tag:blogger.com,1999:blog-49770132631933536552024-02-20T04:29:00.164-06:00ONE NURSE AT A TIMEAnonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.comBlogger218125tag:blogger.com,1999:blog-4977013263193353655.post-67166557864546240732016-01-07T14:50:00.001-06:002016-01-07T14:50:11.828-06:00We have moved! Please follow us at <a href="http://onenurseatatime.org/blog/">http://onenurseatatime.org/blog/</a><br />
<br />Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-80554960489518764322015-11-27T17:21:00.000-06:002015-11-27T17:21:44.420-06:00Amanda Judd tells about her mission with Refuge International<br />
<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">We arrived excited to get the San Raymundo temporary hospital up and running. We had lost time with flight delays and reroutes due to Hurricane Patricia, which was pounding Dallas with an unexpected wallop and caused baggage to be delayed and people to be stranded. Fortunately, thanks to the well-oiled machine that is Refuge International, we were up and running by </span><span class="aBn" data-term="goog_513338034" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Sunday</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;"> afternoon. </span><br />
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The San Raymundo facility is run by a local group of citizens who open up the compound about every 2 months to Refuge International's medical staff and alternately with a group of Italian medical staff who helps in the San Ray facility. While unpaid volunteers provide all of the care, the local group charges a very nominal fee to the patients to cover the costs of the building, maintenance, and upkeep. Having vested interest in the medical care for the community, the locals seem to respect and appreciate the volunteers from Refuge International. The community organization provides Refuge with a locked storage room to keep supplies safe when Refuge is out of the country. This was a good thing, too, since many of our supplies were delayed for 5 days with all of the reroutes. <div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="480" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.1&disp=emb&attbid=ANGjdJ9SeHeDD6JtXfxySUnV7_JdpW1LnzupjBQKFZoRIczzY4aSOrqcdkNHbpqike6awibn4CfYzsM0Qiq71WNKKVhKOuAGypDcDEDNJhicB8F5Pl9NTanC5wnTvgg&sz=w1280-h960&ats=1448666002404&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="640" /></div>
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This is a view from the roof of the temporary hospital, overlooking the cafeteria, the adjacent school (in green), and some of the sleeping quarters.</div>
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<img class="CToWUd a6T" height="640" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.2&disp=emb&attbid=ANGjdJ9f5Kh2kglTcZZNI4MfBdPXwis-jI4yNTphq2MG3nlQXrCMqp67_5LIzJ6h9MAgAXaNAMc8IBxuNNGFe2SFuewh1qs694YmpZTqkiedMWgsdGFxQ9WRqScb0TM&sz=w940-h1280&ats=1448666002404&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="470" /></div>
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Early morning OR setup.</div>
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This is me, ready to go on day 1.</div>
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As an ICU nurse, I was assigned to the PACU, and I was able to observe some of the earliest procedures prior to having patients. I was lucky enough to be on a mission with Dr. Cockburn, a urologist, and his lovely wife Judy. Judy was such a warm, inviting person. She managed intake flawlessly while Dr. Cockburn did consults and surgeries. </div>
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One of the first patients to get a procedure was done by Dr. Cockburn and had a softball-sized fatty tumor removed from his buttock. Dr. Cockburn and the patient allowed us to watch the procedure. The patient was numb but awake. He remained very stoic throughout the procedure and was hesitant to admit that he could feel the removal, at times. It's interesting how different pain is perceived culturally. As Americans, we would probably yell out and make them stop the procedure until we were completely numb, this patient tolerated it until we asked him and was grateful once the procedure was done.</div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="640" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.4&disp=emb&attbid=ANGjdJ87sRIoLVh69Z69mskhoEu9Lal6ndB3R6juIGZX8xATIRNEocEodb0Tk7OW4bmeGkW7s0E4UQaGp-NUz68WyjAqVe0X9YlzGoKPJoNK0bYFp4e7C1n8DCVLeEc&sz=w960-h1280&ats=1448666002404&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="480" /></div>
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Dr. Cockburn operating.</div>
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We did many procedures throughout the week. Of course, the kids always capture your heart. The little boy seen below was named Franco. He awoke quite confused from anesthesia but was quickly captivated by one of the games on Eleanor's phone. He was excited to tell us a story about his "pets". He has 2 chickens and 3 fish. One day he decided to take one of his chickens to school for show-and-tell, but was bemused to find that the chicken had laid an egg at the school. In some ways, I think that it's the sharing of experiences that may have a more lasting impact than the medical procedures themselves.</div>
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Franco with Eleanor, the NP who worked as an RN in the PACU, and Ashley, the translator. </div>
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A beautiful little girl who had a tumor behind her ear removed. She and her mother were an absolute joy to care for. She awoke from surgery happy, smiling, and full of giggles. </div>
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San Raymundo at sunset.</div>
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Of course, there are stories that are gut-wrenching, and make you wonder if our best intentions are not always in the best interest of the people.</div>
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With the exception of my luggage showing up, this day was fairly routine in the way that medical clinics become very routine after a few days when everyone knows their places and jobs. I had retired early to enjoy a shower with my own bath products and had crawled into bed to read my newly arrived book when Nancy (the trip leader) came in and asked Dr. Janet Sweetman, ER doc, to please come to the PACU where a baby that had just been delivered today was retracting with an SpO2 of 50%. For those that don't know this is bad, very bad. </div>
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Evidently, the baby was not trying to latch a number of hours after she was delivered by c-section. Eleanor, the NP working in the PACU, is a lactation specialist at home. Her gut told her something was wrong, so the baby was hooked up to a pulse oximeter. That was when the dangerously low O2 levels were discovered. </div>
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This is when teamwork and ingenuity become really important in a resource-poor environment. </div>
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We managed to get a modified O2 hood on the baby, but had to figure out how to transport the baby to the nearest hospital for more intensive care. Someone was able to get an ambulance, which was more of a regular vehicle than what we think of as an ambulance, to transport the baby The final piece of the puzzle was how to keep the baby warm on the 20 minute transport to the hospital. We all looked at each other and collectively said, "Skin to skin, " but who was going to do this? The mother was unable to travel with the baby because she was still recovering from her c-section. One of the midwifery students immediately volunteered and we quickly moved to the other room where I held up a sheet for her to tuck the baby into her shirt and they were off in the night to the hospital.</div>
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It is a very helpless feeling to do all that you can do and still know that it might not be enough. To know that the randomness of birth would likely give this baby every chance in the world at home but here life hangs by a thread. That Guatemala has the worst newborn mortality rate in the Western Hemisphere and how none of that matters when the mother is looking at all of us wondering if her baby will die and all there is to do is pray. And you pray regardless of what you believe because that's all that you can do. </div>
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When a nurse volunteers to take the baby to the nearest hospital on her bare chest because that's the best chance to keep the newborn warm and alive until it arrives. And it is all that we can do to not break down and cry because of the life that hangs in the balance. </div>
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We were all restless in bed while holding our breaths waiting for news of the baby. </div>
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<span style="color: black; font-family: Helvetica;">I always think of things that I have read when I have experiences like this.</span></div>
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"so much depends<br />upon<br />a red wheel<br />barrow</div>
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glazed with rain<br />water</div>
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beside the white<br />chickens."</div>
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-William Carlos Williams</div>
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In the morning, after transferring the baby to a local hospital, along with some of our L&D and neonatal nurses who stayed for a few hours, the baby did well and was nursing. </div>
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This baby was the 7th daughter of a couple who had so desperately hoped for a son. The only son that they had was stillborn. You couldn't help but notice the tears and ambivalence of the father when he found out that it was a girl. The mother had opted to have a procedure so that she would no longer get pregnant, so this baby was their last chance for a boy.</div>
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A few days later, the father came back to the hospital desperate because the nearest hospital was a private hospital. The hospital was pressuring him for money that he didn't have before they would release the baby. The baby wouldn't have survived to make it to the government hospital over an hour away. We couldn't help out the father with money because that would set a bad precedent and be unethical. </div>
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This brought up many ethical questions. Should we have even tried to help the baby, if the parents couldn't afford the care and we couldn't give them money to help? Had the baby taken an anoxic hit that would cause complications for life? The issues of ethics comes up in one way or another while doing medical work in underserved areas. It is a tough thing and lends itself to criticism and the concept have having an overall code of conduct on these trips.</div>
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Guatemala is such a beautiful country but it's tough here. Really tough. We have people coming from Altaverapaz- a few hundred miles away. The national cancer center is not functioning. Treatable cancers are now a death sentence in Guatemala. People in government hospitals are expected to pay for and bring their own suppose including sutures, etc. If you cant afford private care, you are up a creek without a paddle.</div>
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And then there is happiness:</div>
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One of the days midweek was a 14 hour day today with one amazing highlight. A woman walked in with imminent labor and delivered her baby within about 20 minutes. She rested in recovery for about 3 hours and she walked home with her husband, mother, and healthy baby. This was a picture of the beaming abuela with her new grandson.</div>
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Joy is contagious. She hugged and kissed all of us even though we had nothing to do with the delivery. This work is the antidote to compassion fatigue. </div>
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I thought of a book that I read, <span style="color: #141823; font-family: helvetica, arial, sans-serif;">"Maybe that was how to heal. I told myself stories and learned that I could be made of the ones I chose to tell, not simply the ones that life had laid haphazardly around me."-</span><span style="color: #141823; font-family: helvetica, arial, sans-serif;">Francisco Goldman, The Long Night of White Chickens</span></div>
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Abuela with her newborn grandchild.</div>
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San Raymundo, Guatemala</div>
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<span style="color: #141823;">San Raymundo, Guatemala</span></div>
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San Raymundo, Guatemala</div>
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San Raymundo, Guatemala</div>
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<img alt="11011875_10206944345183780_1931181133155715172_n.jpg" class="CToWUd a6T" height="480" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.14&disp=emb&attbid=ANGjdJ9rKU3saUwj5wyA-uzoI6k5tl2tpGetiwR4BGsMXwYgUHCnG_araSic-tkUsIkB9Bi6kEFZF_4C-d5gEDqj0I8-Vs84orD6ep4wxe7XAk9KTmKCb1BJdh6z6PY&sz=w1280-h960&ats=1448666002409&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="640" /></div>
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San Raymundo</div>
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<img alt="12191629_10206944345663792_6174066433872932614_n.jpg" class="CToWUd a6T" height="480" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.15&disp=emb&attbid=ANGjdJ98PZCmGKztWYB0mcase675CeGnq6wflBtWDpZxPzW53hmrSqnZ_jBRlp41vKH6aBxElAtQ2rLPamsFaQ-cUwhLR766l70BWXeK-HluWlQTJ2hCZYX4eTQmEAo&sz=w1280-h960&ats=1448666002409&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="640" /></div>
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San Raymundo</div>
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The improvisations:</div>
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One of the nurse anesthetists had to give a patient a nerve block. He rigged a machine that was like a train of four to a long needle to locate the nerve. He injected the patient and it worked beautifully.</div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="640" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.16&disp=emb&attbid=ANGjdJ_5TMzXFek4qiOv3hvjaAiBbohwe5gY-3_43dwNzHajxxGMssazf-d-gr5jKDdCt8hACqZkE9Gy8962JYFGfu9IOmCMHMLccGVYEjiDzOFGmHlFNZ1Ig2dFDOs&sz=w960-h1280&ats=1448666002409&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="480" /></div>
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We needed some y-tubing in the PACU because we had only one air compressor and 2 patients that needed O2. Some tubing, a syringe, and a few minutes later, we were in business.</div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="640" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.17&disp=emb&attbid=ANGjdJ_qMty8CurMmspZq1hyIAlnJWPHyGPF10ECf9Xf9OC1fZWxynUgcQM5I38O33aSJkWSnNNGKGgNBy02ewia0ZD7i3ptXvOXoAtJmZvZIc3_mK2z3GH7vrJaXsA&sz=w960-h1280&ats=1448666002409&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="480" /></div>
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The last day during the last surgical recovery, the power went out. Cell phones lit the OR. Iphones were finally used for a greater good.</div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="640" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.18&disp=emb&attbid=ANGjdJ9f1By7ziHAjUAoTfimvH9N7uhKLvW6tgkcEO4Wtrg3If9u1hn0Ml4MRMSgnnBU6SA0EfpgPFGIyz1fx4q3N5T5mlZjMnRNqCxgI1UaVCEPRwISzX_9qJ_7bXs&sz=w960-h1280&ats=1448666002409&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="480" /></div>
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We wrapped up after 4.5 days of clinical. Hopefully some lives were changed and maybe made better with this Refuge Mission. The team was a huge part of the success of the visit. It was a great experience and I hope to do it again.</div>
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Final tally:</div>
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<img alt="unknown.jpg" class="CToWUd a6T" height="480" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.19&disp=emb&attbid=ANGjdJ_FdObTwhT_2G_lSLmZprl-PcCtNT5lhp91QUgW1iEeY8rWaJRkcvIKYMhSGcp8x9LPcu93QiD3jrvHsp2SeDH9g0vPdNItn-RfU5gymoDwtirqLIoFt-DAakE&sz=w1280-h960&ats=1448666002410&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="640" /></div>
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And a great team:</div>
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<img alt="12191772_10207712448026853_775854951335929460_n.jpg" class="CToWUd a6T" height="266" src="https://mail.google.com/mail/u/1/?ui=2&ik=a8028b3ba0&view=fimg&th=15144b5cd5837334&attid=0.1.20&disp=emb&attbid=ANGjdJ9H6fQzbCziGCUi_C62aNvc57-x0uQl2JNAVFv0UcIPkB-iKVlSvNMYuoZ6ZFIMgDIQGKczb-wTGnqxIX58Ay8chB0EZoJ7hlTk0et0qYkZiWddcHCfOGUqCB4&sz=w1280-h532&ats=1448666002410&rm=15144b5cd5837334&zw&atsh=1" style="cursor: pointer; outline: 0px;" tabindex="0" width="640" /></div>
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Thanks to One Nurse at a Time for giving me the scholarship and the opportunity to participate in this great mission with a wonderful organization. I will definitely work with Refuge again and I would highly recommend them for future scholarships.</div>
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Happy Thanksgiving,</div>
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Amanda Judd</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-22477839186264562302015-09-21T14:19:00.000-05:002015-09-21T14:22:20.035-05:00Jo's Nurses work in Chocola, Guatemala<div class="separator" style="clear: both; text-align: center;">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis-dODw-DDTFuDTZinmuYAHPcB_stQl5x2GXoWUFtjIwv4pbxID85LJobQLWv4hRxSs3q95O7P-bSSo2rW9ua_Onda8YnXjNDsZWv15kNbZVXuuKSKVtsDS4pxbCnjjNderAmORNSVidqf/s1600/IMG_3838.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis-dODw-DDTFuDTZinmuYAHPcB_stQl5x2GXoWUFtjIwv4pbxID85LJobQLWv4hRxSs3q95O7P-bSSo2rW9ua_Onda8YnXjNDsZWv15kNbZVXuuKSKVtsDS4pxbCnjjNderAmORNSVidqf/s320/IMG_3838.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">2015 Jo's Nurses with Refuge International</td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc94m6I2kBTLCB_o09FZ-LrMBPN42Lw66Erw4b1NUm8Fua3PP9b1BiZB4JZSdfNhPxzXx7Qaaeg0MWX2cu1_uJD9EquXoDHxN9zGEZ0w89BNs20grVAH16H39x8dojR7J6W3uSCfaEnP2-/s1600/IMG_3418.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc94m6I2kBTLCB_o09FZ-LrMBPN42Lw66Erw4b1NUm8Fua3PP9b1BiZB4JZSdfNhPxzXx7Qaaeg0MWX2cu1_uJD9EquXoDHxN9zGEZ0w89BNs20grVAH16H39x8dojR7J6W3uSCfaEnP2-/s200/IMG_3418.jpg" width="145" /></a><span style="font-family: Arial, Helvetica, sans-serif;"><i><span style="color: #6aa84f; font-family: "Comic Sans MS"; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Chocola is a remote village in the mountainous southwestern
region of Guatemala where there is no government assistance in education,
health or roads. Sadly because of the country's political climate there
is no help for the indigenous people. They're abandoned.</span></i><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 9.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<i><span style="color: #6aa84f; font-family: Arial, Helvetica, sans-serif; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Dr. Sergio Castillo and his wife Veronica first visited Chocola
about 15 years ago. They were shocked to encounter villages in deficient
conditions with advanced illness including malnutrition, infection, and
waterborne illness. They found an abandoned building in the heart of
the community and started a hospital catering to the indigenous Mayan
people. In 2005, after the devastation of Hurricane Stan, Dr.
