Christmas in Ebola

Last night at supper, our site manager was pretending to make a phone call to someone (I can't remember all the details of the joke, but imagine her speaking with a Scottish accent), and she started out by saying, "Yes, hello! We're here in Ebola!..."

While it was just really funny at the time, it's true that "Ebola" has truly become the identity of this place. I was talking with one of the local nurses today while we were posted outside the Suspect tent, and she was telling me how all of life in Sierra Leone has stopped because of Ebola. Schools have been closed since May, hospitals are closed, stores are closed. Literally everything revolves around Ebola. Even Christmas, which was "cancelled" by order of the President.

While Sierra Leoneans were not able to participate in their usual Christmas traditions, we had a few small treats at our ETC. Special meals for the staff and patients, a movie for patients who were well enough to venture outside the tent to watch, and some Christmas music. (You would think that people would be able to remember all the gifts in the 12 Days of Christmas by the third time through the song in it's entirety, but you would be wrong.)

Despite the efforts, much of the day was just the same as any other. While drinking my coffee this morning (and wondering not for the first time if the staff is secretly putting out decaf...), I thought of an episode of MASH where they try to keep a soldier alive until after midnight so his family doesn't have to think of Christmas as the day he died. I told the people at my table that I hoped no one dies today. Obviously, I hope this every day, but I was sharing in the sentiment of my fictitious fellow medical professionals.

Unlike every one of my previous Christmases, this one was exceptionally hot. I was on for admissions today, and the admissions usually come between noon and 2pm, when the heat is getting most intense. Our first ambulance arrived shortly after noon. Heather (a nurse I actually worked with at Medishare in Haiti...small world) and I went in with our Temne speaking nurse to do the triage. There were two patients in the ambulance, and the triage process followed by moving them into the Probable ward took probably half an hour. It seems so much hotter when you're not moving because you can feel how much you're sweating. If you're doing things, you don't think about it. For this reason, people sometimes pace if there's a line to doff. Triage is a lot of standing and waiting while we ask the patient questions. The area isn't that big, and there's plexi-glass to separate the low-risk and high-risk zones. Plus, when you have a suspect patient that you're moving, you have to have a WASH sprayer follow behind you, spraying where you've walked. The point being that it's hard to pace in triage. So while there have been times that I've been in for two hours and been fine, after 20 minutes today I could tell that my moisture-wicking socks were putting forth their best effort to save me from trench foot.

We were moving our two patients into Probable when the second ambulance came. We gave them their admission packets from the Psychosocial department and some water and told them we'd be back to draw their blood. We were hoping that the next patient would be Probable, because if he or she was Suspect, someone else would have to take them in. In the unit, you can only move from low to high risk. Suspect is lower risk than Probable, and we'd already entered the Probable ward so we couldn't go into Suspect. Complicated, yes? And PPE is around $100/suit. But as it happened, we could label the patient as Probable with one look at her. Really we could have labeled her Confirmed, but technically that requires a blood test. Thankfully, our nurse manager had donned and come in for some reason, so she could be our fourth person to carry the stretcher (WASH was busy spraying everything in sight). You're technically not supposed to get into an ambulance to get a patient out, but since they haven't invented the Ebola ambulance yet to eject the patients automatically, Heather got in. We take turns breaking that rule.

Anyways, a bit of background: There are holding centers set up at various points throughout the country. From my understanding, they do blood tests to confirm Ebola. However, they are mostly just to quarantine the sick and keep the disease from spreading. They don't provide treatment. After we got this woman out and got a look at her, we just couldn't help but wonder what in the world these holding center people were thinking in keeping her there that long. If we had gotten her earlier, we might have been able to give her a fighting chance. As it was, she was practically dead. She seized on the way into the ward and then died about 10 minutes later. But at the very least, the Psychosocial department can tell her family (once they find them) that she didn't die alone and that she was with people who did their best to make her comfortable.

