dry rooms are for other patients.

The maternity EHU near Princess Christian was the only one in the country that was delivering women who were at risk for Ebola. Other Ebola treatment facilities were caring for pregnant women but they were not assisting with delivery because of the risk of transmitting Ebola. Pregnant women in active labor were routinely left on their own as the fear of transmitting Ebola during delivery was considered to be so great.

Cullen entered the maternity EHU twice a day, clad in her PPE – personal protection equipment – and “triple gloved” to evaluate and care for the patients. Deliveries happened, and the staff was as prepared as they could be. Many times, the women within the unit would let the staff know that someone was getting ready to deliver. Cullen and the midwives would go in and prepare for the delivery.

Cullen recalls the time a woman delivered a 1,200 gram infant who appeared healthy – a sign that mother and baby were probably Ebola-negative.

But the woman’s labor continued.

“We thought there was another baby in there, but we didn’t know for sure. We didn’t have ultrasound or even a Doppler.  So, apparently still in labor, with no pain meds, the mom started singing out loud. And then one of the workers – there’s a whole team of them who spray chorine to keep the unit as sterile as possible – said to the rest of the workers and the patients, ‘You have to clap and you have to sing to help this woman.’ And they did. And she pushed the second baby out, and this one was about the same size as the first, and also healthy.  

“It was just an amazing, amazing thing, how they communicated their caring and compassion by clapping and singing with this woman in labor.”

The mother’s Ebola test came back negative, and she and her two healthy babies were transferred to the hospital for further care, then went home together.

Cullen stayed with the maternity holding unit, providing care with the "amazing" staff, including some midwives from Princess Christian Maternity Hospital. She helped deliver many babies, always triple-gloved. Still, the fear of Ebola was always only a thought away.

Cullen worked in the holding unit for 32 days in December 2014 and January of this year.

“There was a lot of anguish, and a lot of death. You live, eat, breathe, dream Ebola. It was completely exhausting. You sweat all day. At the end of the day you pour sweat out of your boots.

“I do remember a day when I said, ‘I’m not going into the unit today. I just can’t. I will do anything else.’ And then that afternoon something happened and I said, ‘OK. I’m going into the unit.’”

It was around mid-October 2014 that Cullen told her family she wanted to go to West Africa to help with the epidemic. “My family’s initial response was ‘Are you out of your mind? You could die.’ A friend of mine said, ‘You must have a death wish.’

“But day after day, the news coming out about Ebola just seemed increasingly dire. There was such a need for providers, and I heard that over and over and over.”

Cullen, a 1983 graduate of the College of Medicine – Tucson, went to work with the Indian Health Service in 1984, first on the San Carlos Apache reservation, and then with the Tohono O’odham in Sells, Ariz. She completed her family medicine residency at the UA in 1991 and returned to Sells, involved mostly with health information technology and informatics, with some clinical work. She holds the rank of rear admiral, retired, with the U.S. Public Health Service.

With her experience in working with diverse, underserved populations, and her training as a family doctor, she felt qualified to volunteer in Sierra Leone. 

“I knew people were going to die whether I was there or not,” Cullen says. “But the issue was, how were they going to die. Would it be in comfort and with dignity, and with someone caring for them?

“It was really a matter of conscience and my belief that life is sacred and we have a responsibility to make sure that we use whatever skills we have to help. I’m a physician. That’s what I’m trained to do.”

Cullen returned to her family in Tucson on January 29.

“I want to thank the Pima County Health Department for their care. They called me the day after I got home and said, ‘Hey, we’re going to take care of you for the next 21 days,” the required monitoring period for people who have been exposed to Ebola.

“And I want to thank my wonderful husband and children who understand why I do things like this. It’s funny, but I think if you asked my family they would have said, ‘Oh, we knew Mom would do that.’ I imagine they did, even before I knew myself.”

By Jane Erikson