Castillo partnered with Refuge International to help expand the care to the region.
"To have a complete team of surgeons, nurses, anesthesiologists armed with
medicine was like the answer to our prayers. For me, it's an honor to be
able to help our people. Refuge allows me to help others. I'm like
a bridge for the people with extreme needs and the services of Refuge."
Says Dr. Castillo.</span></i></div>
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<i><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAwXpdMnDMHQ_83yogbnOws8V3RKNZuc74had8mtQfsf-xd0LzUlK7wyvOshndk4YFVElYqmoSszYlIsZaomqA-jIxbwGmk79dDkdSB5lpM1FynirOKzQeA-GUxS1U3y0hDeVXMSOYkplE/s1600/IMG_3399.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAwXpdMnDMHQ_83yogbnOws8V3RKNZuc74had8mtQfsf-xd0LzUlK7wyvOshndk4YFVElYqmoSszYlIsZaomqA-jIxbwGmk79dDkdSB5lpM1FynirOKzQeA-GUxS1U3y0hDeVXMSOYkplE/s200/IMG_3399.jpg" width="163" /></span></a></i></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 9.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span><br /></span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><i><span style="color: #6aa84f; font-family: "Comic Sans MS"; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Dr. Castillo is a very positive, inspirational, humble
man. He remembered all of our names and always greeted us with a big
smile, thanking us constantly for helping his people. I will never forget
our second night there. It had been a busy day, the usual torrential
thunderstorms where playing their symphony on the tin roof. After
a delicious dinner cooked by Veronica we made our rounds in the
hospital. To our surprise the Inn was full. Dr. Casillo had invited
all the families to spend the night because they live so far away and the
thunderstorms were so bad. We had families sleeping in preop,
postop, and even in the courtyard. It warmed my heart to see such
a gracious, giving spirit in action.</span></i><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 9.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbo7SMCbXplr7HVhiAAoVPOvCO5ork2Ju74n0SrJ-F7qRFSb8R0L4VVnytw5vxhnBi_xrdFH_IEhzngy80opgcxresbqiDc6walWULEbHow9zm4yUVRxLJbgUhQkUGJZyDOCZwSg0wLwOF/s1600/IMG_3303.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbo7SMCbXplr7HVhiAAoVPOvCO5ork2Ju74n0SrJ-F7qRFSb8R0L4VVnytw5vxhnBi_xrdFH_IEhzngy80opgcxresbqiDc6walWULEbHow9zm4yUVRxLJbgUhQkUGJZyDOCZwSg0wLwOF/s200/IMG_3303.JPG" width="200" /></span></a></div>
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<i><span style="color: #6aa84f; font-family: Arial, Helvetica, sans-serif; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">I would have to say that our first case was one of the most
memorable and inspirational to me. He was an 80+/- (they don't know their exact
age) old hernia case. Hernia's are very common because they work so hard
and do a lot of heavy lifting. While I was caring for him his son came
back and told us through the interrupter that he walks 8 miles two times a
day to carry wood back to the village for cooking and their campfires.
Wow, was he in good shape. He always smiled, never complained, took no
pain meds and was so grateful for all we did. On so many levels I feel
that the indigenous Mayan people of Chocola have a lot to teach me. They
are truly an inspiration. They are intelligent, </span></i></div>
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<i><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiblzFbbjGxF59hulqbf7MZYwEVQMuQHaZYRRi7Mc2djfEtznKqmuRgdQuZGPI10rpFKQoOtk1eS-cTTG0vUC3FPQ7wfrKf04LuimzsjvO8_-QvGSxQ9rj_fdOpdNTQWMAOsPfjLgJNtnIG/s1600/IMG_3333.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiblzFbbjGxF59hulqbf7MZYwEVQMuQHaZYRRi7Mc2djfEtznKqmuRgdQuZGPI10rpFKQoOtk1eS-cTTG0vUC3FPQ7wfrKf04LuimzsjvO8_-QvGSxQ9rj_fdOpdNTQWMAOsPfjLgJNtnIG/s200/IMG_3333.JPG" width="200" /></span></a></i></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><i>hard
working, disciplined, humble, respectful, compassionate, loving people
with a strong sense of family and community. I feel that as we work
together we can learn and help each other. We can help them with our
medical/ surgical and technical expertise and they can help us take a step back
and realize what is really important in life.</i><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 9.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><i><span style="color: #6aa84f; font-family: "Comic Sans MS"; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Thanks again One Nurse At A Time for the scholarship that
made this amazing opportunity possible to serve the people of Chocola,
Guatemala. Thanks also to Refuge International for their wonderful work
in helping to provide healthcare, adequate nutrition, clean water and education
to those in need. I hope that other nurses will hear the call and
want to help with the wonderful work that Dr. Castillo and his family are
carrying out in Chocola. Thanks again </span></i><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 9.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-17626552769684648882015-04-23T00:54:00.000-05:002015-04-23T00:54:38.787-05:00Update on Emily Scott's experience in Sierra Leone<div style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px; margin-bottom: 12px; padding: 0px;">
Filling In The Blanks</div>
<div style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px; margin-bottom: 12px; padding: 0px;">
My colleague who was infected has tested negative for Ebola and been discharged from the National Institutes of Health. The 16 Americans being monitored as “high risk” contacts have all passed 21 healthy days. My cohort – the clinicians with whom I trained, traveled, and worked – are all home and well past their 3 weeks of monitoring. I am back at my day job. By all accounts, my experience as an Ebola responder has finally come to a full stop. But issues still linger, and details of what we went through are still coming to light. I know a lot of you have questions, because I’ve heard them from you, the most common one being: “All of a sudden you just stopped writing… What happened?”</div>
<div style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px; margin-bottom: 12px; padding: 0px;">
Since many of the details have come out in the news, and because all of the clinicians involved are home and healthy, I think now is an appropriate time to fill in some of the details. I would never endanger the privacy of anyone I worked with, so some aspects of the story will be vague. Most of it you could piece together by picking through the news over the last several weeks, but I can share with you how it felt to be in the eye of the storm.</div>
<div style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px; margin-bottom: 12px; padding: 0px;">
My last good day in Sierra Leone was a Tuesday, the day before I found out that our colleague had Ebola. It was my first day off since arriving in country, and I had plans to meet some friends from my cohort at the beach. After a few days of training and working at Maforki Ebola Treatment Unit, the twelve of us had been split up to work at different facilities based on where Partners In Health clinical leaders thought we would be most useful. Most of my cohort had remained in the Port Loko district to either continue working at Maforki or to help out at Port Loko Government Hospital, where patients with non-Ebola related health issues were treated.</div>
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While it may seem like Government Hospital would be an ideal place to work since you wouldn’t have to worry about Ebola, in reality many of us felt that working there seemed more dangerous than suiting up at Maforki each day. In an Ebola Treatment Unit, at least you know for sure that your patients have the deadly disease, and each time you interact with them, you take the proper precautions. Government Hospital was more of a gray area. It was expected that no patients with Ebola would enter the facility, so clinicians had no need to don their full Personal Protective Equipment (PPE) when entering the wards. Just like in the States, if you’re treating a patient for cancer or malaria, there’s no need to wear a hazmat suit to do it.</div>
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But what if a patient slipped through the imperfect triage system and was admitted to the hospital with Ebola, under the assumption that it was a different disease? Or, what if someone was admitted while incubating the virus but before becoming symptomatic? Ebola has a 21 day incubation period, meaning that if I am exposed to the virus, I could walk around for up to 21 days without showing symptoms and without being contagious. I often wondered how strictly the patients at Government Hospital were being re-screened after admission. If a patient was admitted with malaria and a few days later started showing symptoms of Ebola, would it be caught in time to protect the clinicians who had been treating him without full PPE?</div>
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I never worked at Government Hospital, so I really can’t say for sure. I have heard varying opinions from the doctors and nurses who served there: Some say they felt perfectly safe, and others say they had serious concerns from their first shift there. It was at Government Hospital that our colleague who turned out to have Ebola collapsed, and several other clinicians came to his aid, assuming he had fainted from heat exhaustion.</div>
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I never saw Government Hospital for myself because, as you know, I was sent back to Freetown to work at Princess Christian Maternity Hospital, the Ebola Holding center for pregnant women. I loved the work. The plight of pregnant women in Sierra Leone was like nothing I’d ever seen; I felt my skills were sorely needed, and I woke up excited to go to work each day. I noticed imperfections in infection prevention and control policies from day one, but I did my best to protect myself while I worked with my colleagues to address them. While I wished my concerns had been taken more seriously, my desire to continue my work completely outweighed the level of risk I felt I was taking.</div>
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So when my day off coincided with that of a good friend who worked hours away at Maforki, I jumped at the chance to meet him at the beach to decompress and share our experiences. It was a fantastic day of swimming in the surf, sunning ourselves on the beach, and unloading difficult stories of our work over a healing beer or two. It was jarring to turn back from the gorgeous turquoise waves and think that a short drive away, people were fighting a deadly disease in horrific conditions. But we put Ebola aside just for the day, and lingered as long as we could while the sun sunk lower and lower toward the water, until we knew it was time to head back to reality. I felt recharged and excited for the next day at work.</div>
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Among the stories my friend shared with me that day was the news that our colleague had collapsed while working at Government Hospital. To be honest, we thought nothing of it. Sierra Leone is very hot and clinicians are working very hard; it didn’t surprise me to hear that one of us had passed out from the effort. If you’re used to working in an air-conditioned hospital with plenty of staff, it would be a shock to the body to run from one emergency to another in a poorly-ventilated ward in 90-degree heat. I told my friend to give our colleague a hug and a stern talking to about taking better care of himself when he saw him next. Without going into the details of his situation, I simply did not feel we had any reason to worry about him.</div>
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I was still in my pajamas the next morning when a PIH staff member knocked on my door and asked me to get dressed and come downstairs for a meeting. Again, I thought nothing of it. It wasn’t until everyone was assembled and leadership started telling us that in four months of working in West Africa, PIH had never had a clinician become infected with Ebola yet, that I started to feel the weight of what was coming. It settled in heavy on my shoulders, and I knew what he was going to say before he said it. Our colleague had tested positive for Ebola.</div>
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It was a difficult moment to process because most of my friends were hours away in Port Loko. Almost everyone else in Freetown at that time was from a brand new cohort that had just arrived in country. I was one of only a few people there who even knew who the infected clinician was, and I certainly wasn’t going to share that information. I went back upstairs, put on my scrubs, and went to the unit to work. I donned my PPE and went into the Red Zone, trying to focus on the task at hand rather than the questions swirling through my head.</div>
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The next few days were a whirlwind. I don’t feel it would be helpful right now to share every detail of how things played out, or to pass public judgment on how PIH handled the situation, whether positive or negative. As you know from the news, one of PIH’s Sierra Leonean clinicians fell ill with Ebola shortly after our colleague was diagnosed, and in the end 16 American clinicians were sent home on chartered flights after the CDC deemed them “high risk” for having had physical contact with the infected clinicians after they became symptomatic. It was a frightening few days, and more than a few times I thought to myself, “Am I next?” I have complete certainty that our American colleague followed procedures exactly, just as I felt I had. Where was the breach that exposed him? Had he and the Sierra Leonean clinician made the same mistake without realizing it? Had I?</div>
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An investigation into infection prevention and control procedures at PIH facilities was of course initiated by PIH leadership. My colleagues and I stepped forward with issues and suggestions, while we waited to see what the next step would be. After a few days, myself and several members of my cohort reluctantly decided that it was no longer safe to continue our work there. Please don’t think for a moment that we took this decision lightly. I can say with certainty that absolutely no one I worked with <em style="margin: 0px; padding: 0px;">wanted</em> to leave. Least of all me. I felt that the work we were doing at PCMH was incredibly important, and I honestly wish I could still be there. In dark moments I think about the women I could have helped if I had stayed longer, and hope I didn’t abandon someone to die because I wanted to protect myself. Again, I won’t go into the specific details of what made me feel I needed to leave, but I was (and still am) confident in my decision, although it broke my heart to walk away.</div>
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I don’t doubt the good intentions of Partners In Health. They leaped into the fray in West Africa several months ago when the outbreak was at its peak, when they certainly didn’t have to. The first teams of PIH clinicians bravely provided care at Maforki when there were 100 patients in absolutely horrific conditions. Having been there when we had 10 patients, I am in awe of those first teams. But could things have been done better, made safer, the level of care improved more in the interim between those first days and now? I think so. The events of the last several weeks have shed some light on those issues, and on what changes need to be made.</div>
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Since I left Sierra Leone, I am hopeful that PIH has been addressing infection prevention and control issues and improving the safety of their clinicians while continuing their commitment to the people of Sierra Leone. By their own admission, emergency response isn’t PIH’s specialty; they are an organization that normally works on long-term development projects. As cases of Ebola drop to the single digits in Sierra Leone and to zero in Libera, PIH’s real expertise will come into focus: Health system strengthening. After the last case of Ebola is over and emergency response groups have left, Partners in Health will remain in Sierra Leone and Liberia for years. They will continue to work in government hospitals and rebuild health systems that were ineffective to begin with and completely destroyed by the outbreak.</div>