The point of this post wasn't meant to be about that patient. I was aiming more for the lighthearted aspect coming up next, but I got carried away (according to The Cousins, this is a Grosh sibling trait). The real point is that I now understand what "Get out 10 to 15 minutes before you start to feel sick" actually means. As I said previously, it was really hot today. I felt hot 20 minutes into my In time. The Suspect ambulance bay doesn't have a canopy over it, so we were in full sun when getting the stretcher out. And then we had to carry the stretcher down to Probable, stepping in like 40 foot baths on the way there. (40 is probably an exaggeration.) Once you lose your breath in the PPE, it's pretty difficult to get it back. I am out of shape, and I was definitely out of breath by the time we got this woman into a bed. We did the other two blood draws, then we came back to this woman. Even though she passed, we still have to draw blood for various statistical and tracking reasons. But my blood draw partner was being very slow. I started pacing around the ward. My goggles seemed like they were getting really tight on my head and I was starting to get a headache. Once you're dressed, you're not allowed to adjust anything you're wearing. The goggles sometimes sit funny on my nose and my nose was getting really stuffed up but my face was simultaneously dripping sweat (I do, in fact, understand how unattractive this sounds, in case you wondered). So all you can think about is touching your face. Thankfully, Heather and I were in with other people, so when I said, "Hey, I have to go doff right now," she didn't have to come out with me (buddy system at all times).

I got out to the doff station and it seemed to take the sprayers an exceptionally long time to put their gloves and shields on. I requested that they give me the quick version of the spraying, otherwise I promised to throw up on them. My sprayer was quite helpful, and he remained calm even when I got stuck in my suit. There's a big flap that's sticky and covers the zipper down the whole front of the suit. By the time you're opening the flap and zipper, the goggles are off, so you have to keep your face up in the air so no Ebola splashes into your eyes (though this is highly unlikely because you've already been sprayed with 0.5% chlorine 3 or 4 times). So you blindly fumble around feeling for the flap and/or zipper while someone who speaks English as a second language speaks to you through a mask and a shield. ("Move your hand over. No, the other way. Down. Okay.") In my frenzy, I ripped open the top of my suit instead of pulling the tab away from the zipper, so I couldn't actually get to the zipper to unzip it. Luckily, there was a person in line to doff behind me and he or she got me out (the sprayer can't touch me because he's in the low risk zone and I'm high risk). You would not believe how good it feels to take off the goggles and the mask and get a full breath of fresh [chlorinated] air. Once that happened, I no longer had to throw up. I just took my chlorine bath, then my fresh water bath, and then I got a drink. Or I went to change into new scrubs because mine were dripping with sweat.

Updates: The Siblings. Early Sunday morning, the brother passed away. His sister followed the next afternoon. Sometimes you do your best and it isn't enough.

Highlights: Sometimes your best is good enough. My favorite little lady (did I mention previously that she spits like a camel?) got her second negative blood test back the other day, so we are hoping to discharge her tomorrow. Last night, she went out onto the back "patio" area behind the Confirmed ward to sit with a few other ladies. Anna, my housemate and one of the chief "Psychos", told me she was back there. You actually have to leave the unit and walk the whole way around the fence in the big rocks to get to that area, so it's a process. Anyways, I went out to see her. This was, of course, the first time she had actually seen me, even though I've been caring for her for 10 days. I tell the patients my name, but who knows if they hear and/or understand me. We also get our names written on our heads before we go in so our coworkers can identify us. But again, I'm not sure if patients are concerned with reading my head. The psychosocial people can't go into the ward, so this is where they always meet with patients and/or patient families. So a psychosocial guy was back there and translated for me. I told her my name and that I'm the one who steals her blanket and won't give it back until she eats her meal. She laughed. I just love her.

A 13-month-old was brought in yesterday. The mother is dead from Ebola, the father is supposedly in a holding center somewhere. Someone has to take care of this child in the ward, and it can't be a nurse because we can't let anyone sit in PPE continuously. Sometimes another patient can look after a child, but our only other patient in the Probable tent at that point was a 6 year old boy. The whole thing was a mess for a bit. But then Anna found a survivor who was willing to go in and take care of the child. They don't have to be PPE trained because, obviously, they've already had Ebola and they're immune. It was really special to see this lady taking care of the baby today. Not only is she a survivor, but she lost her own baby and husband to Ebola. For once, I don't have words to describe it. The baby is going to need every advantage she can get because her tests came back positive Ebola and positive malaria. Human contact is a good place to start.

