An Ebola treatment unit in the city of Butembo, in the eastern Democratic Republic of Congo, has 30 beds. Tonight, they're all full.
"I don't know how this is going to slow down," says Dr. Rupa Narra, a U.S. pediatrician who arrived in August to work for Doctors Without Borders. "It's the most devastating thing I've ever seen in my life."
With at least 6,800 confirmed cases and more than 3,310 deaths since May, the latest outbreak of Ebola in the Democratic Republic of the Congo is on track to be the worst on record. Last week, Narra's unit lost eight patients — all under the age of 5.
The outbreak is being driven by the Bundibugyo strain of ebolavirus; which has no approved antiviral medication or vaccine. Without these medical options, about 30% of adults who are diagnosed with the virus die within two weeks. The death rate is even higher for children, whose immune systems are less developed. For newborns, the virus is almost always fatal.
While children have made up 1 in 4 confirmed cases in this outbreak, they represent 1 in overall 3 deaths.
Narra and her colleagues spend their days providing supportive care: running fluids through an IV, giving oxygen or blood transfusions. Treating hypothermia, fever or secondary infections as their patients' bodies try to fight the virus. Part of her role is helping train about a dozen doctors and nurses in Butembo on how to adjust this care for pediatric and newborn patients.
"I had to change my mindset, that we were going to save kids," Narra says. "Now, it's — we're going to minimize suffering, and we're going to let the Congolese staff know that they did everything they could to save that baby's life."
The Bundibugyo strain can often begin with symptoms similar to malaria, so 15 of the beds in the unit are for sick patients who are waiting on test results. The other 15 beds are for confirmed Ebola patients. But in recent days, Narra says, there are so many people coming to the clinic that they have begun using quarantine beds for confirmed cases.
"It's still not enough," Narra says. "I know everyone is trying to scale up as fast as possible, but it's moving at a rapidity that never was the case."
There's a tricky thing about taking care of kids in an Ebola unit. Because there's no approved vaccine — it's hard to find someone already immune to the virus, from a prior infection, who can watch over the smallest patients. Narra and her colleagues are limited to about an hour at a time due to the difficulty and risks of working in protective gear.
Shortly after she arrived in Butembo, Narra says, a young mother died in the Ebola unit soon after giving birth. Her newborn daughter was entirely alone.
"I didn't know what we were going to do with this baby, because there were no other family members who had been exposed, and there was a high likelihood for this child to have Ebola," Narra says.
But when she entered the baby's room — there was a woman there, holding her in her arms.
"Actually, she was an Ebola survivor," Narra says. "She did not know the family and agreed to take care of this baby."
The baby lived for 10 days — but eventually succumbed to the virus. Her caregiver never left her side.
Narra is no stranger to crisis. She worked as an epidemiologist in 2014, responding to the West Africa Ebola outbreak that killed 11,310 people. She was a pediatrician in an emergency department in Brooklyn when COVID-19 hit the United States. She worked for Doctors Without Borders in Haiti.
"I've never seen anything like this," she says. "The speed of transmission, along with other aspects of a fragile healthcare system."
The latest Ebola outbreak is concentrated in the eastern border region between the DRC, Rwanda and Uganda, where fierce clashes between the Congolese army and Rwandan-backed paramilitary forces have forced families to find refuge in cities like Butembo. Meanwhile, the region's healthcare system is already stretched thin, treating children with malnutrition and outbreaks of malaria or measles on a regular basis. The conflict, and cuts to foreign aid have disrupted routine vaccinations and other assistance.
As a pediatrician, there's little Narra can do to help a kid feel a little less scared.
Every day, before she sees her patients, she puts on a fully disinfected hazmat suit. Only her eyes are visible.
"You're 5 years old, and these people walk in with what looks like a spacesuit. Of course you're going to scream!" she says.
She can't bring in a toy to distract them, wear a funny hat. Pick them up and show them around the clinic, bouncing them on her hip. She can't hold their hand through the night, when they get really sick.
"That's been the very difficult part for me — is I can't be at the bedside of this critical child," she says.
She remembers one 5-year-old patient in quarantine, waiting on test results, whose father would sit with her, letting her watch Bollywood movies on his smartphone. Narra, whose family is from southern India, recognized one of the songs — a number from the romantic comedy, Desi Boyz.
After her shift that day, Narra took off her gear and ran outside to her patient's window. She knocked, this time looking like herself –- and did her best Bollywood dance moves from the film.
"And then, she was smiling, laughing and clapping," Narra laughs. "I was like –- I don't even know these moves but I will make them up for you!"
A few days later, the test results came back for the little girl: negative. One bright spot, in Narra's painful summer.
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