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Here’s a perfect example: In Sierra Leone, when a person is admitted to the hospital a family member normally stays with them. This family member does much of what is considered to be “nursing care” in America: feeding, bathing, turning the patient. Sierra Leonean nurses do not regularly assist patients with these activities because there is always a family member at the bedside to do it. After Ebola ran rampant through hospitals, spreading from patient to patient and killing healthcare workers, no one wanted to set foot in a hospital any longer. No one can sit by the bedside of a family member with Ebola and expect to escape infection themselves. Even when Ebola patients were isolated to separate Ebola Treatment Units, and regular hospitals began to resume care for other illnesses, the fear remained. It will be a challenge to convince Sierra Leoneans that it is safe to bring sick people to a hospital, and to visit and care for their loved ones there.</div>
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In the meantime, Sierra Leonean nurses will have to learn to care for patients in ways they never have before. I heard from many American clinicians who were shocked by what appeared to be the apathy of the nurses, who didn’t bathe or regularly turn ill patients, leaving them to develop bedsores. But these nurses have been risking their lives to provide care during an Ebola outbreak in exchange for a pittance from the government that may or may not arrive; they are worn out, and afraid for their own lives. It also helps me to remember that they have never witnessed care being given at the level that we provide it in the United States. They have nothing to compare to. What seems inhumane and unacceptable to us is the status quo for hospitals in Sierra Leone. Education can change this. PIH will tackle these issues, and more, for years to come.</div>
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Shortly after I left, I heard that another facility in which PIH works had received its first case of measles. It won’t be their last. With vaccination programs shut down for nearly a year during the Ebola crisis, West Africa is a measles outbreak waiting to happen. Care of pregnant women and newborns was abysmal before Ebola, and even worse now. Everyday illnesses like malaria, typhoid, cancer, heart disease… you name it, and I guarantee you wouldn’t want to be treated in Sierra Leone if you came down with it. PIH is staying in West Africa to try to change that.</div>
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For more on what occurred in Sierra Leone surrounding our colleague’s infection, check out these articles. I’ve included one by the New York Times and a couple of others from Partners In Health’s perspective. I find some truth in all of these articles. Very little in global health is ever completely black and white, including my experience in Sierra Leone. My hope is that everyone involved will learn from this situation and continue to improve our efforts as humanitarian responders. I know I have.</div>
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New York Times article: <a href="http://www.nytimes.com/2015/04/13/world/africa/pattern-of-safety-lapses-where-group-worked-to-battle-ebola-outbreak.html?_r=0" style="color: #19196a; margin: 0px; padding: 0px;">Pattern of Safety Lapses Where Group Worked to Battle Ebola Outbreak</a></div>
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Article by PIH clinician: <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2015/04/ebola_treatment_in_sierra_leone_and_united_states_who_decides_where_doctors.html" style="color: #19196a; margin: 0px; padding: 0px;">All Lives Matter</a></div>
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Letter from PIH’s founder: <a href="http://www.pih.org/blog/dr.-paul-farmer-redoubling-our-efforts" style="color: #19196a; margin: 0px; padding: 0px;">Redoubling Our Efforts</a></div>
Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-61467174828977432392015-04-14T22:36:00.001-05:002015-04-14T22:39:40.380-05:00Switching gears. <div dir="ltr" style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">
Hi All, we're back in Tegus to regroup for a day - head out on the road again morning early. This past couple weeks we've been wandering the north/Caribbean coast of Honduras, visiting hospitals and public health clinics, Garifuna communities, other NGOs and people living with HIV. It's been fascinating, exhausting and informative.<br />
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Fascinating: Beautiful white sand beaches where mostly Hondurans vacation and not Americans. The cruise ships call this stop "Banana Coast" probably to not scare people who google "Honduras" and find out it's the most violent country in the world outside war zones.<br />
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Exhausting: we drove TWELVE hours from Trujillo to Tegucigalpa. TWELVE. I'm tempted to sit on a pencil to retain the crack between my buttocks!<br />
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Informative: The northern communities have an incredibly positive view of MSF - starting 40 years ago with Hurricane Fifi, Hurricane Mitch, maternity programs, HIV programs before they were widely available, and the list goes on. Rarely did we have to introduce ourselves.<br />
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The northern area is lush grazing land for cattle - mostly milk production as evidenced by horses carrying big metal containers on either side of the saddle, going to market? The vast banana palm farms give way to the "African palms" - native forests (I can imagine what this used to look like when covered with native mahogany and other native trees) now cut down for huge scale production of palm oil ... It's not the "slash and burn" of small subsistence farmers as we were taught in school. This is industrial scale destruction for economic gain of huge corporations. Sad really. We still see butterflies, and all sorts of different birds, so maybe not all is lost yet.<br />
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The roads are dotted with fruit stands - coconuts, watermelons, mango, all sorts of fruits - cheap and plentiful. Fish is only a hook toss away. Yet in this lush landscape, where food is abundant, people still complain of "lack of economic opportunities" as the reason for migrating to the US. We don't hear "violence" as a reason in the north. Yet, it costs about $6000 - 7000 to pay a coyote to take them all the way to their US destination, and that's after riding the train La Bestia all through Mexico. Most have family members in the US who send for them, and few unaccompanied minors other than those who are going to reunite with their parents.</div>
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I don't understand this - everyone talks of how poor Honduras is as a country. How so much is lacking. Yet, I look around and see morbidly obese people everywhere (not just Americans!), new cars, tall buildings, food aplenty ... I can't say this country is as badly off as many I've been in. Yet the statistics say otherwise. There are lots of foreign companies working here, NGOs, foreign governments donating money for construction and programs ... So where is the disconnect? Corruption? Is it any worse than anywhere else in Central/South America or indeed, worldwide?</div>
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If I can figure it out, I'll let you know :)</div>
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We were able to have a little down time - the beaches along the coast are spectacular. Chockablock full over Holy Week/Spring Break, but otherwise solitary. Trucks are overloaded with sacks of plastic bottles to be recycled (into what?). A first time greeting, even with a person you don't know is with a kiss on the cheek and handshake. Radio music is 80s - Queen, Christopher Cross, Air Supply. The alternative is the one and only CD in the car which is an oldie of Jose Miguel wailing love songs in Spanish that, after the 50th play, I DEMANDED be removed! Then turned on my iPod and listened to the entire podcast of Serial. Saved my sanity!</div>
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Hugs to all - I leave you with the beach at Trujillo ("Banana Coast") and a Garifuna woman making and selling pan de coco (bread made with coconut oil that is absolutely delicious).</div>
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Sue</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-86549639896464598352015-04-03T21:50:00.000-05:002015-04-03T21:50:26.329-05:00Dora the Explorer Returns to Honduras!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9T-kSSQlSSEHSbPu42TtWCL8hqzhi7YoiAWWe_zR8OOfcPqYwcKw2zqdwhNGN6HSKp1T9Ggj5WJNTSQWFblpcqBZWkkkHcIXrELNrgyFNcxZMe6RF-laNm_yCWYsPU1AK4QbmqnYzAkXp/s1600/WP_20150402_10_05_18_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9T-kSSQlSSEHSbPu42TtWCL8hqzhi7YoiAWWe_zR8OOfcPqYwcKw2zqdwhNGN6HSKp1T9Ggj5WJNTSQWFblpcqBZWkkkHcIXrELNrgyFNcxZMe6RF-laNm_yCWYsPU1AK4QbmqnYzAkXp/s1600/WP_20150402_10_05_18_Pro.jpg" height="180" width="320" /></a></div>
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<span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">Hi All, </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">I'm in the midst of a 2 month mission with MSF/Doctors Without Borders to explore the health situation all over Honduras. With my partner Edgardo (who I met in Uganda in 2006!) and a driver, we're visiting all of the hospitals in the country, some smaller health centers, community leaders, other "actors" in health ... And looking at what might be good interventions for MSF future projects. </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">So far, it's been fascinating!</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">The country is lovely: rolling hillsides of banana trees, sugar cane, corn, "African Palms," seaside communities. Highrises and places where horses still do much of the work. Claro phone satellite dishes on top of tin roofs and communal wood fires and cooking ovens. Eating fresh fish and shrimp/conch every day along with fresh hot rolls sweetened with coconut oil. Edgardo tucked into a bowl of stewed iguana (yes, I had a taste - not bad) and iguana eggs. Birds of prey that look like small vultures scour the fields for dinner. There are pine forests and cactus and pine forests. Herds of cattle graze on the sides of roads and amble down the middle of traffic.</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">People have been very friendly everywhere and certainly stare at our Toyota Land Cruiser covered with the doll figures in the picture (MSF has long worked here with the street population, HIV, violence, etc). </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">So far we've been mostly in the north/Caribbean coast and the past few days have been meeting with Garifuna leaders. Garifuna are ethnically different than native Indian/Spanish mixed folks - they were originally black African slaves taken to the island of St Vincent, escaped and settled all along the Carib coast of Central America. They retain their own language, customs, music (Punta) and traditions. Our interest is to see if they have unique health needs - as a people, they are reputed to be more sexually active, have higher STI and HIV rates and have more young pregnancies (as young as 12 and 13). From their perspective, they are simply more open about speaking of sexuality. However, government statistics show double the rates of STI/HIV as the regular population and a UNICEF study showed average age for boys and girls becoming sexually active is NINE.</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">It's also been interesting to see the conditions of and in the hospitals. The two main tertiary care hospitals are huge, sprawling, disorganized, smelly, and would be a nightmare to try to become involved in. Both hospitals' ERs are chaotic, patients lying on gurneys lining the hallways unattended with blood hanging, open wounds, smell of infection, no cardiac monitors or IV pumps, crowded, no triage, armed men everywhere ... A real mess. </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">Yet, here in Tela, their 10 yr old hospital is clean, neat, good equipment in working order, new mattresses, paint ... The only thing I can attribute the difference to is leadership. Management that cares, is engaged and involved, with vision and pride in quality of services and facilities. </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">So far the ideas we have are three:</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">1. Provide HPV vaccine to children age 10/11. There was one pilot program of about 30,000 doses done a couple years ago, but the government doesn't have the funding to continue. We feel this would have a HUGE impact on the health of the next generation and an organization like MSF could pull it off ...</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">2. A smaller community hospital Puerto Cortes has new leadership and desire to fix up their neglected facility. With a staff who is eager for improvement, and without a lot of bureaucratic hang ups, we could rehab their ER, provide equipment and training plus get involved in their newly created Adolescent program so we could touch on all aspects of Sexual and Reproductive Health.</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">3. Provide an interim physical space for a large hospital Pediatric ER - they are in the process of rebuilding but have no plans for what to do with the patients while the construction is being done (they say 6 months, but realistically 2 years!). We could provide modular spaces or inflatables, take over the care and improve systems, training, etc. and have a hand in the construction of the remodel. Then once they are ready to move back into the renovated space, they would have had a couple years "doing it right" and would keep those new ideas and systems as MSF withdraws.</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">These are just ideas we're throwing out as we move along our journey. It will be up to the coordination team and Geneva to make decisions about next steps.</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">Now it's Holy Week and the country is on vacation. We're taking advantage of being on the coast to enjoy a few days of rest. We'll do the same in our next weeks - work 5 or 6 days and have a day off in a lovely spot: Copan, where there are Mayan ruins on the border with Guatemala and the islands to the south off the Pacific Coast bordering El Salvador. What a wonderful adventure this is!</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> </span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">I'll be home soon, </span><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"> ready to have a lovely summer in Seattle. Hope all's well in your world. </span><br />
<br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">Much love,</span><br style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;" /><span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;">Sue</span><br />
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<span style="background-color: white; color: #222222; font-family: Calibri, sans-serif; font-size: 16px;"><br /></span>Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-8432169652307901882015-03-25T23:26:00.000-05:002015-03-25T23:26:11.276-05:00Save the Date: Saturday May 30!<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span class="meta-prep meta-prep-author" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">Posted on</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><a href="https://wanderingaimfully.wordpress.com/2015/03/26/save-the-date-saturday-may-30/" rel="bookmark" sl-processed="1" style="color: #19196a; font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;" title="3:14 am"><span class="entry-date" style="margin: 0px; padding: 0px;">March 26, 2015</span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h1>
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Transitioning to home life has been a bit strange. In my heart, I wasn’t ready to leave Sierra Leone. I wish I could still be there doing good work, falling exhausted into bed each night and looking forward to helping my patients again the next day. It’s an abrupt change: I went from feeling like there weren’t enough hours in the day to help everyone I wanted to help, to suddenly being back at home on my couch, not allowed to touch a patient for 21 days. The best thing for me right now would be to dive into another mission, but nobody wants me traveling to the developing world while I’m self-monitoring for Ebola. Fortunately, I have <a href="http://onenurseatatime.org/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;">One Nurse At A Time</a> to keep me busy!</div>