Last night after we finally got back from the ETC, we sat around the supper table talking. (Well, some talking, some on the second round of the 12 Days of Christmas. Or the 6th chorus of Good King Wenceslas from the Europeans.) Someone asked where we all were last Christmas and we went around the table and shared. We're kind of like the band of misfits who have formed a little family. I hardly know most of these people, but we'll always share a connection from our time together here in Ebola.      

Merry Christmas to all, and to all a good night! Much love

I Wonder As I Wander

I figured that tonight I could stay up late and write an update since I probably won't be sleeping anyways. Tonight I am thankful for my Australian housemate who removed the giant spider from my bedroom wall. And when I say 'giant', I mean, this was either the biggest spider I've ever seen or it was second only to that one tarantula in Haiti. This after I reached into a box in the pharmacy for an IV catheter and grabbed some sort of praying mantis-like bug instead, which caused me to scream and throw the whole box of IV caths onto the floor. And there are real praying mantises (manti?) in the wards. Too many bugs in Africa (but no leopards yet...).

Moving on. My donning/doffing training was now a week ago, but it feels like a lifetime. Last Sunday, Tim and I went to the ETC, put on the suits and walked around outside a few times to get used to it. (Basically, the little Romanian doctor watched us put them on and then said, "Okay, walk around. I come back for you in 45 minutes.") Monday we had a few more lectures, and then Tuesday we shadowed in the wards. From Wednesday on, we worked.

When I got here, the ETC had been open for about 10 days, and we were only receiving confirmed patients. There were seven. Sometime this week (though I couldn't tell you when) we opened our suspect and probable wards as well. So the work has tripled. Our ETC is staffed largely by local staff. It's similar to Haiti in that they have some trouble with critical thinking and problem solving. Some of them, I've found, don't know how to take a pulse, but they do work hard in other areas (like feeding and changing patients). But sometimes it's just like herding cats.

Four paragraphs in, I still haven't figured out exactly what I want to write in this post. My feet hurt. The Mennonite in me was too strong when I was shopping, and I didn't buy those inserts. Tim brought inserts, but forgot to take them out of his boots the first day and lost them. I comfort myself with that. My big toes are actually still numb, four hours after taking the boots off. We all get a slight cough at night. For some reason, the chlorine concentration seems a lot higher in the evenings, so if I come out right before the shift change, it's really overpowering when I'm being sprayed down. Kind of like suffocating in a swimming pool. It's been dubbed the Chlorine Cough. One size does not fit all. I could put at least one other person in my scrubs with me.

A girl I know from Haiti has been working with IMC in an ETC in Liberia. Before I came to Sierra Leone, I would read her facebook notes about her experience. I remember one post where she described Ebola as mean. I think that sums it up pretty well. Sometimes there doesn't seem to be a rhyme or reason to what it does. Or, rather, we can't figure out everything that's going on with a patient because we don't have _______ (fill in the blank with "equipment", "lab capabilities", etc). It's just a bunch of doctors and nurses (and logistics and sanitation people) who get in a huddle every day and say, "Okay, how do we keep this person alive today?" Sometimes it works, sometimes it doesn't. Yesterday we discharged two patients cured, and today we sent three to the morgue before supper was passed.

I wonder sometimes what the patients think of us. Can they tell us apart? Or are we just giant white blobs with eyes? Do they become familiar with our voices? There is one WASH (it's a UN/WHO grouping for things that fall into one of the Water, Sanitation, or Hygiene categories) guy who makes me feel safest when he's doffing me, and I have no idea who he is (I am trying to learn the names of like 100 people who all wear masks and hoods), but I recognize his voice. When I hear that voice say, "Wash your hands," I feel like, "Oh good, this guy knows what's going on and is going to take care of me." I wonder if it's like that for the patients? Do they feel any connection to the caregivers? Does physical touch help as much when it's with hands wearing multiple gloves?

