Cool Factor

A few days ago, two coworkers and I were discussing how many different kinds of people you meet doing international work. "You definitely meet all kinds..." I said. In light of the President's Day weekend activities at home, one of them asked if we use every part of the pig when we butcher. (I did give the correct response, but then one of them asked what the squeal was.) "What about the ears?" the other asked, "What do you do with those, wear them?" she laughed. And after I had to respond, "So, funny story...", I realized that I am actually the "all kinds."

We haven't yet discovered what makes our newest nurse unusual. He spent a few weeks working in Liberia last Fall, so his training here is a bit abbreviated. But as seems to have become the custom, I take the new person into the ward for his first admission. And it always seems to be a clown ambulance... So the other day, the new nurse joined me and my national nurse for the admission. Per the training director's orders, he was still only allowed to observe, he couldn't touch any patients.

It was a bit of a fiasco trying to triage these three patients. It seemed like they had collaborated on the ambulance ride to come up with a story. We already knew they were from a quarantined home, and the ambulance nurse told us that it was because someone died. The patients were a brother and sister and their nephew. All three looked at us with their bloodshot eyes and denied contact with any sick person. We would try to ask the child questions and the uncle would jump in and answer. "Have you had hiccups?" we asked him. He shook his head no and then hiccuped. Eventually it came out that their mother had been in another ETC and survived. Carrie was on the other side of the plexiglass and finally said, "We know someone died. Who died?!" Their father.

We walked all three patients into Suspect. We had to draw blood on all three and start lines in two of them. When we were in triage, I had washed my hands and somehow poked a hole in my outer glove when turning off the faucet on the bucket. If something happens to the outer glove but the first is still intact, you can just put a new glove on over the second. So someone threw me another pack of surgical gloves. So now we had three bloods to draw and two lines to start and I'm wearing three gloves on my dominant hand. Luckily they all had pretty good veins and my local nurse could do IVs. Our new nurse, who works in the ER at home, was still watching, much to all of our frustration.

I drew the first patient's labs and then moved on to the woman who needed labs and a line. The local nurse was going to work on her. I put the tourniquet on just to look. The patient had nice veins in her AC, so I grabbed the nurse two 18 gauges. I went to the patient's other side and told her she could squeeze my hand if she wanted to. I wasn't sure how much English she understood, but I talk to my patients anyway. (I mean, I have full conversations with Bud...) Then the nurse stuck her and I discovered that she had definitely understood me. She almost broke my hand. And that's when I looked at my nurse and saw that she had stuck the patient in the hand with my 18 gauge. "The veins are too small for this needle," she told me. Right...that's why I was aiming much higher in the arm... So we had to do the whole sticking/hand in the vice grip thing again. The nurse got the access and we drew the lab, then we started taping down the IV. Apparently "let go" was not in the patient's vocabulary, so I was reaching across the bed and trying to put the tegaderm on with one hand. The nurses here aren't experienced with tegaderms. While I was trying to be helpful, I ended up getting one of the strips on the back of the teg stuck across my three middle fingers. Really stuck. I tried to carefully pull it off, but I knew my glove would rip and there was no way I was getting a fourth glove on (oh, I mentioned that this was also on my right hand?). I soaked my hand in a bucket of 0.5% chlorine. Props to the adhesive manufacturers. And, of course, the one pair of scissors we keep in the ward was nowhere to be found. Oh hey, then we somehow lost the line. After we came out, it was pretty funny that I had taped three of my fingers together, but when my goggles were fogging and there was no end or success in sight (no pun intended), I wasn't as amused.

The next day when we finally got labs back (because it's back to taking 12-36 hours), they were all positive. A few hours ago when I was in the ward, we moved the the brother and nephew into a different pod so they wouldn't have to watch the woman die.

I had another new experience this week. While I was on R&R, a group from a University in the States stopped by to discuss a study they're doing. As a parting gift, they left us two cool vests. I finally got to wear one. We had a mandatory training this week and sent most of our nurses during the afternoon shift, so Carrie and I took the vests and went in to do afternoon meds. I've heard that it's below zero at home. Here the ambient temperature is 94. Then put on full PPE and go inside an unventilated tent. Vest with five giant ice packs in? Yes please. It was a bit unpleasant when putting it on in the pharmacy, and it's a little weird to have spots on your body that almost hurt from cold when you can feel sweat on other parts of your body.

We had fluids in two different wards, and we figured we would spend about an hour in each ward. And then two of our suspect patients pulled out their lines. At the same time. (Yes, one was the kid from the day before.) When we were getting ready to restart the first line, Carrie was inspecting my face and said my corners were getting close (you have to see all four corners of your hood/mask inside your goggles). In my frustration, I must've opened my mouth too wide a few too many times, because after I blew two of his veins, Carrie said she couldn't see my bottom corners and I had to leave.

So I only got to spend an hour in the cool vest, which was kind of pointless because I didn't even get to take advantage of the vest's purpose. However, I did notice that I did not get out of breath at all while inside, and that was really nice. I'm told that March is the hottest time of the year here, so I'm sure there will be more opportunities to use them. I hope everyone at home is enjoying the 100 degree difference.

There and Back Again

It's not that I love (or really even like) to fly, but sometimes I feel relieved to be back on an airplane. Like a third home, if you will. Which is why not being able to get on that airplane is so anxiety-provoking. The end of January was my R&R time, and I was really excited about it. There are two airlines flying into Sierra Leone right now, and the one I was on flies on Sundays and Wednesdays. I arrived at the airport with more time than I would have needed, in spite of having to get out of my car at the entrance, walk in, wash my hands, get my temperature checked, get back in the car, drive 60 feet, get out, wash hands, get my temperature checked... Anyways, I had plenty of time, and then the flight was delayed getting in. By two hours. Despite the fact that the plane actually stops 100 yards from the airport, they still loaded us all onto a bus where we sat for almost an hour.

