Wednesday, April 8, 2015

Only in Ebola land...

Only in Ebola land is there:

- temperature checkpoints everywhere - at every police checkpoint (~3 -4 on our way from the house to the center), at every restaurant, security guards checking our temperature at the house, and security guards checking our temperature at the center when we arrive and leave.

- possibility of being fined by the police if you don't have isagel/hand sanitizer in your vehicle.  This is checked at the police checkpoints.

- handwashing buckets at public entrances

- the #1 Ebola rule: 'No touch' policy.  In a culture where everyone touches every acquaintance they come in contact with, it's pretty difficult to abide by this.

- rubber boots (or gum boots as the Europeans say) are the footwear worn by everyone at the Ebola center.

- our footwear is sprayed with bleach as we enter and leave the center.

- you sweat an average of 1.5 liters inside the PPE (personal protective equipment) in ~ 1 hour.

- are we not allowed to share drinks or food off of each others plates.

- Ebola songs sung 'Ebola pac an go'...(Ebola pack and go)

- everything is brought to a halt: schools are closed down (primary/secondary/college), organized sports are stopped - no football/soccer, no large party's or meetings at the beach, mining jobs are stopped, road construction is put on hold, markets are largely downscaled,

- Red Cross burial teams presently average around 70 burials per day.

If there's any suspect cases in the community people are suppose to call 117 for safe transport.  One of our survivors, now employed with us was a taxi driver who contracted Ebola from a patient he transported.  When 117 is called a Surveillance officer goes out to the scene to obtain a history and see if the patient meets the criteria for a suspect Ebola case.  If they have a fever with three other symptoms (diarrhea, vomiting, muscle pain, joint pain, weakness, loss of appetite, hiccups, unexplained bleeding) they are transported to an Ebola center as a suspect case for testing.  

Ambulance arrival 

Case numbers are going down!  So awesome!  All the staff keep asking how long I'll be here...I tell them end of May, and by the grace of God Ebola will be gone by then too.

Wednesday, March 11, 2015

More survivors discharged

Drone view of the Center. The WASH (Water and Sanitation Hygiene) system is on the far left - ie the bleach water setup, then the Red Zone 5 treatment tents with the morgue tent at the end, the 2 meter partician with the tin roof, and the Green Zone (as described in last post - psychosocial, change rooms, showers, bathrooms, staff office, pharmacy, supplies, laundry,). 

 The entrance to the center.

 This is shift change/handover.  Dance, singing, clapping time - how cool isn't that!

Yesterday we had 3 survivor discharges and one death (not sure if Ebola related).  How awesome to have 3 survivors going home in one day!  It was an emotional time as two patients were mother and son, and another patient was an orphan who went to stay with other family members.  When you hear the stories of how Ebola has taken so many members of one family it breaks your heart!  Yet it's so neat how these people's lives have been spared, by the grace of God.  I so wish I could post pictures on here of patients to give you a little glimpse...

Sunday, March 8, 2015

My first week

My first week at the Ebola Care Unit...well lots to take in but good!  The center is set up in the community of Kontorloh, a suburb of Freetown, Sierra Leone on a local soccer field.  This area was considered a hotspot and was in need of a facility.  MedAir partnered with a local organization called Lifeline Nehemiah Project who've been working in this area since 1996 with orphans, rehabilitating child soldiers from the civil war, along with many other projects.  At this point Lifeline is also working with quarantine distribution kits for families in quarantine. 

Entrance to the 'Green Zone'.  Each person who enters or leaves signs in/out, washes their hands with 0.05% bleach solution and has the bottoms of their shoes sprayed. 

 The center is divided into the Red Zone and Green Zone areas.  Red Zone is the high risk area where patients infected with the Ebola virus are, and the Green Zone is the remainder of the facility.  There is 2 meter fenced off area between the two zones, as seen in the picture below.  To the left is the ambulance unload area in the Red zone.  I was standing in the Green Zone area when taking the picture.

Green zone area consists of the psychosocial team tent, triage area, donning area (dressing area), bathrooms, & showers as pictured here.

The Green zone area continues to the tent on the left - office area, stock area, pharmacy, and lab staff area.  The tent on the right is the staff lunch area.  Beyond that is the donning area (undressing area), and laundry.

 Pharmacy/lab team area.

 The fierce lab team.  They draw all our samples.  The samples are then picked up by a military officer who brings them to one of two of the labs in Freetown that process Ebola samples.  


 Laundry area

Some of the PPE (personal protective equipment) is bleached and reused (boots, googles, rubber gloves, and aprons), the other pieces are disposed of and burned. 

 The Red Cross has a burial team who picks up each body for safe burial practices.

The Red Zone consists of  the ambulance area, triage area, our suspect/probable tents where patients are tested and wait for the results.  When confirmed they then are moved to our confirmed tents.  The facility has 20 beds in total spread over 5 tents. 

Triage (means to sort) area.  Red Zone on the left, Green zone on the right of the fence.

Doffing (dressing) area.  Staff are specifically designated as 'dressers'.