I wonder these things when dealing with a few patients in particular. There is one lady who is just the cutest. She always has her eyes closed, perhaps because she thinks people won't bother her. But I always wake her up so that she eats and drinks something. She waves me away and I keep poking her and talking. Then she usually sighs and sits up. She takes a few bites and then as soon as I move on to another patient, she lays back down. I figure she might think of me as the especially irritating one.

Then there are two who probably aren't thinking much of anything right now, just maybe feeling a little bit. Tim and I agree that we feel a bit more connected to these two patients because they were some of the first to come in when we started working. They were the first patients we really got to know. A brother and sister, brought in by their teacher. Ebola had already killed their parents, and she had been looking after them. The day before they were fine, and now they are laying in adjacent beds dying. I had asked a few people to pray for them because I can't see them living without a miracle. Ebola is a hemorrhagic disease, though only a small percentage of people actually bleed. These two are bleeding. For a few days, we were constantly changing the boy. His diarrhea has stopped now, at least, but he's still slowly bleeding from IV sites. She is bleeding at her sites and in her mouth. Ebola patients often get confused, and these two actually switched beds last night. I talk to them and rub their backs, and I try to keep her blanket tucked in around her because she always seems to want a blanket, and I wonder if they know I'm there. I wonder what, if anything, goes on in their minds. Do they feel like someone cares for them even if they don't know what's happening?

I have tomorrow off. I'll probably still go in, though, to see how the patients (mostly the kids) are doing and because Tim will be by himself. The other expat nurses (who serve as the team leads) either have off or will be coming off the night shift. And one is actually going back to the US tomorrow. So I'll probably go help out after I take advantage of the fact that I can sleep in.

In other news, I never was successful in getting my chair into the bathroom. It is just too wide for the door frame, no matter which way I turn it. However, I did determine that the sink was sturdy enough for me to stand on. It did take me a bit to figure it out, but, again, the dial was in Chinese, and I did ultimately succeed in getting hot water. 64 degrees Celsius is a bit hotter than I would've needed, but I can't complain. Except for tonight when I will not be showering before going to bed because I still have no lightbulb in my bathroom and I don't have any desire to accidentally happen upon any of the giant spider's friends.

Temperature Control

Apparently my group brought cool weather and good internet with us when we came to Lunsar from Freetown. There are two housing options here in Lunsar, and I am staying at the Bai Suba Resort. I don't really know why it's called a resort, since I associate that with a beach, and there is no beach. But it's really nice. I have air conditioning, which I haven't quite figured out (thank goodness I brought my sweatpants), and a water heater, which I also have not figured out. Hopefully I make some progress with that tonight, because I'm refusing to shower until it's warm. 

We arrived in Lunsar Wednesday afternoon, and then Tim, the other nurse, and I went to the Ebola Treatment Center (ETC) for a brief tour. They take your temperature before you enter, and I had to wait outside for a few minutes and let them recheck me, because apparently my first reading was "a little high." I haven't been told yet what "a little high" actually is, but I'm definitely curious based on the fact that at several police checkpoints the infrared thermometer has read me at 34-34.5° C, and the police seem okay with that. I know I'm usually cold, but that's a temperature reserved for therapeutic hypothermia.

Anyways, yesterday, six of us had a few hours of lectures on ebola from an epidemiologist. It was really interesting. And today our training continued with the donning and doffing of the PPE. We joined the group of local nationals who will be working in Makeni. I thought about writing out all the steps of the donning and doffing for you to read, but that would be really long, and I only want to type "wash hands" so many times. Maybe when I run out of ideas for what to post... 

We partnered up for this practicing, since you always have someone to help you get ready and make sure no skin is showing. At the end of the day, the epidemiologist told me that my partner is a survivor.