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One Nurse At A Time is an awesome nonprofit that helps nurses volunteer their skills at home and abroad. I am lucky enough to be Vice President of One Nurse, and it is constantly inspiring to work with others who share my passion. I have loved watching first-mission nurses light up the way I did the first time I set foot in Kenya almost a decade ago. Because I feel so strongly about the importance of One Nurse At A Time’s work, I have helped organize our first fundraising event for this May. For those of you who have been enjoying my blog and want to support this kind of work for nurses everywhere, this is a way to do it! Myself and at least two other Ebola responders will be there to share our experiences in West Africa. There will be appetizers and drinks, a performance by a Guinean dance and drum group, a silent auction with some awesome items and experiences, and a chance to try on our Ebola suits if you want to!</div>
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All of your kind words meant so much to me while I was on this mission, and I would love the chance to see all your faces and thank you in person. You can <a href="http://www.brownpapertickets.com/event/1362515" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;">buy tickets here</a> and please feel free to invite your friends! Here’s the official invitation:</div>
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<img alt="" src="https://blogger.googleusercontent.com/img/proxy/AVvXsEhDJhCVeNoABR2vR-3PkGZ-6FmifSskvkp-75kNzmP3YR-O90qWUPwfna7EF9_LzHD6RsnMHU5FsXobjNuOJPv5PasJ_0XdQTKVP5LNGhZ2wl74CtQZLITerRiYqc-tAxutwXL_hqJNN5NAAK5xq9V8qOADXbdn6-K-HE7wlCVkoyQa_SBJZkv3VCNfqOzd2nvgMZrl-DSw8ZJ2HUSbC3fYd3xKAxMy9g=s0-d-e1-ft" style="border: 0px; height: auto; margin: 0px; max-width: 100%; padding: 0px;" /></div>
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You are invited to One Nurse At A Time’s celebration</h1>
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Come hear about Sue Averill and Emily Scott’s recent experiences working at Ebola clinics in West Africa</h3>
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<b style="margin: 0px; padding: 0px;">When:</b> <span class="aBn" style="margin: 0px; padding: 0px;">Saturday, May 30th at 7 p.m.</span><br style="margin: 0px; padding: 0px;" /><b style="margin: 0px; padding: 0px;">Where: </b>Nalanda West, 3902 Woodland Park Ave. N, Seattle, WA 98103</div>
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<li style="list-style: square; margin: 0px 0px 0px 20px; padding: 0px;">Appetizers and drinks will be served</li>
<li style="list-style: square; margin: 0px 0px 0px 20px; padding: 0px;">The <i style="margin: 0px; padding: 0px;">Message from Guinea</i> drum group will perform</li>
<li style="list-style: square; margin: 0px 0px 0px 20px; padding: 0px;">There will be a silent auction of art, experiences and get-aways</li>
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<b style="margin: 0px; padding: 0px;">An amazing party supporting a great cause!</b></div>
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Tickets are $30 each.<br style="margin: 0px; padding: 0px;" /><a href="http://onenurseatatime.us10.list-manage.com/track/click?u=9ea380aa5d53670991eec2622&id=17b3557da9&e=951b22d020" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" target="_blank">Sign up here.</a><br style="margin: 0px; padding: 0px;" /><a href="http://onenurseatatime.us10.list-manage.com/track/click?u=9ea380aa5d53670991eec2622&id=7e9992bcc3&e=951b22d020" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" target="_blank">M</a><a href="http://onenurseatatime.us10.list-manage.com/track/click?u=9ea380aa5d53670991eec2622&id=550fff7eec&e=951b22d020" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" target="_blank">ap of event location</a></div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-71089762294321256992015-03-22T22:17:00.003-05:002015-03-22T22:17:46.168-05:00Home and Healthy<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span class="meta-prep meta-prep-author" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">Posted on</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><a href="https://wanderingaimfully.wordpress.com/2015/03/23/home-and-healthy/" rel="bookmark" sl-processed="1" style="color: #19196a; font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;" title="12:24 am"><span class="entry-date" style="margin: 0px; padding: 0px;">March 23, 2015</span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h1>
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As some of you already know, I arrived home in Seattle a few days ago. It is a bit earlier than I was planning on leaving Sierra Leone, which is deeply disappointing to me. Since one of our PIH colleagues tested positive for Ebola, I’ve been pretty absent on this blog; while I have been writing a lot for myself as a way to process everything, the only experiences I can share with accuracy and fairness are my own.</div>
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I have never for a moment been cavalier about the work we were doing in Sierra Leone, but the true cost was suddenly brought into sharp, painful focus when our colleague’s test came back positive. Since no PIH clinician had contracted Ebola yet, it was easy to put the possibility in a back corner of my brain where it wouldn’t be examined too closely or often. Now, it takes up far more real estate in my head than it should. From venting with my colleagues, I know that most of them feel the same way. For the first several days after our colleague fell ill, we were intensely aware of every sensation our bodies experienced – a mild, passing headache; an achy neck after a bumpy car ride; feeling tired in the middle of the day. I’m not a religious person, but I did something close to prayer when I went to the bathroom each morning that what came out wouldn’t be diarrhea (sorry for the over-share!). If I thought too hard about it I’d get a moment of chest-tightening panic: Was this the first sign that I was getting sick too?</div>
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My beloved oral thermometer kept my worries in check. I bought it at the drugstore before I left the states, choosing a bright orange one because it was a cheery color. I don’t think anyone has ever gotten so much use out of a thermometer in such a short period of time. Whenever my mind starts to spin, I pop it under my tongue, close one eye, and focus on the digital readout right in front of my nose. I watch the number tick up, slowing down as it reaches my body temperature. I can tell by how fast the numbers change that it’s going to be normal. Three little beeps tell me I’m officially afebrile, and I can take a deep breath again.</div>
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Which is why I felt confident facing CDC questioning at immigration in Chicago – I had just checked my own temperature minutes before. I’d sucked down an impressive amount of water and done my best to sleep on the long flight. The last thing I wanted to tell the CDC interviewer was, “You know, now that you mention it, I do have a bit of a headache, feel pretty exhausted, and I’ve got all these aches in my joints…”</div>
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As it happened, my colleagues and I had more fun at immigration than we probably should have. Knowing we were nearing the end of a long journey and, for the first time in a while, had access to world-class healthcare should we need it probably made us all a little giddy. I scanned my passport at one of the kiosks and, along with the rest of my colleagues, was rewarded with a slip of paper with a big black X across it since I was coming from West Africa. The immigration officers checked our passports and handed us surgical masks to wear. We gathered in a small group of masked travelers watched over by an official, giggling about how alarming we probably looked to everyone else. We were led to a few rows of chairs and asked to wait, as a CDC official behind a blue curtain called each of us in turn to be questioned about our exposure to Ebola. Friendly airport employees brought us juice boxes and granola bars, and thanked us for our work. Each time one of my friends was called to be interviewed, we could still see their silhouettes and hear them through the thin blue curtain; it looked comically like confession from our side, as though we would be asked to recount our sins of the past few weeks.</div>
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We had worried that coming back to the US so soon after an American clinician had contracted Ebola would be unusually difficult (see Kaci Hickox’s experience for reference). In reality the process was completely rational and simple. A CDC employee asked me a series of questions to determine my risk category, went over the process I’d adhere to for the next three weeks, and issued me my Ebola responder goody bag: a chart to record my temperatures and symptoms, a contact list, a card to carry in my wallet, and an illustrated list of Ebola symptoms (as though I might forget!). I even got a cell phone loaded with minutes and the CDC’s number so that Public Health can get in touch with me any time and vice versa. I’ll call it my burner phone and pretend I’m in the CIA.</div>
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Before I knew it, I was done. With no time to say a real goodbye to my friends as they were still being interviewed and I had to catch my connecting flight, I joined the everyday crowd of people navigating their way through the airport, none of them the wiser that I’d just returned from fighting Ebola in West Africa. Not that I’m any risk to them at all, of course. But I felt so defined by the experience I had just stepped out of, that it seemed to me that strangers would be able to take one look at me and somehow see it.</div>
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The reality is that I’m at no more risk than I was before all this happened. I was not exposed to our colleague after he was ill, and I am confident that I personally followed safety protocols as strictly as possible. There is no reason for me to be quarantined and no law requiring me to do so, as I <a href="https://wanderingaimfully.wordpress.com/2015/02/22/and-were-off/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;">explained before I left</a>. Public Health started counting my 21 days when I arrived in the US, but on my own calendar I’ve marked my last shift in the Red Zone, and the last time I treated a confirmed Ebola patient, which was a few days before that. I’ll feel safe personally when I get three weeks out from those markers, although obviously I will continue to take my temperature and comply with Public Health for as long as I’m required to. I’ll do my best in the meantime to get back to normal life, although for me “normal” will be a tough bar to reach until everyone I served with is home and healthy.</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-63182618860585019742015-03-16T22:37:00.001-05:002015-03-16T22:37:45.692-05:00Update<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span class="meta-prep meta-prep-author" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">Posted on</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><a href="https://wanderingaimfully.wordpress.com/2015/03/16/update/" rel="bookmark" sl-processed="1" style="color: #19196a; font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;" title="11:56 am"><span class="entry-date" style="margin: 0px; padding: 0px;">March 16, 2015</span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h1>
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I apologize for my silence over the last several days. I’m sure most of you have seen in the news that a PIH clinician was infected with Ebola. I have been reeling from the news since it was announced, and struggling with how to continue writing this blog as my colleague fights the virus. I have no information to share that you won’t read in the news, so all I can honestly tell you is how I’m doing.</div>
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To assuage any worries about my well being: I am feeling completely healthy and my risk category has not changed. I am not the clinician who is infected, nor am I among the other Americans who were flown home due to possible exposure. I will try to write more soon, but for now please send all of your positive thoughts to my colleagues. Thank you all so much for your concern and support!</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-27109137060109168042015-03-07T18:40:00.000-06:002015-03-07T18:40:29.827-06:00Aminata and Baby Boy<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h1>
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Written Friday March 6</div>
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On the day Abass died, I was on my way back to Freetown where I have been assigned to work at the holding center for pregnant women for the rest of my time here. Let me explain what that means:</div>
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With limited resources, it isn’t feasible to have Ebola Treatment Units in every town in Sierra Leone. Ebola Holding Units are used to isolate and treat suspected patients until their Ebola status can be confirmed. EHUs are peppered around the country, and patients with a wide variety of maladies show up there to be triaged to see if they fit the case definition for Ebola. If they do not, they will either be sent home or referred to a government hospital for further care. If they do show symptoms that make clinicians suspect they have Ebola, they are admitted to the holding unit and cared for until their Ebola blood test (called a PCR) comes back. Depending on the center, a PCR result can take anywhere from several hours to several days. The patients whose results come back positive are then transferred to a full Ebola Treatment Unit for care.</div>
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The holding unit where I now work is specifically for pregnant women, and it is the only one in the country. Even before Ebola, the state of obstetric care in Sierra Leone was abysmal. In 2010, one in every eighty-three women died in childbirth (that’s forty times higher than in the US). Since the outbreak, pregnant women have been completely abandoned.</div>
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The problem is that labor and common complications of pregnancy can look frighteningly like Ebola. If a pregnant woman showed up to triage in America complaining of abdominal pain, weakness, and nausea, we would assume she was in labor. But here, among healthcare workers who have watched their colleagues die, everyone sees Ebola. They also know that the mortality rate among pregnant woman with Ebola is nearly 100%, and with limited resources, a case can be made that time and medicine would be better spent on someone who has a chance of surviving. Add to that the fact that the viral load in the fetus, placenta, and amniotic fluid is very high (and even a normal labor is a very messy processs involving a LOT of bodily fluids), and suddenly a woman in labor looks like a bomb about to go off.</div>
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As a result, many pregnant woman have been isolated and essentially left to die since the outbreak began. Princess Christian Maternity Hospital (PCMH) is the only hospital for pregnant women in the entire country, and descriptions of it during the height of the outbreak are horrifying. A <a href="http://www.newyorker.com/tech/elements/ebola-maternity-ward" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" target="_blank">New Yorker article</a> from last October makes it sound like hell on earth: “Inside the ward, a woman writhed and groaned on the floor in a pool of bleach and bloody diarrhea, a full body bag lying next to her. Staff entered and exited without properly donning protective gear. There was a shortage of numerous supplies, and used equipment was being discarded in a hole dug outside. A woman wandered between rooms, holding her dead infant.”</div>
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Since then, the situation at PCMH has improved, although it is still by no means ideal. On the compound that PCMH shares with the children’s hospital, PIH staff now help run a holding unit to care for pregnant women who would otherwise be turned away. The main hospital now cares only for pregnant women who are clearly Ebola negative; the others come to us.</div>
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Our unit is housed in what used to be the radiology building. Like Maforki ETU, the nurses station and donning and doffing areas have been added on to the original structure with tarps and wood. We have enough beds for nine women in three rooms, plus two little rooms with a bed in each designated for deliveries. There are six international PIH staff, and plenty of national nurses. Our family practice doctor leaves tomorrow, so for now we nurses will run the show.</div>
