Every day I cry a little bit when my alarm goes off at 6:20. Not because I don't want to go to work, but because waking up is hard. So I hit snooze for the next 20 minutes or so and then hope I'm not late for breakfast.
We take a van to the site, hoping all the way that we beat the bus full of national staff. If we get there at the same time, there's no room to change and no hope of finding scrubs that fit. Yesterday, a man without pants handed me my boots.
At 8am, all the nurses and doctors gather around the whiteboards (because no disaster response is complete without whiteboards) to get handover from the night shift. We're still working on how to do a proper handover (i.e. not just reading out loud everything on the board about every patient). We have plenty of handover opportunities to practice. While all the international nurses do 12 hour shifts, the local nurses (and the international doctors...) are split into 3 shifts: 2 6's during the day and a 12 overnight (during which they usually sleep).
We make several passes through the wards on each shift, so after handover, we have to make assignments. There's usually plenty of chiming in about who wants to do what, or who just did that job yesterday, or who can't go in because they picked open a zit on their face (you can't enter the hot zone with an open cut). The first pass is for patient care (feeding those who need help feeding, changing those who need changed, etc). In the morning we also have a phlebotomy pass to draw labs on patients and start or restart IVs. Not many nurses here have those skills. Or, I get put on phlebotomy with one of our four "lab techs" only to find that he thinks it's acceptable to try to draw blood on a 4-month-old with an 18 gauge needle. We've since introduced him to the butterfly needle.
Our second pass is always medications and vital signs (called TPR here, for Temp, Pulse, Respirations). Let me tell you, it is a real treat to try and get heart rate and respirations with goggles. I'm not sure who, but someone thought it would be a good idea to clean all of our goggles with some sort of scratchy device. It doesn't even matter anymore if you put the anti-fog spray on them, because you can't see a thing through all the scratches as soon as you put the goggles on your face. Sometimes if you tilt your head just right, you can see out the top or bottom. But you have to find a clock that's working first. Yesterday, I was helping with medications and I was doing the TPR so the national nurses would have time to hang all the IVs (we can't leave them attached when we aren't in the ward, so we do a 500mL bolus - or whatever can go in - before we have to leave). We got a new expat nurse in a few days ago, so she was following me around. It was her first time in the ward, so she wasn't touching patients, just getting a feel for things. She volunteered to watch the time so (theoretically), we could get TPR done faster and then help with the rest of the drips and meds. As we were in the middle of getting a pulse on one woman, the clock died. Second hand just stopped moving.
With so many fluids, the med pass often takes at least 90 minutes. Then there's yesterday when the national nurses saved the two hardest patients for last (I assume hoping that I would do them), and then they told me that they just couldn't give meds to those patients because they wouldn't cooperate. These women are laying on the floor and I think they ignore us sometimes, but I really didn't have much trouble hooking up their lines. But then I just had to wait another half hour until they were finished.
Anything that goes into the ward can't come out again. So we have to call all of our vitals (and doctor assessments) over the fence to the person posted outside. When the med pass goes really long, it's hard to leave the ward and then know you have another 10 minutes of shouting and enunciating to do while you can feel all the sweat inside your suit ("Bed C7." "C7." "Temperature 38.2" "38.2" "Pulse 130." "113?" "130. One. Three. Zero." "One three zero."). I'm always so thankful when the person outside isn't one who wants to double check every patient after we finish.
The doctors make a round through the ward once a shift with a nurse who speaks Temne. Often they come in during the med pass, tell us to hang another bag on a patient, and then get to leave before us. Something we're going to discuss at our meeting in an hour. Most of them are really good at helping out, though. ("Everyone does nursing care during Ebola!")
Our last pass of the shift is patient care again, which includes passing the next meal. Then we have change of shift and handover, and we do it all again with the afternoon shift.
We may also have admissions and discharges. If possible, we try to clump the discharges in with another pass. That might mean that psychosocial comes and says that the discharge is ready from their end, so you yell over the fence to whoever is in the ward and say, "Hey, get so-and-so ready to go and send them to the shower!" But sometimes it's a bit more organized than that. Admissions can be a bit trickier, depending on the number of patients and their conditions. If the first patient you triage isn't ambulatory or they're wet (vomiting and/or diarrhea), they go right to Probable. Then if the next patient is better, you have to send someone else in for them because you can't go backwards to Suspect.
So to answer those who have asked what I do when I'm not in the suit: I help to make all of the above things happen! There is a lot of organizing and coordinating that goes on outside the ward, between medical and WASH and/or psychosocial. We have to make sure the labs get collected out of the hot zone, disinfected, and sent to the lab. We have to sign off meds in charts, sign off lab draws, and make sure the local nurses sign off their charts. We also always have a person posted outside each ward that has people in it in case they need something (i.e. "Hey, C16 is vomiting! Get the doctor to write for zofran and then bring it to me." or "So-and-so needs another blanket!").
It all depends on the number of patients and their conditions and the number of staff. Yesterday was so slow. We had so many national staff on in the evening that I didn't need to go in a second time. I ended up folding and organizing all the clothes in the psychosocial tent. I had gone in there to ask for long sleeves and long pants for our patient who also has TB. We had to put her in the convalescent tent all by herself so she wouldn't infect any of the other confirmed patients.
This woman really amuses me. She speaks English really well, and I saw her very soon after she got admitted, so she has started calling me "My Friend." Any time she sees me (in PPE), she says, "It's my friend! You're my friend!" However, the other day I went to talk to her through the fence when I wasn't in the ward. I said my name so she would know who I was (name is always written on my head, remember), and she said, "Nice to meet you." ... So she recognizes me in the PPE, but not as a regular person. Guess that answers my question about whether or not it's possible to connect with a patient when you just look like a marshmallow with goggles.
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