Ebola treatment centre for pregnant women opens
The medical charity Medecins Sans Frontieres has opened its first Ebola treatment centre specialising in care for infected pregnant women.
MSF says the death rate for expectant mothers is extremely high, and health workers treating them, particularly during childbirth or miscarriage, are especially vulnerable to catching the virus.
The BBC's Tulip Mazumdar has been given access to the facility, in the Sierra Leone capital, Freetown.
Building work is still continuing at the maternity section of the latest MSF Ebola clinic on the outskirts of the capital.
It's been erected at the site of one of the city's most prestigious secondary schools, Methodist Boys High School, in Kissy.
The classrooms are empty - schools have been closed for months. The playing area is now home to MSF's sixth treatment centre in Sierra Leone. When it is fully operational, it will have 80 beds, and a special focus on treating pregnant women suspected or confirmed to have Ebola.
Against all odds
Across town, at another former school turned MSF Ebola clinic, 16-year-old Lumatu Samura cradles her eight-month-old niece, Mamusu. She's sitting behind an orange plastic partition, which separates the sick from the strong. Lumatu has very recently recovered from Ebola, but she has chosen to stay at the centre to look after little Mamusu, who is extremely sick.
Lumatu may not realise it, but she is a very special Ebola survivor. Not only does she now have some immunity to the virus, which is why she can safely look after Mamusu, but she is also one of only a handful of people in the world known to have recovered from Ebola while being pregnant.
Speaking from inside the "Ebola zone" about 3m (10ft) in front of me, Lumatu, who lost her own baby early in her pregnancy, explained what happened to her.
"I had a cold at home, and my joints were aching, " she said.
"My father knew he couldn't keep me at home. So he sent me here [to the treatment centre].
"I was bleeding for two hours. No-one would touch me.
"After the bleeding, I was put on a drip. I started to feel much better. Now I am recovered.
"But I need to stay and look after my sister's baby."
Six pregnant women have been admitted to the MSF Prince of Wales Treatment Centre since it opened on 10 December. Only Lumatu has made a full recovery.
Dr Greg McAnulty, one of the doctors who's been treating her, said: "Unfortunately, pregnant women are very at risk of dying from Ebola and complications related to Ebola.
"The reasons seem to be related to delivery or… the foetus dying earlier in the pregnancy.
"The prognosis for the foetus is terrible, and there seems to be a concentration of the virus in them. So even when babies have been born alive, they tend not to survive.
"It's an awful, awful situation. You have a woman who is at high risk of dying herself and a baby who invariably dies as well."
Back at the new Ebola treatment centre focusing on pregnant women, so far only one expectant mother has been admitted.
A key reason for the need for a specialist unit is the risk the women can pose to the health workers treating them.
Delivering babies is particularly dangerous. Experts say the viral load of Ebola in both the placenta and the foetus, as well as the surrounding fluids, is extremely high - even if the woman herself has recovered.
Dr Benjamin Black, an obstetric doctor on sabbatical to MSF researching how best to treat Ebola-affected pregnant women, said very little was known about Ebola and pregnancy.
"The Ebola virus is attracted to certain types of cells within the body. The placenta happens to have a lot of those cells and invades [those cells] so it can multiply… because of [that] you get a high amount of Ebola virus in the placenta and therefore crossing to the baby."
Ebola in pregnancy
- 95% of pregnant women infected with Ebola died, according to a very small study in the Democratic Republic of Congo
- No child born to an Ebola-positive mother, or foetus whose mother has died, is known to have survived
The field co-ordinator overseeing the running of the clinic, Luis Encinas, said: "Our focus is to protect the health staff and then to save the mother, and - if it's possible - to save the child. Even if the pregnant woman is cured, the delivery moment is such a high contamination moment, we need to take care - during the delivery - of the health staff as well."
He said health staff had extra protection in addition to the personal protective equipment used by employees treating other Ebola patients.
"Not only do we have gloves and goggles, we have the full equipment and sometimes we have extra equipment like an incubator where you put your hands in the gloves [attached to the screen] and you have like a window of protection so you can do the delivery… without [being] exposed to some liquid by accident."
There is still very little known about exactly why the death rate for pregnant women is so high. But it's hoped this new treatment centre will help give at least some women their best chance of surviving.
Dr Black said: "Before this epidemic, we were working on an understanding that maternal mortality would be around 95%, but that was based on very small studies from previous outbreaks. From our experience so far with MSF, we probably have more women surviving then that.
"For the baby there's not a huge amount we can do."
He said that so far from all previous epidemics including this outbreak, there had been no recorded cases of babies being born and surviving if their mother had had Ebola.
"But that's not to say it can't happen, it just means it hasn't happened yet."
The World Health Organization said there was early hope that more pregnant women would survive in this outbreak.