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In our small unit next door to the full hospital, we do the best we can to keep these women alive until they can receive proper care. Because we can’t be sure which patients are having common labor complications and which have Ebola, we do all of our care (and if necessary, deliveries) in full PPE. Although some of our patients do turn up positive (one this week and two the week before), we see many more complicated labors than we do Ebola. Unfortunately, the only way to distinguish between the two is to do a PCR blood test. A lab run by the Dutch has recently arrived on-site that can process our samples in several hours, but before that it could take days. On my third day at the holding unit, the Dutch lab’s generator was broken so no tests were being processed.</div>
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Unfortunately, the time it takes to get Ebola test results is the difference between life and death for many moms and their babies. If a woman shows up at triage hemorrhaging, for example, in America she would have an emergency cesarean section to save the lives of her and her baby. Here, bleeding is a sign of Ebola, so she must first come to our holding unit. No one will perform a c-section on a woman suspected of having Ebola. It would be too risky for the staff, and if she did have Ebola she would likely bleed to death during the surgery anyway. But for those woman who arrive likely bleeding because of a placenta previa or a uterine rupture, we hope we can keep them stable long enough to prove they are Ebola negative and get them to the operating room.</div>
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To make the situation worse, prenatal care has halted along with the rest of the country’s health systems since the outbreak began. Aminata* is a perfect example of this. She was the first patient I cared for at PCMH holding unit, and when I first saw her she was lying on the ground next to her bed, barely conscious. She had arrived at the hospital eclamptic – a condition of pregnancy in which high blood pressure causes seizures (for reference, I usually tell people that eclampsia is what Sybil died of in Downton Abbey, which, it’s worth noting, was 100 years ago). I have never seen an eclamptic patient in America. Because our moms get consistent prenatal care, the warning signs are identified early and I often see pregnant woman with PRE-eclampsia (essentially, we have caught them before the condition is serious enough to cause a seizure). In Sierra Leone, no one is caught at the pre-eclampsia stage.</div>
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Aminata had come to traige unconscious, and because she was living in a home that was quarantined due to contact with an Ebola case, no one at the main hospital would touch her. She was admitted to our holding center, and the national nurses reported that they had delivered her baby vaginally overnight, while she was still unconscious. Her first PCR had come back negative, but because she had come from a quarantined home, protocol required that she have another test three days later before the main hospital would take her or her baby.</div>
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When I found Aminata lying on the floor, her little baby boy was wrapped in a lapa on her mattress a few feet away from her. She was not aware enough to know that he’d been born. My colleague and I lifted her onto the mattress and began to clean her up when I saw her eyes roll back into her head and her eyelids begin to flutter. I knew what was happening only from books, and it took me a moment to process that I was seeing my first eclamptic seizure. A second later her arms began to twitch, and her whole body followed. I turned her onto her side while my colleague shouted out to the Green Zone for medications. A minute passed, maybe two. Aminata continued to seize while we waited for medications to be drawn up and handed in to us. I felt like I was in a nightmare.</div>
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Aminata’s seizure spontaneously resolved just before her medications arrived. Among other things, we treated her with intramuscular injections of magnesium sulfate, though in the US she would have been on an IV drip under constant supervision. In an Ebola holding unit, where the heat often drives us out of our suits and away from our patients in under an hour, there is no way to continuously monitor an extremely ill woman. There are also no IV pumps to make sure the exact dose is administered, and no lab testing to check the level of magnesium in her blood.</div>
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Despite all this, Aminata has come around. One of the PIH-ers who has been working at PCMH for weeks told me that they often see good outcomes in eclamptic mothers, despite their shockingly late arrival for treatment. When I visited Aminata yesterday she was lethargic but completely conscious, a huge improvement from the day before. I unwrapped her baby and put him on her bare chest, and she stared down at him in wonder.</div>
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Unfortunately these two are not out of the woods yet. The little boy is small (to the naked eye, anyway; we don’t have an infant scale) and not interested in breastfeeding. We have been feeding him formula while we encourage Aminata to keep trying, but it’s not a viable long-term solution for a woman who can’t afford the formula, let alone clean water to mix it with. But soon their fate will be out of our hands. Aminata’s second Ebola test came back negative, so we cannot keep her in our unit any longer. The day before, the woman in the bed next to her turned out to be Ebola positive. Every minute Aminata spends in our holding unit puts her and her baby at risk for catching Ebola from someone else. Aminata is no longer ill enough to be admitted to the main maternity hospital, so she’ll go home with her family tonight. In America, I would refer her to a lactation specialist to make sure her baby eats and gains enough weight. Here, there’s no such thing.</div>
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The sad truth about this job is that I can take on my own small role, and nothing more. I wish I had the time and resources to follow up on Aminata, but in reality I barely have a moment to chart on the care I gave her, before some other issue falls at my feet. Yesterday one of the lab personnel saw a pregnant woman wandering around alone in the hospital compound, vomiting. Without touching her, she guided her to our holding unit, where the 17-year-old told our nurses that her mother, father, sister, and brother had died of Ebola. She said she had come to the hospital when she started to have vomiting and diarrhea, and had been turned away at triage. For the past three days, she had been sleeping in the hospital compound, being sick in the lab stairwell.</div>
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After a fair amount of horror at the idea that an Ebola-positive young woman had been wandering around the compound spreading infectious fluids everywhere, we got to the bottom of her story. Her family had actually passed away three months ago, longer than the incubation period, so she hadn’t really had Ebola contact. If she was going to catch Ebola from her relatives, she would have gotten sick in the first 21 days. The nurses at triage confirmed that they had seen her and turned her away since she didn’t meet case definition: Her vital signs were fine, no fever, just a pregnant woman with morning sickness. She’d told them that the person she was staying with since her family died had kicked her out of the house, and she had essentially turned up at the hospital out of desperation.</div>
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We all breathed a little easier knowing that, based on her history, it was unlikely that she had Ebola. Her blood test came back later that day and confirmed that she was negative. Like Aminata, this young woman now poses a problem that we aren’t equipped to solve. She insists that she has no place to go and no one to turn to now that we must discharge her. With no social worker and no idea what options we have, we PIH-ers turned to the national staff to help us come up with a solution for her. The last I heard before I head to leave for the day was that the staff was collecting some money for her. She’ll get her discharge package from us (clothes, medicines, and a certificate saying she tested negative for Ebola) and presumably they’ll send her on her way.</div>
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As the Ebola outbreak gets under control and the Sierra Leonean government attempts to return to normal healthcare, the issue of pregnant women will continue to be a problem. No one quite knows what to do with them. Over dinner tonight we got a call asking us to admit a woman in labor coming from a quarantined home. My colleague asked the usual questions, trying to get a sense of how likely it was that the woman had Ebola. As she untangled the story, it turned out that this woman was not in fact in labor – just very pregnant, and looking like she was about to pop. She had no symptoms of Ebola, no fever, no indication that she was sick at all. But she was hours away in Port Loko district in a quarantined home, looking like she might go into labor at any moment and making everyone very nervous. Couldn’t we just hold on to her until she went into labor?</div>
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The trouble with pregnant women in the setting of Ebola is that they’re all in a gray area. If this woman had not been pregnant, she would have remained quarantined in her home and only been brought to a holding center if she began to show symptoms. According to case defintion, she has no business being in a treatment center. But when she goes into labor, who will care for her? With no maternity care available in Port Loko, can we reasonably ask an untrained traditional birth attendant to do this delivery without PPE under the assumption that the mother is Ebola negative? If we tell her to come to our unit when she goes into labor, will she get here in time?</div>
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No matter what decision we make, it won’t affect just this one woman. We’re told there are actually ten women in quarantined homes in Port Loko in various stages of pregnancy. We can’t take them all at our holding unit. They would more than fill all of our beds, and we would have no space to care for the women from Freetown who continue to show up needing care. Much as we’d like to, we can’t take on all the pregnant women in Sierra Leone in day. We are at ground zero for rebuilding maternal care in this country, doing the best we can one day and one patient at at time.</div>
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*Names changed to protect privacy</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-38393456995522686952015-03-04T21:55:00.000-06:002015-03-04T21:55:00.836-06:00Abass’s Smile<h2 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 28px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h2>
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I arrived for my evening shift at Maforki on Monday anxious to hear how my patients had fared since I’d last seen them 24 hours before. I expected (and part of me hoped) to hear that Foday had passed away and was no longer suffering. No one I worked with could remember seeing a patient recover after progressing to the bleeding stage, so it had begun to feel like we were simply torturing him. I dreaded the thought that Abass might have died.</div>
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I immediately scoured the whiteboard with patients’ names and breathed a deep sigh of relief to see that Abass was still on it. When day shift reported that he had seemed a little better to them, I told myself it was because he was on the upswing; that the worst hadn’t killed him, so he would survive.</div>
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Monday night taught me that you can’t make predictions about Ebola. Another patient in Abass’s room, a 36-year-old woman named Mariatu, had been looking comparatively well when I met her on Saturday. She was sitting up in bed, eating and drinking and completely lucid, unlike her roommates Foday and Abass. Although she had diarrhea and vomiting the last time I’d seen her on Sunday, she still seemed to be in better shape than the others. When we reached her bedside during our first round in the Red Zone, she was moaning with pain and laboring heavily to breathe. Since we hadn’t anticipated Mariatu being in so much discomfort, we hadn’t brought any pain medicine into the Red Zone for her. We had used our last dose on a patient in the previous ward. She would have to wait until our next round in a couple of hours before we could get her some. Promising her that we would be back to take care of her, we left Mariatu in bed moaning in pain.</div>
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When we returned for our second round at 9:45 pm, it felt eerie in the dim fluorescent light of the Red Zone. We found Mariatu lying on the ground just outside the door of her ward. I suddenly remembered another nurse checking under the beds while he was giving us a tour of the Red Zone, and telling me about this “weird Ebola thing” – that patients often crawl out of bed near the end and die on the floor.</div>
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But Mariatu was still alive, breathing hard and looking at us with wide, terrified eyes. I helped my coworkers sit her up against the wall, then stepped into the ward to check on Foday and Abass. When I turned back to the door a minute or two later to ask if they needed help getting Mariatu back into bed, they told me she was already dead.</div>
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I couldn’t believe I’d heard right. I started to take a moment to process it, then looked around at the rest of my team who were moving forward with the job at hand. With only 90 minutes in the Red Zone, we don’t have any time to waste. Mariatu’s body was left where we found her and covered with a lapa. Ebola is extremely contagious in the bodies of the deceased, and it wasn’t our job to care for her any longer. The corpse team would be called after we left the Red Zone, and they would come the next day to move her to the morgue so the specially-trained burial teams could come to pick up her body. Nowadays every death in Sierra Leone (whether Ebola-related or not) is handled by the burial teams in full PPE, just to be safe.</div>
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With nothing left that I could do for Mariatu, I walked back to check on 10-year-old Abass. He and his 25-year-old neighbor Foday were now both lying on mattresses on the floor; they’d been moved out of bed when they were agitated and the clinicians worried they might fall. Abass had pulled his IV out since we’d last seen him, and another team member felt he would die overnight if we didn’t get another one in him. In the poor light, no one felt excited about attempting it: An accidental needle stick injury to one of us is statistically a death sentence. One of the national nurses stepped up without missing a beat, and had a beautiful IV in Abass’s arm before the rest of us could even tell her to be careful. We hooked him up to a bag of IV fluid and were feeling pretty good.</div>
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Then the lights went out.</div>
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I won’t pretend it isn’t scary to be the the Red Zone of an ETU at night with no lights. You become extremely aware of all the infectious material around you that you suddenly can’t see. I hate to be dramatic, but it does feel a little like a horror movie. Unfortunately power outages aren’t an unusual occurence, so our more experienced coworkers had warned us beforehand that if we found ourselves in total darkness in the Red Zone, we would have to stop whatever we were doing and leave. I knew we had to go for our own safety, but I wanted to scream out of frustration, since we’d just arrived and had barely started caring for our patients. I was fortunately still holding the battery-powered LED light I’d shined on Abass to help the national nurse get more direct light to start his IV. We all agreed we could take a moment to unhook his IV fluids, otherwise he would tear his IV out again as soon as we walked away.</div>
