Fatu Kekula

Last updated June 25, 2019

Fatu Kekula is a Liberian woman who was a nursing student during the Ebola virus epidemic in Liberia. Four of her family members became ill and could not access medical care in a hospital. She improvised a "trash bag method" that would allow her to care for her family members without becoming ill herself. Three of her family members survived the epidemic, and Kekula herself did not contract the virus. The trash bag method has been recognized as a relatively simple and accessible way for people to protect themselves in an epidemic if they cannot get treatment in a hospital.

An epidemic of Ebola virus disease occurred in Liberia from 2014 to 2015, along with the neighbouring countries of Guinea and Sierra Leone. The first cases of virus were reported by late March 2014. The Ebola virus, a biosafety level four pathogen, is an RNA virus discovered in 1976.

Ebola outbreak

On 27 July 2014, Fatu Kekula's father, Moses, became ill and was taken to a local hospital in Kakata, Liberia. Unknown to the family, the hospital bed he was given had just been used by someone who died of Ebola. After hospital staff began contracting the disease, the hospital shut down; Kekula attempted to take her father to a hospital in Monrovia, but they were all at capacity. Kekula took him home, where three other family members became ill: Kekula's mother, Victoria, her sister, Vivian, and her cousin, Alfred Winnie.^[1]

Kakata, Kak-ah-tah, is the capital city of Liberia's Margibi County and is located in Kakata District just over the Du River bridge which is its border with Todee District. It is a transit town at the heart of the historical natural rubber cultivation belt in Liberia. The city is colloquially known as "Kak City". The City host the Office of the National Civil Society Council of Liberia, Margibi Chapter. The Council which is headed by Mr. Friday Edwin Crusor, is known for its diligent role in Advocacy, Dialogue, and Peacebuilding among others.

Ebola virus disease (EVD), also known as Ebola hemorrhagic fever (EHF) or simply Ebola, is a viral hemorrhagic fever of humans and other primates caused by ebolaviruses. Signs and symptoms typically start between two days and three weeks after contracting the virus with a fever, sore throat, muscular pain, and headaches. Vomiting, diarrhea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally. The disease has a high risk of death, killing between 25 and 90 percent of those infected, with an average of about 50 percent. This is often due to low blood pressure from fluid loss, and typically follows six to sixteen days after symptoms appear.

Monrovia is the capital city of the West African country of Liberia. Located on the Atlantic Coast at Cape Mesurado, Monrovia had a population of 1,010,970 as of the 2008 census. With 29% of the total population of Liberia, Monrovia is the country's most populous city.

At the time, she was in her final year of study to become a nurse. Doctors would not come to her house due to the contagion risk, but one did advise Kekula over the phone.^[1] Some doctors told her to leave her family and not go "anywhere near them," however, she said that she could not have done this because "your family is your family."^[2]

Kekula quarantined her sick family members in a makeshift isolation room—an unfinished room outside the house.^[2] She was able to start IV lines to administer drugs she purchased from a local clinic.^[1] She also treated them with oral rehydration therapy.^[2] Kekula did not have access to standard personal protective equipment from the highly-contagious disease, so to care for her sick family members, she improvised a new method. Her method has been called the "trash bag method." It involved placing trash bags over her socks and tying them off at the calf. She would then put on rubber boots, over which she added another layer of trash bags. She also wrapped her hair in a trash bag. She also wore a raincoat, a surgical mask, and four gloves on each hand.^[1] After each bout of caring for her sick family members, she would carefully remove her gear and spray herself with chlorinated water. She would then burn the contaminated equipment. Her weeks of caring for her sick family led her to use four boxes of surgical gloves, as well as several bags of raincoats.^[2]

Intravenous therapy (IV) is a therapy that delivers liquid substances directly into a vein. The intravenous route of administration can be used for injections or infusions. Intravenous infusions are commonly referred to as drips. The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body, because the circulation carries them. Intravenous therapy may be used for fluid replacement, to correct electrolyte imbalances, to deliver medications, and for blood transfusions.

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy should routinely include the use of zinc supplements. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.

Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemicals, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. "Protective clothing" is applied to traditional categories of clothing, and "protective gear" applies to items such as pads, guards, shields, or masks, and others.

On August 17, Kekula's four family members were taken to a hospital when space became available. Her cousin died the following day, while her mother, father, and sister all recovered.^[1] Her success rate (75%) was noted to be much higher than the average success rate in Liberia during the outbreak (30%).^[3]

After the outbreak

Kekula received donations from around the world so that she would be able to complete her nursing degree. She was accepted into the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia. An Associate Dean at Emory University stated, "What better place than Emory to train a nurse who will return to the front lines of the fight against Ebola? And what a great opportunity for our current students to be able to study alongside someone who has faced a crisis that threatened her country, her own family and herself? It’s a perfect match."^[4] She was particularly interested in learning more about caring for burn injuries, as Liberian children sometimes fall into the open fires used for cooking.^[3]

Nell Hodgson Woodruff School of Nursing is the nursing school of Emory University in Atlanta, Georgia. The school awards the Bachelor of Science in Nursing (BSN), Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), Doctor of Philosophy in Nursing (PhD). The school is named after Nell Hodgson Woodruff, wife of long-time president of The Coca-Cola Company Robert W. Woodruff. Mrs. Woodruff left nursing school when she married, but she supported nursing causes throughout her life.

Emory University private research university in Druid Hills, Georgia, United States

Emory University is a private research university in Atlanta, in the U.S. state of Georgia. The university was founded as Emory College in 1836 in Oxford, Georgia, by the Methodist Episcopal Church and was named in honor of Methodist bishop John Emory. In 1915, Emory College moved to its present location in Druid Hills and was rechartered as Emory University. Emory maintained a presence in Oxford that eventually became Oxford College, a residential liberal arts college for the first two years of the Emory baccalaureate degree. The university is the second-oldest private institution of higher education in Georgia and among the fifty oldest private universities in the United States.

Atlanta is the capital and most populous city in the U.S. state of Georgia. With an estimated 2018 population of 498,044, it is also the 37th most-populous city in the United States. The city serves as the cultural and economic center of the Atlanta metropolitan area, home to 5.9 million people and the ninth-largest metropolitan area in the nation. Atlanta is the seat of Fulton County, the most populous county in Georgia. Portions of the city extend eastward into neighboring DeKalb County.

Impact

Workers from international aid organizations learned about Kekula's "trash bag method" and began teaching it to other people in West Africa who did not have the means or ability to make it to a hospital.^[1]

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References

1 2 3 4 5 6 Cohen, Elizabeth (26 September 2014). "Woman saves three relatives from Ebola". CNN. Retrieved 24 September 2018.
1 2 3 4 Dixon, Robyn (6 October 2014). "In Liberia, one woman's singular fight against Ebola". Los Angeles Times. Retrieved 24 September 2018.
1 2 Cohen, Elizabeth; Bonifield, John (10 April 2015). "'Fearless' Ebola nurse trains at Emory University". CNN. Retrieved 24 September 2018.
↑ O'Neal, Lydia (12 January 2015). "Liberian Woman Saves Three from Ebola, Enrolls at Emory". The Emory Wheel. Retrieved 24 September 2018.

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[Cohen_2014-1] 1 2 3 4 5 6 Cohen, Elizabeth (26 September 2014). "Woman saves three relatives from Ebola". CNN. Retrieved 24 September 2018.

[Dixon_2014-2] 1 2 3 4 Dixon, Robyn (6 October 2014). "In Liberia, one woman's singular fight against Ebola". Los Angeles Times. Retrieved 24 September 2018.

[Cohen_2015-3] 1 2 Cohen, Elizabeth; Bonifield, John (10 April 2015). "'Fearless' Ebola nurse trains at Emory University". CNN. Retrieved 24 September 2018.

[O'Neal_2015-4] O'Neal, Lydia (12 January 2015). "Liberian Woman Saves Three from Ebola, Enrolls at Emory". The Emory Wheel. Retrieved 24 September 2018.