Check and ready to go in.  Our names are written on our heads and the time we enter on our sleeve.  The max time inside the Red Zone is suppose to be an hour.  This is where the heat becomes a killer - yikes!!  So hot!  Staff members follow us along the fence in the Green Zone to chart, pass food, ORS (oral rehydration salts), medication, or personal items needed for patients.  
William (a lab tech) and I going in to draw a new patients blood work.

Our tables where we pass items from the Green to Red Zone.
The fence where nurses follow the team inside the Red Zone.  The door to the left from the Red Zone to the left is for patients who were tested from the suspect tents, and are negative.  They shower and receive new clothes when being discharged.  They are quarantined for 21 days after and followed by our psychosocial team for potential exposure.

Doffing (undressing) area

Doffing is considered high risk, so we have trained staff to walk us through the process that takes ~ 15 minutes.  Every piece of equipment you remove you need to wash your gloved hands with chlorine solution. 

Initial spray down.

 Spray down

 Boot spray

 Initial glove removal

 Washing gloved hands between removal of each piece of PPE.

 Face shield removal

 Apron removal

Immerse the apron x3 in the chlorine solution, then x3 in the rinse solution

Goggle removal

 Hood removal

Creole reminder:  'Wash yo han's'

Unzipping the suit

 Mask removal

 Last boot spray

This first week has been a good one, we discharged 4 survivors, and no deaths on my shift.  So far I've only seen the better side of Ebola and not the awfulness of it firsthand.  I wish I could post pictures/video's of the survivors being discharged and the celebration with it.  Love it!  We have a few orphan girls from Ebola claiming their parents lives, that's heartbreaking.  

Thanks again so much for everyone who's praying.  Can't do this without God's protection.

Back to Africa

Ebola.  Where to start?  It's so neat to see how God coordinates different events, this situation being one of them.  In June I got an email from Samaritans Purse looking for nurses to work with the Ebola outbreak in West Africa, specifically in Liberia.  I was on the fence, part of me wanted to go, part of me didn't.  So I prayed about it and emailed SP back stating the date I would be available after my work commitments - July 28th, flights were being looked into.  I then remembered we were having a friends weekend at the lake coming home that day, so I emailed again asking if the departure date could be pushed back by one day to July 29th.  Not a problem, so flights were booked.

On my way home from the lake July 28th I received a call informing me of different safety issues at the hospital - riots, etc and in the country.  The borders were now temporarily closed.  This was the same time when Dr Kent Brantly was infected and evacuated (first Ebola case in the US), as well as the SP international staff being evacuated.  I have no doubt God was at work in that situation with the timing of everything, if I would've left on the 28th...who knows where I would've been stranded.  

Even with this situation I did not feel that door was completely closed.  I was sent to the CDC (Center for Disease Control) in Alabama for the 3 day training course by Samaritans Purse then referred on to MSF and MedAir.  God made it possible for me to get connected with MedAir, including jumping some hoops for me to be deployed by them.  Feb 23rd I left home, flying to the MedAir headquarters in Switzerland for field debriefing for a few days, then on to Freetown Sierra Leone - March 1st.  I'm scheduled to be here for 3 months, Lord willing, then return to Lausanne Switzerland for my 3 weeks of 'temperature monitoring' time.  
A Dr who I worked with in the Philippines with SP said it perfectly in relation to the story of the good Samaritan:
‘The well-known Bible story of a person who was hurt, helpless, and needing to be rescued is easily accepted intellectually.  And credit is given to the Samaritan who chose to help.  When the plea came for me to render my skills in the Ebola outbreak, I was challenged to examine my convictions.  Will I be like the Samaritan, or will I pass on by, remaining in my comforts?  ‘Do not withhold good from those to whom it is due, when it is in the power of your hand to do so’ Proverbs 3:27 ‘

A few other verses that have encouraged me:
Psalms 91: Those who live in the shelter of the Most High will find rest in the shadow of the Almighty. This I declare about the Lord: He alone is my refuge, my place of safety; he is my God, and I trust him. For he will rescue you from every trap and protect you from deadly disease.’

Luke 9:24 ‘For whoever wants to save their life will lose it, but whoever loses their life for me will save it’.

Job 14:5 'You have decided the length of our lives.  You know how many months we will live, and we are not given a minute longer.'

Matt 6:25 'That is why I tell you not to worry about everyday life - whether you have enough food and drink, or enough clothes to wear.  Isn't life more than food, and your body more than clothing?  Look at the birds.  They don't plant or harvest or store food in barns, for your heavenly Father feeds them.  And aren't you far more valuable to him than they are?  Can all your worries add a single moment to your life?'

There were things I had to work through in my mind about this whole situation, but God taught me new things and I have no doubt His hand was in this all.  The quote by Fred Deviito is so true 'If it doesn't challenge you, it won't change you.'  

I've been so blessed by my family, church family, and friends by coming alongside this ministry by prayers, encouragement, and support.  Thank you doesn't seem adequate!