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As soon as we had unhooked Abass’s line and resolved ourselves to leave, the ceiling lights sputtered and flickered back to life. The Red Zone is not a comfortable place to be, but I silently cheered that we wouldn’t have to leave. We restarted Abass’s fluids and decided to try to feed him since he was awake and calm. Fortunately some formula had been left in the Red Zone, so I drew up a few mililiters in a small syringe, squatted on the floor next to his mattress, and held it to his lips. I knew he had painful mouth sores and I worried that he’d refuse it, but he silently swallowed the tiny amount that I squirted into his mouth. I flicked away an ant that skittered across his mattress. Another nurse sat above him, stroking his head. We both encouraged him to eat and cheered him on every time he swallowed a few drops. His eyes met mine while I told him how well he was doing, and I felt sure he was lucid. I tried a silly little dance and suddenly he was smiling. His grin was weak but wide, and his eyes were bright, and all of a sudden I could clearly see the little boy he was before he was sick. I laughed and smiled back at him as hard as I’ve ever smiled, certain that he would see it in my eyes if I could just smile hard enough, even though my mask and hood covered every other part of my face. He babbled at me in a language I couldn’t understand, then called out “Auntie, auntie!”</div>
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I don’t know how long my friend and I sat there, entreating him to swallow drops of formula, rubbing his head and his bare chest, dancing and singing in our suits, hoping to elicit another smile. We were rewarded with a few more beautiful grins before Abass shut his mouth and refused to eat any more.</div>
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Our time was up anyway. I knelt beside him and told him he was strong. I promised we would be back for him soon. Maybe he didn’t understand, but I think some things don’t need to be translated. I reluctantly stood up and walked away, leaving him alone with his neighbor Foday struggling to breath, and the body of Mariatu just outside the door. As we were leaving the ETU later that night, one of the other nurses told me she thought he had a shot.</div>
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Abass died the next day.</div>
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I don’t know if he was afraid, or in pain, or even if anyone was there with him. I hope someone was. I hope I made his last night a little less frightening. I think I brought him joy and I have to believe that matters.</div>
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I wish I could find the right thing to say to make his death meaningful, but I don’t think there’s any meaning in a 10-year-old dying alone on the floor. I could rant about how he might have been saved if he’d had access to the best medical care in the world, but I’d rather just let him be a sweet little boy than an example of all the injustice in the world. Even though it was only for a fraction of the time I spent with him, I’ll always think of him as Abass with the big contagious grin and the bright eyes, not as one of thousands of children who have died of Ebola. I didn’t know him very well, but now you all know a little piece of him too, and I think that counts for something.</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-67113934499071383132015-03-02T23:08:00.003-06:002015-03-02T23:12:17.403-06:00Foday and Abass<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span class="meta-prep meta-prep-author" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">Posted on</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><a href="https://wanderingaimfully.wordpress.com/2015/03/02/foday-and-abass/" rel="bookmark" sl-processed="1" style="color: #19196a; font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;" title="7:44 pm"><span class="entry-date" style="margin: 0px; padding: 0px;">March 2, 2015</span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="meta-sep" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;">by</span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span class="author vcard" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; margin: 0px; padding: 0px;"><a class="url fn n" href="https://wanderingaimfully.wordpress.com/author/emilymwende/" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;" title="View all posts by Emily Scott">Emily Scott</a></span></h1>
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Written Sunday 3/1<br />
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The only word I have been able to find to describe this experience so far is surreal. Today it became real for me.</div>
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Today was our first day actually treating patients in Maforki, PIH’s Ebola Treatment Unit. Yesterday we set foot there for the first time, donned and doffed our suits twice to get a tour of the Red Zone, but didn’t do much actual patient care since we were still getting oriented. Today we were buddied up with a more experienced clinician and assigned specific patients to care for during our shift. Today Ebola ceased to be a faceless mass of African suffering, and became two individual human beings.</div>
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I’ll give you all the lay of the land at Maforki before we get much further. Maforki ETU belongs to the Sierra Leonean government, unlike many Ebola centers that were constructed from the ground up by the nonprofits that came to run them. When PIH arrived in Port Loko at the peak of the outbreak last October, they were the only international health workers in the entire district, which had 150 confirmed Ebola cases and zero adequate facilities in which to treat them. The Maforki ETU had been converted from a school and was overflowing with patients literally dying for care. When PIH staff came to tour it to learn about how to construct an ETU, the Sierra Leonean health minister stopped them in their tracks. He was tired of international groups coming to tour government ETUs, telling them what was wrong, and then leaving to build their own instead of fixing the existing centers from the inside. He insisted that his people could not wait 8 weeks for care while PIH constructed their own center. He wanted them to start working in Maforki the next day. PIH could see that he was right, and they have been doing the best they can with what they have at Maforki ever since.</div>
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Maforki is a built out around what used to be a school. The patient wards are the old classrooms, large concrete buildings painted red on the outside, with several beds in each. When it was turned into an ETU, additional basic structures were added at the periphery: a triage area, nurses’ station, meeting room, areas for donning and doffing PPE. Nailed together out of mismatched wood and blue tarps, the whole thing looks a bit ramshackle, but the center is known in the area for giving excellent care. Port Loko residents who fear they have Ebola ask to be brought to Maforki because they have heard they’ll be treated well.</div>
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To enter, you must dip the bottoms of your shoes in a bucket of chlorine, wash your hands in chlorine, and have your temperature taken at the gate. The whole center is divided into two main areas: the Green Zone and the Red Zone. The clinicians’ areas are in the Green Zone, so we can have meetings, draw up medications, eat meals, etc in an area that is not contaminated with the virus. The patient wards are in the Red Zone. No one steps one foot into the Red Zone for any reason unless they are in full PPE, and nothing you take into the Red Zone is allowed to come out.</div>
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At the beginning of each shift, the staff gathers in front of the large white board that shows the names and medical information of each of our patients. Today there were ten (five confirmed Ebola, and five suspect). We discuss how each one fared overnight, and divide them up between the nurses. My group of nurses was assigned to the confirmed Ebola patients, so we huddled at the nurses’ station to make a plan.</div>
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Because we are limited to 90 minutes in our PPE, we need to decide everything we’re going to do before we enter the Red Zone. We also need to be deliberate about gathering any supplies we might need, since there’s no way to step back out of the Red Zone to grab something once you’re inside. The Suspect Ward does have a wooden slide from the window of the supply room in the Green Zone going over the fence into the Red Zone, so if we need something we can ring the bell on the Red Zone side and someone will slide whatever we need down to us. But again, that just wastes time in your suit.</div>
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So my team drew up all of the medications we thought we’d need, IV start supplies, plenty of bags of IV fluid, rags, and lapas (beautiful African fabrics used for just about everything, but in this case as sheets). I found myself giving doctors tips on how to draw up meds, since at home they are normally the ones writing orders, while nurses carry them out. Here in Maforki, it’s all hands on deck and the doctors gladly do nursing care with the rest of us. One of our patients had just been confirmed Ebola positive this morning, so we would need to move him from Suspect to the Confirmed Ward. We had been told he was too sick to walk, so we brought a body bag to put him on so we could carry him.</div>
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Then it was time to don our PPE. I hunted for two pairs of gloves in my size, as well as a pair of black rubber boots that fit me, out of the many drying on a rack in the sun outside the nurses’ station (exposure to sunlight kills the virus, too). Then I joined the rest of my team in the donning room, the last stop before you enter the Red Zone. A few Sierra Leonean staff double-checked us as we donned our suits. They cut thumb holes in the sleeves so they wouldn’t ride up and expose our wrists, and sprayed de-fogger on the inside of our face shields. I felt myself start to sweat as soon as I zipped my gown up. After writing our names and whether we were a nurse or a doctor on the front and back of our suits, they noted the time we were entering the Red Zone on our sleeves, and literally gave us a stamp of approval on our forearms. We were ready to go in.</div>
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As we walked through the doorway into the Red Zone, I took up the “Ebola pose” that we had been taught in training – interlocking my fingers in front of me at about the height of my navel, to discourage me from reaching up to touch my face or anything else around me. One of the Maforki nurses told me that when he’s in the Red Zone he pretends he’s playing a giant game of Operation, trying not to touch anything around him that he doesn’t have to. He assumes that every surface is contaminated with Ebola.</div>
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The Red Zone is designed to flow from lowest to highest risk, so the first ward we came to was Suspect. The Suspect patients (who have Ebola symptoms but have not yet had a positive test) are divided between those who have dry symptoms (fever, headache, hiccups, weakness, etc) and those who have wet symptoms (vomiting, diarrhea, and bleeding). The idea is to decrease the likelihood that one patient will infect another with Ebola. “Wet” patients produce a huge amount of highly infectious diarrhea and are often too weak to make it to the toilets. Many wards have old cholera beds, which have a large hole at the center that patients can position themselves over, with a bucket on the floor underneath to catch their waste.</div>
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Unfortunately Maforki does not have its own lab, so we send our blood samples to another nonprofit which runs our lab tests and emails us the results. The process can take 12-36 hours. In the meantime, all suspect patients must be housed within the Red Zone in case they do turn out to be Ebola positive. We don’t get many patients who return after they’ve been discharged negative, which is reassuring. We did have an 11-year-old girl in the suspect ward today who was here for the second time. She came to triage once before and was admitted to Suspect because her symptoms met the case definition for Ebola. She turned out to be negative and was sent home after a few days, but because she spent time in an ETU, she had to be followed as a “contact” for 21 days. At some point during that monitoring period, she spiked a fever again and was brought back to us. A fever by itself isn’t cause for alarm, but fever plus a history of contact with an Ebola patient is one of the case definitions that makes a person an Ebola suspect. Since she’d had contact with Ebola patients in the last three weeks, we had to re-admit her and test her again. On my first round of the day, I found her sitting in the alone in the courtyard of the Suspect ward, where I imagine dozens of children used to play during recess at school. We brought her a fresh bottle of cold water and encouraged her to drink but she refused. All I wanted to do was comfort her, but it’s incredibly hard to connect with a child from inside a suit that makes you look like a monster. Fortunately her test came back negative today, and we sent her home for another 21 days of monitoring.</div>
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Another one of our patients today was not so lucky. Foday (names changed to protect privacy) was brought to Maforki yesterday already very ill, and his test came back positive this morning. We needed to move him from Suspect to the Confirmed ward. When my team of four entered the Suspect Wet ward, Foday lay curled in bed in his own waste. We carefully cleaned him up, stepping over to a sprayer who followed us with a tank of chlorine on his back to rinse our outer layer of gloves whenever they were visibly soiled. Once Foday was as clean as we could get him, we rolled him onto the body bag we had brought with us and lifted him out of bed. Communicating with each other the entire time, we made our way out of the Suspect ward, through the gate into the Confirmed area, and lay him down on a bed in a room with the other Confirmed patients.</div>
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In the bed next to Foday lay 10-year-old Abass. When we visited him yesterday he had barely responded, and we worried over the bleeding we saw at his gums – a late sign, and not a reassuring one. Today he was reaching out for something with both hands, probably a family member whose presence he was hallucinating. The team before us had given him his meds, but I couldn’t help walking over to him to try to give him some comfort. When I entered his field of vision he recoiled. Between the language barrier and his delirium, I couldn’t explain to him why his family wasn’t there to wipe his face and hold his hand, and he was instead being cared for by a stranger dressed like an alien.</div>
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Having used up a lot of our allotted time already, we went to work giving Foday his medications. At Maforki we are aggressive with IV fluids, although it’s difficult because we can only give them while we are inside the unit with the patients. Experience has shown that if we hook up an IV line and leave it hanging, we will return a couple of hours later to find that the patient has accidentally ripped it out and bled everywhere. So we did the best we could with the time we had left, giving Foday IV fluids, antibiotics to prevent secondary infections, artusenate for malaria, and paracetamol for his fever. Although we had cleaned him up after he’d soiled himself again, by the time we had to leave he was already lying in his own diarrhea for the third time since we’d arrived about an hour before. With no time left, we had to leave it for the next round of clinicians.</div>
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Although we technically can spend 90 minutes in the PPE, a good chunk of that is taken up by the doffing process. As I’ve mentioned before, removing our PPE is the point at which we’re most likely to contaminate ourselves. We have infectious body fluids all over us, and we have to get out of our suits without getting a speck of it on ourselves. Here’s the process:</div>
