Be the change you want to see in the world. ~ Ghandi

Monday, January 26, 2015

More daily life in Sierra Leone...and Momo goes home!!

Hi All, 
First, a prize to whoever can explain the choice of brand names for the latrine covers.


Next pic is of me in Triage today. 

 We stand behind 2 meter barrier fences to interview patients, then come within arm's reach to take the temperature - hence the face shield (and gloves).  It's been decided that we nurses can do the triage, screen patients in or out, write admitting orders, etc.  I normally work ICU, but today and tomorrow am in Triage to cover the nurse who's working overnight shift.  I admitted one man who looked sick and indeed is positive with a high viral load, and a pikin who was limp and had a "convulsion" last night and hadn't woken up.  He might be malaria instead cuz no contact exposure.
We ended the day with 18 total patients - I think it's probably a record low.  YAY!!!  The president of SL said schools will open in late March.  Everyone is counting the outbreak over, but it's not yet.  It's not gone.  Cases are not rising nor falling, more holding steady.  I heard Liberia is doing much much better.  YAY. Today there were lots of celebrations as 3 were discharged cured.  And 5 were "no case" - in the Suspected area and blood test negative.  We all breathe a sigh of relief when a test is negative.
Yesterday I had to pronounce a 7 yr old boy dead.  It was especially sad because I'd been with him a couple hours before dripping ORS into his mouth with a syringe.  Poor little guy.
I have to tell you - I absolutely LOVE my Nokia Lumina phone.  Got it just before coming here to be able to stay in touch.  Well, the camera is amazing and I take pics all over the place, and especially for work.  Yesterday, the ICU nurses made the mistake of putting a patient chart inside the bag of medications and sent it "in.". Well, what goes "in" can't come "out" And they were averting their eyes, heads hung, hoping to not get in trouble.  I had one stand inside and hold it up page by page as I took pictures of it, then sat down with the phone and recreated it.  They saw the amount of work it took and came slinking over to apologize.  I'm guessing that's never going to happen again :)
Worked on Arts and Crafts between patients in Triage today - trying to create a new system for stocking/inventory control for the items we need at a moment's notice inside ICU.  So I cut up empty gloves and masks boxes and taped them together to create my masterpiece.  Tomorrow will talk with The Powers and see if we can trial it.  Also working on a training for nurses of how to mix IV meds, hang them, count drip rates, etc.  Amazing that they don't uniformly know this stuff, but ... One of my daily lectures is about 3 way stopcocks..

The last picture is to make you smile.  This little girl was sent home yesterday cured.  All possessions taken inside are burned (including cell phones, clothing - anything that can't be sterilized with 0.5% bleach), so they shower and we give them clothes and shoes to go home.  She and her mother were admitted when I first arrived.  Mother died within days, but the pikin survived.  She will now be cared for by an uncle and his family ...
Wish I could have been there to cheer when Momo went home, but it was on my day off.
Thanks to all of you for writing and sending your encouragement and positive thoughts our way.  Day by day, we do the best we can.
Much love, 

