It was around this time, in late September, that Dr. Nkeshimana checked his phone during a meeting and saw 10 missed calls. Now head of the health workforce development department at Rwanda’s Ministry of Health, he previously headed the emergency department at Kigali University Hospital and was appointed first responder in an infectious disease outbreak.

“When I got on the phone I already knew it had to be serious. I said, what kind of disease are you talking about? Is it Ebola? (My colleague said) ‘no, it’s number two on the list,’” says Dr. Nkeshimana. “The call was in the morning and he said to be ready at 1:00 pm, because then I will give you patient number one.”

For the next few hours, Dr. Nkeshimana was rapidly telephoning the 24-hour list of trained first responders, who had participated in pandemic simulations in preparation for this eventuality.

“Actually, as expected, some of them were very afraid and didn’t want to join,” he says. But they were enough; At one in the afternoon they had gathered at the new treatment center, while their colleagues “hijacked” a nearby hotel that became their isolated base, to prevent them from bringing the infection home.

“It was very, very, very, very scary,” says Dr. Nkeshimana. “When we arrived at the treatment center to go to the patient area… there was another obstacle to overcome: who went in first? You could see people shaking. They have the knowledge, the experience, they are the best in this area. But they are already shaking, we were all scared.”

The first week was the worst. “It was very, very, very deadly because people had an advanced stage of the disease and the team was getting used to the work environment, overcoming their fears,” says Dr. Nkeshimana, adding that most of the 15 people who lost their lives died that week.

‘What if I did something wrong?’

Treating Marburg is no easy task, and not just because there are no specifically approved treatments or vaccines. Patients at the white clinical health center suffered from severe vomiting, diarrhea, and fevers of up to 42 degrees. As their conditions deteriorated, they bled profusely.

Meanwhile, the doctors and nurses who came, almost all of whom already knew at least one patient by name, were equipped from head to toe in critical but hot and cumbersome personal protective equipment (PPE).

“We had enormous sweats. We would probably spend two hours wearing PPE, then carefully leave the red zone to go to the green zone, drink water and let someone else take over,” says Dr Nkeshimana. “Every time you left the red zone you kept thinking, what if I did something wrong, like the way you took off or put on your clothes, and I got infected?”

The team, who were closely monitored with health and temperature checks, had to follow rigorous infection control regulations on everything from the order in which they removed their PPE to where they kept their documentation. They were also unable to return home, but stayed in a hotel requisitioned by an “isolated bubble.”