So the suit. It wasn't as bad as I thought it might be! But we weren't in an actual tent, and everyone says we've had some cool days this week. But we put on the PPE and walked around outside for 10 minutes to build up a tolerance. Our trainers were expats from the Liberia ETC, and they said they only had one person pass out in the unit. But when the tip for avoiding it is, "Leave 10-15 minutes before you start to feel sick", I'm not sure what to do with that advice. At least they told us when to get out (or, leave so you can spend 10 minutes doffing): When your mask starts concaving with your breaths and/or you have to bend over to breathe and/or you think you're suffocating. Good to know.

In other news, Tim looked at my chargers and said I can use them without a converter. I was feeling brave, and it worked! No smoke or sparks. Not sure if that would've happened anyways, but sometimes I feel dramatic.

As I mentioned, we have internet periodically. It's just in the restaurant area where we get our meals. Speaking of which, tonight someone from home asked what I was eating. The woman who owns the resort, though born here, lived most of her life in the UK and is a fusion chef. So for supper I had shrimp and rice and cabbage. Always the rice. I know that sounds spoiled, but let me tell you about breakfast. Four slices of bread and gizzards. I thought another nurse was kidding when she said it. But she wasn't. And I knew I was putting the suit on today, so I had to eat something. It was a very big psychological obstacle for 6:45am.

Now I am going to go make a second attempt at getting my chair into the bathroom so I can be tall enough to mess with the water heater. I thought it couldn't be done, but Tim tells me he did it.

Looking forward to more training tomorrow and then supposedly being on the schedule Tuesday.   

Fresh Off the Boat

I specifically remember a chapel in elementary school where some guy with a safari hat talked about God asking people to go to the jungles of Africa. And I prayed, "God, please don't call me to the jungles of Africa." So we compromised. It's not the jungle.

I have time for a quick update since our car is late. I got to the airport and made it through immigration, a health check, getting both my bags, and customs and still hadn't found my guy. I considered getting panicky, then saw a Doctors of the World person outside, so I figured I had one last option. Walked outside and didn't see any sign, but then I heard someone yelling my name. And there were three other people with him, so I wasn't alone on my boat trip.

We took a bus from the airport to the speed boat. There are stars here. There aren't any in Port-au-Prince. There are also crickets. Because there's vegetation!

I really enjoyed the boat ride. Mostly because of these two people I was facing. They were all decked out in their tactical gear, complete with zip off khaki pants (some of you know how I feel about these). They were the only people talking. It was a language I didn't recognize. So they would jabber and then both laugh really loud at the same time. It made me think they were minions.

Our luggage came on a separate boat and we had to show tickets for our bags. One of the guys in my group handed me my ticket, and, since I had a bag for each hand, I promptly stuck the ticket in my mouth. Going to have to quit doing stuff like that.

We stayed at this nice hotel/resort. Air conditioning, water heater. What more is there to say? Land Cruisers everywhere. IFRC, MDM, UKAid, China Aid, CDC, etc. All the humanitarians swapping stories and name dropping ("Sudan" and "When I got evacuated from such and such place...") to try to subtly outdo each other and speaking whole sentences without any words besides acronyms.

Got picked up this morning and came to the IMC office for a very brief orientation, and now we're hanging out waiting for our car. It had to make a 4 hour trip to the airport for the poor person who missed their boat.

Not sure when I'll have internet again. And I realized I have adapters for my plugs but no converter, so who knows when I'll charge my phone again.

Twas the Night Before Travel

A new blog! Hooray! Two reasons for this: 1. I thought it might be a good idea to have a more ambiguous title (since only 2 months of the last 4 years were actually spent in Saint-Marc), and 2. I can no longer figure out how to get into my old blog to write on it.

So, it is midnight the night before I'm leaving. However, I'm not awake because I'm still packing. Because I finished (mostly) hours ago. Everyone is impressed, I know. I was awake because the Packers game was on and cousins were here. Now I'm not sure why...

Anyways, I'm leaving tomorrow afternoon (or...today) from Harrisburg and I'll be traveling for about 24 hours. Then I look for a guy, and said guy will take me to a boat. That is all I know. According to google, the official language of Sierra Leone is English, so I didn't have to learn how to say "Don't touch my stuff!" in another language.

I'm not sure what kind of internet access I'll have, but I will update when I can. Love to all!