Saturday, January 24, 2015

Another day in Sierra Leone - and some good news too

Hi All!
Plan for the day:  
1.  Sleep in.
2.  Go to "Super Market" - can't wait to experience a Sierra Leonean super market!
3.  Have lunch with an old Ethiopian pal from my mission there in ... 2008?  He was a lab tech and went to med school and is now in Freetown working in a pediatric hospital.
4.  Skype with Pete in the evening (morning in Seattle).
5.  Go to bed early and start 6 in a row before another overnight on Super Bowl Saturday (Go Hawks!)
Two pieces of GREAT NEWS!!!  Our 5 month pregnant patient was successfully induced and survived!!!  HURRAY!  She is the 19th documented pregnant Ebola survivor for MSF since the outbreak began nearly a year ago.  She is glowing, happy, laughing and thankful.  
Second thing - Momo tested Ebola NEGATIVE yesterday - WAAAAAHOOOOO!!!!!!!  He's still a bit foggy and rummy - I think still a bit fluid overloaded and perhaps a bit tox from liver and kidney failure.  His hands and feet are still swollen, so I can imagine his brain is as well.  But he's asking to move to the other tent (they all know going to the other tent is a step in direction of survival and going home) and is eating, drinking, walking without staggering, making sense, following directions and even initiating conversations.  Thanks to everyone who has sent such strong positive vibes his direction and prayers - it's all worked and he's improving right before our eyes.  From being chased back into his room with a stick to survivor.  Wow.
A couple pics to share with you - one of a survivor hired as a caretaker to watch/feed/clean the pikins (small kids).
  And one of a ladder - there is lots of construction going on.  Amazing these men can do hard physical labor in this heat.

We are now up to about 60 survivors since this ETC began Dec 10.  About 300 total patients, about 30 still in now.  The 300 includes patients that are brought into "suspect" but get ruled out with lab tests.  Probably half are discharged as not Ebola.  Some are malaria, some are just symptoms we don't diagnose a cause.  We are not a hospital nor do we diagnose or treat anything other than Ebola.  No meds, no time, no space.  We try to get the "negatives" out of the facility as quickly as possible so as to not expose them to the virus in any way.  There is always a risk.
Still teaching at every opportunity and enjoying seeing the nurses get a bit more empowered every day.  After all, we will leave and they will stay.  One gift is to leave behind as much knowledge as possible.  
Hope all's well at home.  Keep sending your happy thoughts to these people.  Keep spreading the word - Ebola is not over.  We have hope.  We're all working hard to overcome.
Love to all,

Tuesday, January 20, 2015

Go Hawks!

The good news:  I got to sleep in til 9 today! 
The bad news:  I have to work a 12 hour overnight shift for the first time in 32 years.

It's now been a week working at the MSF Switzerland Ebola Treatment Center (ETC) and I'm feeling pretty comfortable.  Whereas in the training in Geneva I felt like a zombie-like Frankenstein monster moving in the PPE suit, I'm relatively comfortable in it now.  "Comfort" is a relative term, of course.  I'm getting used to drops of sweat running down my back, legs, neck, face (especially upper lip into my mouth!).  I can even safely dance a little jig in it. :)

Your Krio lesson of the day (with a nod to Heather) :

"De pikin (pronounced pee - keen and accent on the 'keen') de suck bobie?"
Translation:  "Is the baby breastfeeding?"

Our numbers are down.  When I arrived a week ago, we had 20 patients in ICU and about 50 patients in total.  As of yesterday we had 19.  Many deaths, of course, some survivors (I think we're up to around 45 - 50 now since Dec 10).  It's too early to know why the decrease - are there really fewer cases?  Is it because there are more beds available in more centers?  Are people just not reporting because their house will be quarantined by the military for 21 days and no one allowed to leave?  Or is the virus just taking a breath before coming roaring back like it did last summer?  The only time to let down our guard is once 21 days have passed with no cases.  Until then ...

There are survival stories, of course.  Right now we have 17 year old "Momo" who is wild as can be.  One of the features of Ebola is incredible mental confusion.  Despite Valium and Haldol, Momo almost made it out of not only ICU, but out of the Triage area into the "clean" space.  Since we can only touch him in full PPE (and if he rips your PPE, you're at huge risk), so the staff were sheparding him with a long stick.  And a couple days ago, he staggered nearly into the decontamination shower!

One survivor (they have immunity for an uncertain length of time) working for us inside caring for patients was just as wild as Momo and has taken him on for special attention.  He recognizes he was just as confused and even threatening the staff that he would slap them if they tried to start an IV or give him meds.  He's strong enough to manage Momo and get him back into a chair or onto the mattress on the floor.