When we finally landed in Brussels, I had 45 minutes until my next flight. We all had to stand in line and get our temperature checked. And then I took off sprinting through the airport. (Is there a Guinness record for number of airports you've run in?) I am weaving in and out of people on the moving sidewalk, huffing and puffing with my two backpacks stuffed full because I refuse to check a bag. And after 10-15 minutes of that, I come to find myself in line at passport control. Stupid European Union. Stamping your passport at the first point of entry rather than your final destination.

Made my way to the airline service desk to try to rebook my flight. Ended up having to buy a whole new ticket. And that's why I don't check bags, folks! My luggage would still be lost somewhere in Singapore. Even the ticket agent was relieved. Anyways, because I had to buy a new ticket, I technically had to leave the airport and come back in, which meant they stamped my passport AGAIN. I was already nervous about running out of pages because they used three whole pages for my SL visa. By the end of this story, I'll have 4 more stamps.

I did finally make it to Croatia, and I was only three hours later than my original arrival time. I was spending the week with two of my friends from Haiti. A car from the hotel was supposed to meet us at the airport earlier (Becky and I were supposed to be on the same flight from Munich), but now I figured I'd just take a taxi. I exchanged some money and was looking for signs when I suddenly got hugged. My first human contact in six weeks (other than the accidental high-five with Carrie)! Becky had talked the hotel into driving back to the airport to get me.

We spent that evening walking around Split. We walked a bit more than we intended to, since we didn't take the map with us and we ended up getting lost. Luckily we found a coffee shop where some guy called his friend to ask for directions and then drew us a map on his receipt. By the time we got back to our hotel, we were too famished to put any effort into finding a restaurant. Plus it was really cold. So we asked the manager if there was anywhere that delivered pizza. He called some people and then ended up buying the pizza for us.

Alex finally joined us on Wednesday, and the three of us had the evening together before Becky had to head back to Germany on Thursday. After we dropped her off at the airport, we rented a car and set off on an adventure trying to find this national park. I just knew there were waterfalls and that's what I wanted to see. We had the route on Alex's phone, but the blue dot didn't move, so figuring out where we were was a little difficult sometimes. The closer we got, the lower the temperature got, until we were finally in a Croatian winter wonderland. I had packed my chacos for the hiking, but luckily I had decided to wear closed-toed shoes. I also had my mittens. Yes, I brought mittens to Africa.

We paid our entrance fee, got the map, and our hot chocolate, and cheerily set out walking through the snow. We found the waterfalls within 10 minutes. And then we probably could've turned around and gone back to our car and been perfectly content. But we kept walking. I was okay until we got to the pavilion where we were waiting for the ferry. The windy pavilion. My shoes and socks were wet by then. The Korean woman we had picked up along the way (because I need an Asian wherever I go), thought it would be appropriate to play songs from the Frozen soundtrack on her phone. The ferry finally came a half hour later, and we took what I'm sure is a lovely ride up the river when it's green and 70 degrees. Then we hiked from the dock up to the shuttle area. I was so thrilled to get on the shuttle. Until it took us back to Station #1, where we had to get back out and hike the 20 minutes back to the park.

Friday we checked out of our hotel and drove to Dubrovnik. I can't believe our tiny car didn't blow off the roads in the monsoon we were driving in. I am also thankful that they did not stamp my passport when we drove through Bosnia. We had the same trouble with the blue dot and finding our apartment and ended up driving in a circle three times. But then we found that that's because our apartment wasn't on a street. In Split and Dubrovnik (and I'm sure numerous other places I haven't been), there are mini towns inside old palace walls. There are just walking roads, but they all have names. Names that show up on google maps and make you think you can drive there. But we finally found it, then an hour later found the person to let us inside, and then we could go get pizza and more salad. (I ate salad and doughnuts on R&R like it was my job.) It kept raining on Friday, and Alex had to leave very early on Saturday morning for her flight, so we didn't do much exploring. I walked around inside the castle walls some on Saturday before I set off on my trek to the airport shuttle. I would definitely go back to Dubrovnik and spend more time being touristy.

And now I'm back in Lunsar and it feels like R&R was a nice malaria med dream I had. The next wave of patients came, and our confirmed ward is almost full again. But full of peds this time. We have a whole bunch of teeny tiny babies, like six months and under. And then we have a bunch between 8-13. A lot of them are from the same families. Four patients were from the same quarantined house. They got sick on day 18 of their quarantine. This morning a nurse and I were feeding and changing one of our 10 year olds, and I was encouraged that she was sitting up and chatting. And then I asked my nurse what she said. Apparently, our patient had rambled on and on about how someone had stolen her orange this morning. Encephalopathy is never a good sign in our ward. So we'll see.

Walking in Split

Inside Diocletian's Palace

Random apartments inside the palace walls

Inside the site of my first salad. Lots of people were sitting outside, but we opted for indoors. It's hard to control utensils while wearing mittens.

We paid the $3 to walk around in the "catacombs" under the palace. January definitely isn't tourist season (someone in a restaurant asked us why we were even in Croatia), so we were the only ones there.

Plitvicka Jezera - the national park. I'm quite sure that Slavic languages would not be my thing.

I think you can see our little ferry in there somewhere

The Before picture. There is no After.

Our apartment in Dubrovnik up there on the right. Just 65 steps or so with our bags.

Inside the castle in Dubrovnik. Alex was gone by then, and I'm a terrible lone tourist, so I don't know what it's called.

I may have gotten lost while trying to find the path to walk around the top of the castle walls. So I toured some apartments inside the castle until I found my way back out.