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I approach a national staffer in full PPE who has a tank of chlorine on his back attached to a sprayer, and as he sprays I wash my hands (or rather, my outer layer of gloves) for a full minute. He then sprays the whole front of my suit, and then asks me to turn around so he can spray the back. When he’s finished, I tear off my apron very carefully so that the pieces don’t snap and flick any fluid at me. Then I wash my gloves with the chlorine sprayer for a full minute again. Next I move to my doffing station, where I stand in a bucket of chlorine and shuffle my feet for a full minute, to kill the virus on my boots. I step out of the bucket and into my doffing station, where a bucket full of chlorine awaits. I open the tap and wash my gloves again for a full minute, making sure to keep some chlorine in my hands at the end to splash on the tap, so I don’t pick up any virus that I left there when I turned it on. I step over to a full length mirror leaned against the wall, and slowly, carefully unzip my suit and then pull the hood back off of my head. I wiggle the suit down my torso, past the top of my boots onto the ground, making sure to only touch the outside. I then pull my hands forward, letting my sleeves roll off and my top layer of gloves with them. Now my suit is off except for my feet, so I do the Ebola dance and shuffle my boots out of the legs of my gown. Then I carefully nudge the suit over to a sprayer on the Green Zone end of the doffing station, who waits until I turn away to spray it down with chlorine (we don’t want anything splashing into our eyes). While he sprays my suit, I step back into the chlorine bucket and clean my boots again. Once my suit is sprayed, I pick it up with one gloved hand and deposit it in a large trash can (I still have my inner layer of gloves on at this point). I return to the chlorine station and wash my gloves for a full minute. Then back to the mirror, where I ever so carefully grasp my face shield with both hands, pull it as far away from my face as I can, turn my face the other way with my eyes closed, and remove it. Back to the chlorine station to wash my gloves for another minute. Next it’s the same process with my face mask, pulling it far away and turning my face so that if anything splashes, it won’t go into my mucous membranes. Then another minute of hand washing. All that’s left at this point is my final layer of gloves, which I remove at a glacial pace. The goal is to never touch my hands with the dirty outside surface of the gloves. Try putting on some gloves, dipping them in mud, and then getting them off without getting ANY on your hands. It’s tougher than it sounds. My buddy clinician, still in PPE, stands in the Red Zone and supervises me through this entire process to make sure nothing is missed. Once that is done I turn to the chlorine sprayer, who sprays the front of my boots, asks me to turn, sprays one side, asks me to turn again, sprays the other side, then asks me to turn so they can spray the back. I then lift one foot at a time while they spray the soles of my boots as I slowly back out from the Red Zone into the Green Zone. With all of my PPE finally off and my boots clean, I wash my hands for a full minute with chlorine, and then again for a minute with soap and water. To be extra safe, I’m not supposed to touch my face for then next half hour.</div>
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By now it’s almost noon, and we head to the nurses station to re-hydrate and have a snack before our second round in the Red Zone. I’m feeling fine physically. I seem to be one of the lucky ones who is surprised when our time is up, and I come out of my PPE almost as dry as I went in while others return with their whole scrubs a shade darker from the sweat. Emotionally, it’s harder.</div>
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By our second round in the afternoon, Foday was looking worse. He was having pretty much constant diarrhea, rolling over to vomit into a bucket next to his bed, and dripping blood from his nose. His fever had risen and he was tachycardic. Dried blood was caked all over his nose and mouth. We started a second IV and rushed fluids into him, and tried to clean him up from head to toe. At some point he decided he was done putting up with all of these white-suited monsters poking at him, so he rolled over and tried to stand up, clearly agitated. With two IVs hooked up and blood running down his face, any quick movement on his part would mean spraying infectious blood all over the place. As a nurse, everything in my heart wanted me to go rub his back, help him back into bed, and calm him down enough that we could continue to care for him – while everything in my brain was shouting, “Get away from him!” Suddenly my PPE seemed so fragile. He eventually calmed himself down and crawled back into bed, and I was left feeling surprised and ashamed at how afraid I’d been.</div>
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Most of the clinicians who have been here a while think he’s too far gone to recover, and I hope if they’re right that he passes away soon. I’m heading back to Maforki shortly for an evening shift, and I know we’ll do everything we can to make him comfortable. Even if he is going to die, he doesn’t have to die in pain and covered in his own mess.</div>
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Night shift tells us little Abass is looking better today, and I’m looking forward to seeing him for myself. I hope that telling Abass and Foday’s stories stories has put faces to the outbreak. The numbers we hear on the news are PEOPLE, every one of them just as important as us and our families. I will never understand why some people’s lives seem to matter more than others; why if I get sick I’ll be flown home to receive the best medical care in the world, while Fuday is dying in his own filth while we do what we can for him with the little we have.</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-87141963571780515052015-02-28T21:54:00.000-06:002015-02-28T21:54:05.623-06:00Trained and Ready<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px;">Written Friday 2/27</span></h1>
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Those of you who know me know that I’m always freezing; in the middle of the summer you’ll still likely find me curled up by the fireplace. So maybe I have the ideal constitution for working in an ETU. On Thursday and Friday we donned full PPE and trained in the mock Ebola Treatment Unit, and while I can’t say that it was a comfortable experience, I came out the other end feeling pretty good. One of my team members told me, “You were peppy in there!” which I’ll take as a compliment. When it comes to working for two hours in 80-degree heat completely encased from head to toe, I think getting out of it without heat stroke or a panic attack is a win.</div>
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<div class="wp-caption aligncenter" id="attachment_493" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Practicing treating patients in full PPE in the mock Ebola Treatment Unit " class="size-medium wp-image-493" height="225" src="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender.jpg?w=300&h=225" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Practicing treating patients in full PPE in the mock Ebola Treatment Unit</div>
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In an effort to prepare us, our instructors had described in great detail the science behind what we all know already: That it is really dang hot in there. Inside the PPE is a micro-climate of 40-50 degrees Celsius and 100% humidity. This is, as our trainers put it, an “un-compensable” environment – meaning that our normal heat dissipation mechanisms (i.e., sweating) won’t work. We were repeatedly admonished that there is NO HURRY in the ETU; if we over-exert ourselves, core temperatures can reach critical levels in under an hour. They key is to pace ourselves.</div>
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<div class="wp-caption aligncenter" id="attachment_489" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender-2.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Yikes" class="size-medium wp-image-489" height="232" src="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender-2.jpg?w=300&h=232" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Yikes</div>
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A couple of members of our group did overheat during our training in the mock ETU. Although it’s awful to watch someone you’ve grown close to as they struggle against the limits of what our bodies are capable of, it was nice to see our little family rally to help each other out. If someone starts to feel unwell in their PPE, the most important thing is to admit it and get out of the red zone asap. If someone faints and goes down in their PPE in a real Ebola unit, we’ll have a whole new set of problems. Fortunately my friends headed straight to the doffing stations, and with a little fluid and electrolytes, ice packs under the armpits, rest, and kind words, they were right as rain.</div>
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While the heat turned out to be the least of my problems, I was struck by just how restricting the PPE is once I tried to do my job from inside it. Between a hood, face mask, and face shield, my field of vision is pretty restricted. And if I don’t get my mask on just right, my breath fogs up my face shield and suddenly everything is a blurry mess. The first time I donned the full getup, I pulled my hair up in a tight bun, thinking it would be best to get it out of the way altogether. I discovered quickly that with the big lump of hair at the back of my head, if I tilt my chin to look downward, my hood pulls back from my face mask, leaving a strip of completely exposed skin on my forehead. One of the lovely Sierra Leonean nurses, who probably knows more about working in an ETU than I ever will, told me that a braid down the back works best and I was happy to follow her advice.</div>
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Another restriction to adjust to is wearing two sets of gloves on top of each other. This is great from an infection control standpoint, but garbage when you want to start an IV. Most nurses I work with in the States will throw on a tourniquet and run their bare fingers over a patient’s arm to feel for the best vein – it’s usually a better bet for finding a good one than just looking. Here, we will be hunting for shriveled veins in severely dehydrated patients, with two layers of gloves between our fingers and their skin. I’m told that this is one of the areas that the Sierra Leonean nurses excel in. While we try over and over to get an IV in, another PIH-er told me that the national staff “could get blood out of a rock.” So I’ll be keeping an eye on how they do it!</div>
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<div class="wp-caption aligncenter" id="attachment_492" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender_3.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="My fingers after an hour in PPE" class="size-medium wp-image-492" height="236" src="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender_3.jpg?w=300&h=236" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
My fingers after an hour in PPE</div>
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As we acclimated ourselves to the PPE, we split up into teams to do rounds in the mock ETU that is set up at the training center. Ebola survivors were stationed in each ward to act like patients, and we were expected to manage their care as we will in the real world. I know I just missed the Oscars, but in my opinion every survivor we worked with should get one. As we approached one man who seemed to be unconscious, he suddenly leapt up and lurched towards us, ripping out his fake IV and trying to escape. Even though I knew there was no real danger, no actual Ebola blood spurting all over the room, it definitely got my heart pounding.</div>
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While the mock ETU was invaluable in preparing us for the real thing, I was a bit disappointed to see the national nurses take a backseat role. Our doctors made decisions and called out orders, while the nurses carried them out obediently. One of the things I’m most excited about doing here is helping to strengthen the national nurses’ confidence and critical thinking. The impression I get is that nursing education here is very task-oriented, and they are encouraged to follow protocols without necessarily understanding the reasons behind them. Although many of the nurses we trained with were very intelligent and experts at their job, one of them told me, “The doctor is always right.” In any scenario, that can be a dangerous way of thinking, since nurses should be the doctor’s eyes and ears, their final check before care is administered, and strong advocates for their patients. But in a country ravaged by Ebola where there were hardly any doctors to begin, it will be even more essential for nurses to step up and take a leading role. I do hope that once this outbreak is over, what remains are some newly trained, skilled nurses who are motivated to build their country’s health system back from the ground up.</div>
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One perfect example is a young woman I’ll call J., a beautiful Sierra Leonean nurse I met during training. She volunteered to work at a government ETU last September, without asking her family’s permission since she knew they would not approve. At that time, nurses only received two days of emergency Ebola training before being tossed in to work at an ETU. J. has been treating Ebola patients ever since, and only gets to see her husband and child when she travels back home to visit them on her days off. I asked her if she wanted more children, and she told me she does not “because it doesn’t leave time for my work, and I love my work.”</div>
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It has been such a joy getting to know the national nurses at training. All of these wonderful men and women showed up to our last day of class on Friday dressed in a gorgeous array of African fabrics. Apparently Friday is “African dress day” which made the Americans look pretty shabby in our old scrubs. Nonetheless, it was graduation day and a festive atmosphere as we all rushed around posing for photos and saying goodbye to our new friends.</div>
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<div class="wp-caption aligncenter" id="attachment_491" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender_2.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Seen on our drive out to Port Loko. I can't get over what African women manage to carry on their heads!" class="size-medium wp-image-491" height="238" src="https://wanderingaimfully.files.wordpress.com/2015/03/fullsizerender_2.jpg?w=300&h=238" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Seen on our drive out to Port Loko. I can’t get over what African women manage to carry on their heads!</div>
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Directly from training our group left for Port Loko, a district hard-hit with the virus, where PIH’s Ebola Treatment Unit is located. Here we are being housed at a tent city run by a Danish emergency management organization, which looks a lot like MASH and feels like arriving at a colony on Mars. Several large tents are each separated into six rooms, with a cot, mosquito net, and a light in each. Though it looks sparse, it’s actually quite fancy, with air conditioning, wifi, hot showers, and electricity by generator. Plus the food is fantastic, and apparently there is a clothing-optional tanning area (I’m not kidding). Although I greatly appreciate the hospitality and the amount of organization and effort that it must take to keep a camp like this running so that health workers can do their jobs, I can’t help but feel ashamed at the stark contrast between one side of our fence and the other. It is jarring to sit under a nice tent under bright lights, listening to music and going back for seconds at the buffet, while Sierra Leonean kids walk past the fence in threadbare clothes and stare.</div>
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After months of waiting, hoping, reading the news itching to be here, tomorrow is the big day. We’ll go to the ETU in the morning, where we will don our PPE and treat Ebola patients for the first time. Maybe I should feel nervous, but I don’t. I’m just glad the wait is over and I can finally have a hand in the important work that needs to be done.</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-43742886609147738602015-02-26T22:05:00.000-06:002015-02-26T22:05:16.833-06:00Stairway Troll<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px;">Written Wendesday, 2/25</span></h1>