The confused patients are the hardest to manage.  You work so hard to get an IV into them for massive hydration (5-6 liters of IV fluid per day plus ORS and water) and literally as soon as you turn around, they have pulled it out and water and blood are pouring everywhere.  We can only be inside for one hour and no one is inside all the time, so it can be quite discouraging.

I'm really enjoying the national staff. Some say they are lazy, but I prefer to give them the benefit of the doubt.  I think it must be difficult to deal with all the different approaches by all the expats, not to mention the accents - German, French, Aussie, American, Mexican ... Not easy for them.  Plus, even though nursing school is 3 years, they are not taught critical thinking skills.  Nurses do what they are told to do. 

Every opportunity I get, I start teaching.  Basics, why certain activities (like giving ORS) are so important, how the virus is cured, what the lab values mean, how the body functions, even how to use a 3 way stopcock on an IV.  It's really fun to see the light bulb come on and questions asked.  Once I go over something, I ask them to share with their colleagues.  And they do.  But I keep repeating over and over.  The nurses and aids rotate areas and shifts (ugh) so there are always new combinations to work with.

A couple nights ago the expat nurses met and divided duties.  I am now in charge of ICU.  It's not an ICU in the sense of what we have at home.  There are no machines, no invasive care.  Just patients that need a close eye, can't walk, can't drink by themselves, usually on IVs, children (the under 5 yr olds are especially vulnerable) and older (over 40ish is also higher risk of death).  I like staying busy and having to problem solve and work to instill the notion of critical thinking for the staff.  Yesterday one of the nurses came up to say they are concerned because Momo and one other young man have generalized edema and the nurses are concerned about too much IV fluid.  That's the first time they have come forward like this, and I'm delighted.  I know we'll have steps back, but celebrate the steps forward as well.

Yesterday I came to work pumped up over the Seahawks win.  I couldn't watch the game but Pete and Angela were on Skype voice with me for the first half (I'm 8 hours later here) giving me the play by play.  I told the gathered group of nurses, nursing aids, pharmacy staff, etc. all about American football, the Seahawks and got them all chanting GO HAWKS!  with a fist pump.  I addition to my masking tape nametag I wear each day, I put one "Go HAWKS" and all day, I kept getting shouts across the compound of "Go Hawks" - so cute and another way to bond and have fun.

The second picture above is my daily notetaking sheets.  Crumpled from sweat.  By 7:30 am the backs of my hands are forming droplets.  Inside the first layer of gloves in the PPE, I take them off and they are filled with several mls of sweat in each finger.  Amazing.  I drink about 2-3 gallons of water a day and try to eat some salt at each meal.  The feet are feeling a little better plus I rub a couple times a day when I put on dry socks.  The legs and knees are still throbbing constantly so also try to massage them.  Just hope they will eventually adjust to walking in the gumboots over the rough rocks.

Third pic above is in the "Suspect" area.  Patients who present to Triage with symptoms + or - fever are admitted here. The Ebola blood test is taken (above).  Lab draws it, dressed in full PPE.  Imagine.  You must write patient information on the blood tube first, then take the sample, spray the outside of the tube, spray the inside of a zip lock bag, drop in the tube, spray the outside of the bag, spray the inside of another zip lock bag, drop in the tube/first bag, then spray the outside of that second zip lock.  All this goes into a solid blue container with chlorine solution inside and is hand carried about 2 blocks to the lab at the entrance to our ETC (by the way, if you read about the Freetown response, we are the Prince of Wales School ETC).  Imagine doing all of that in the heat and humidity of this place. 

Thanks to all of you who have written and who continue to follow our progress.  Don't believe the media accounts of "it's getting better".  It's not better until Ebola is GONE and no new cases for 21 days.  Only then can we stop these massive efforts.  The world turned away with disinterest last summer and it came roaring back.  Keep reading, keep interested, keep donating and keep sending positive thoughts and prayers to these people and those of us here to help.  We all need your support.

Much love to all,