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I am currently taking up residence on the stairway landing between the third and fourth floors of our guest house, where the wifi has been most reliably good today. It’s a nice way to meet all the PIH-ers I don’t know yet, as they pass me on the way to their rooms and laugh knowingly at the lengths it sometimes takes to get a good signal. One of the long-term staffers jokingly calls us “stairway trolls.”</div>
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<div class="wp-caption aligncenter" id="attachment_480" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 247px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender8.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Blogging in the stairway. I go where the wifi is! " class="size-medium wp-image-480" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender8.jpg?w=237&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="237" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Blogging in the stairway. I go where the wifi is!</div>
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It’s late and I’m still a bit jet-lagged so I know I should go to sleep, but I am bursting at the seams with new information and experiences and I’m afraid that if I don’t write it all down, little details will start slipping away. The past two days of training have been fascinating.</div>
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We spent most of Tuesday learning the case definition of Ebola, which sounds boring but turns out to be the bedrock of everything we do here. Patients will show up to triage at an ETU with a variety of symptoms, and it’s our job to decide who should be admitted to be treated for Ebola, and who should be sent to another healthcare facility or home. Sounds easy, right? From what the news tells us, it seems like turning up at an ETU with a fever would be an automatic admission.</div>
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The trouble is that there are several tropical diseases here that have similar symptoms to Ebola (Lassa Fever, for example, looks very much the same with the exception that Ebola patients commonly have hiccups). So why not just admit them to be safe, and then figure out what they have for sure once you have them quarantined in the ETU? Because of the nightmare scenario of admitting a person with suspected Ebola who turns out to only have malaria, but then they catch Ebola from having some contact with another patient while they waited to be diagnosed.</div>
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Patients who are admitted to an ETU through triage join the other non-confirmed patients in the “suspect” ward. This means they automatically live in the Red Zone, the high-risk area that we healthcare workers can’t set foot in without being completely suited up. As much as we will try to keep suspected Ebola patients separated from each other before they are confirmed, it’s not possible to guarantee that one won’t infect another. One of our case studies described a patient in the suspected ward (who turned out to be Ebola positive) who was delirious, ripped out his IV, and wandered into other suspected patients’ rooms, spreading his blood everywhere. If any of those other patients had turned out to be negative, now they were at serious risk. Essentially, it would be horrible if patients came to the ETU Ebola-negative, and then caught it there.</div>
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We don’t want to admit non-Ebola patients to the suspect ward if at all possible, but we also don’t want to send someone home who turns out to have Ebola after all. Here’s another nightmare: You triage a patient and wrongly decide that her symptoms don’t meet the case definition for Ebola, and she goes home and infects her entire family.</div>
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If Ebola tests were instantaneous and 100% accurate, we wouldn’t face scanarios like this. Unfortunately, they aren’t. The amount of time it takes to get results on a PCR (the blood test for Ebola) has decreased during this outbreak in many cases from days to hours, but many places don’t have a lab that is sophisticated enough to handle blood samples as hazardous as these. And even if your patient’s Ebola test comes back negative, they don’t get an automatic ticket home. In the first few days of the illness the viral load may not be high enough to be detected by the test, so they’ll have to remain in the ETU for a few more days and re-test, to make certain that the initial PCR wasn’t a false negative. One of the national nurses told me today that she felt their most egregious mistake at the start of the epidemic was that they sent patients home after one initial negative test. She was clearly upset as she recalled that they had sent home one of their health workers despite his symptoms because his Ebola test was negative, only to have him return a few days later and die shortly thereafter.</div>
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Now I’ll complicate things even more. It would be easier to adhere to the case definitions that guide us to admit a patient if we were certain that every patient was being perfectly honest. But people who don’t want to be admitted to an ETU often hide their symptoms, denying that they’ve had diarrhea or vomiting and insisting that they feel fine. You may also triage someone who has no fever, which lowers your suspicion, until you ask the right question and find out they’ve been taking Tylenol in order to bring their fever down.</div>
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Many of the examples I’m using have come from real case studies that we discussed in small groups in class, which for me has been the most valuable part of training so far. You think you’re somewhat prepared, until you find your group split down the middle trying to decide what to do with the case you’re discussing, which is an actual situation that clinicians faced in an ETU.</div>
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We were faced with another sobering reality today, as Ebola survivors had been invited to our training to share their experiences with us. They sat in a row at the front of the class, bravely recounting the hell they had somehow managed to survive. While one survivor took his turn to speak, others stared blankly at the floor as if re-living their experiences. Another leaned back and covered his face with his hands, seemingly willing himself not to remember what he’d seen.</div>
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Most of the survivors we heard from contracted Ebola while caring for their ill family members early in the outbreak. In one case, a patient was sick in a government hospital but the nurses refused to care for her because they feared Ebola. When her family came to the hospital to do what the nurses wouldn’t, they all became infected. In another case, an ill woman refused to go to the hospital, so her family members who were health workers cared for her at home. They started IVs on her with their bare hands, and of course infected themselves.</div>
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One man told us that when he went to an ETU his family had no hope for his survival, and that “with every tick of the clock, they called me to ask, ‘Are you ok?'” Their experiences in holding centers, which screen patients for Ebola and transfer them to ETUs if necessary, were horrific. One man recalled sharing a toilet with 10-15 people, diarrhea and vomit covering the floor, leaving anyone who didn’t already have Ebola to almost certainly be infected. The medics were so terrified of their patients that they handed them medicine through a barbed wire fence. “Nobody helps anybody,” he said. “It’s like the day of judgment.”</div>
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Once they were transferred to an official ETU, many described how grateful they were for the competent care they began to receive. One survivor explained that healthcare workers in the ETU were confident in their PPE, and therefore not afraid to enter the ward and care for their patients. They repeatedly thanked their Sierra Leonean caregivers, insisting that “the staff are making so many sacrifices.”</div>
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When they were asked what the worst and best moments of their experience had been, I was certain they would all say that their best day was when they were pronounced Ebola negative and discharged. But most of them described that moment as conflicted; although were overjoyed to have survived, they knew they had to return to lives in which many of their family members, including spouses and children, had died. One man’s wife died of Ebola on the same day that he was discharged home cured.</div>
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Surprisingly to me, most of them described their “best” moment as an experience with a healthcare worker. It put faces to the constant message we are hearing that providing quality, humane care in the ETUs is essential. At the beginning of the outbreak, the care in ETUs was horrible and degrading (how many photos did you see in the news of patients dying alone on a cement floor?). Many people chose to keep quiet if they were sick, terrified of what would happen to them if they turned themselves in. Our trainer told us of one case in which a patient’s mother was told that he had died in an ETU, only to have him return to his village cured a week later. His neighbors ran from him, believing he was a ghost. After thinking that her son had gone to an ETU and died, the mother refused to seek treatment when she fell ill, and she died of Ebola at home few days after her son returned.</div>
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<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender6.jpg" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;"><img alt="Enough Beds For Everyone" class="aligncenter size-medium wp-image-482" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender6.jpg?w=249&h=300" style="border: 0px; clear: both; display: block; height: auto; margin-bottom: 12px !important; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 0px;" width="249" /></a></div>
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Although ETU care has greatly improved (and it is now criminal to remain at home if you have Ebola), some people still resist seeking treatment. Confirmed Ebola patients are interviewed to determine who they have been in contact with since showing symptoms, and those contacts are actively monitored for 21 days. Community health workers visit them at their homes to check their temperatures and ask about symptoms, but it can be difficult to get the true story. Our trainer encouraged asking the families to step outside of their houses to take their temperatures, using the example of an old woman who told the health workers she felt fine, but was unable to stand up when they asked. In other cases, people who are aware of what time the health workers are coming have removed their sick family members from the home to hide them. There has been a big push to involve local leaders in the process of monitoring; as our trainers pointed out, the villagers will never trust us as much as they trust an authority figure they already have faith in.</div>
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There is also an intense focus here on safe burial practices. Since an Ebola patient’s viral load increases the longer they are sick, corpses are extremely infectious. Studies have shown that the virus can live on dead bodies for 6 days. In a culture where washing the body of the deceased is a common and important ritual, that spells disaster. We were told that some burial practices include mourners washing their faces with the water used to clean the body, or in extreme cases even drinking it. While that may seem abhorrent to us, try to imagine if a stranger from another country wanted to take the body of your child from you without a funeral or a coffin. It’s easy to understand why many Sierra Leoneans refuse. Unfortunately, this can mean that a single funeral can set off a chain reaction in which everyone who attended contracts the virus.</div>
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<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender5.jpg" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;"><img alt="FullSizeRender(5)" class="aligncenter size-medium wp-image-483" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender5.jpg?w=179&h=300" style="border: 0px; clear: both; display: block; height: auto; margin-bottom: 12px !important; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 0px;" width="179" /></a></div>
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I could go on and on, but I should follow the health workers’ cardinal rule (to take care of myself first) and go to bed! It has been a fascinating few days. I take notes furiously and hope that it’s all sticking in my brain somewhere, ready to be called forth when I need it in the coming weeks. I’m excited to get into the mock ETU tomorrow and start practicing getting my hands dirty (or rather, my outer layer of gloves. Never, never my hands).</div>
<div class="wp-caption aligncenter" id="attachment_481" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 190px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender7.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Yep, that's me in there!" class="size-medium wp-image-481" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender7.jpg?w=180&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="180" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Yep, that’s me in there!</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-63521660312715940772015-02-24T21:39:00.000-06:002015-02-24T21:39:06.288-06:00National Ebola Training Academy BeginsWe made it to Sierra Leone! It was touch and go for a minute in DC, where we sat on the tarmac for 3 hours while they plowed the runway and de-iced our plane. As we watched the time for our layover in Brussels trickle away, I started to get pretty nervous – flights into Sierra Leone only leave twice a week. Fortunately we landed in the nick of time, and the wonderful flight attendants made an announcement that there were some humanitarian workers trying to make a tight connection to West Africa, so everyone else kept their seats so that we could get off first!<div class="entry-content" style="font-size: 14px; line-height: 22.75px; margin: 0px; padding: 0px 0px 10px;">
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<span style="font-family: inherit;">Something like 30 hours after we left Boston, we finally landed in Sierra Leone on Sunday night. The same smells I know from East Africa made me feel at home from the moment I stepped off the plane. Even after so many hours of travel and sleeplessness, I knew I was exactly where I was supposed to be.</span></div>
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<span style="font-family: inherit;">The reality of the Ebola outbreak hit us as soon as we walked across the tarmac and reached the door to enter the airport. Chlorine</span><span style="font-family: Arial, Helvetica, sans-serif;"> hand washing stations awaited us outside, and everyone was made to wash their hands before being allowed to enter. After reading so many news stories about it over the past several months, it was surreal to be actually washing my hands with chlorine to prevent spreading Ebola for the first time.</span></div>
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Once inside, it was probably the most fun I’ve ever had in customs. We were surrounded by other humanitarian responders from MSF, World Health Organization, Direct Relief, you name it. It was lovely to chat with them all as we waited. After clearing customs, I waited in line to have my temporal temperature checked (another surreal experience). It’s an odd moment, if you let your imagination run away with you and start to wonder what might happen if your temperature comes out high… Fortunately, I was a normal 36.3 C and was waved right on.</div>
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A short bus ride, ferry trip, and another bus took us to the Partners in Health guest house, which is lovely. We were met with another handwashing station at the front door, and had our temperatures checked and recorded, as we will every time we enter the building. We are sharing an apartment with electricity by generator, running water (though not hot), and wifi that comes and goes. We even have a washing machine! My coworkers are laughing at me right now as I sit on the couch, blogging beneath a line of drying scrubs and underwear.</div>
<div class="wp-caption aligncenter" id="attachment_475" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; clear: both; font-family: Arial, Helvetica, sans-serif; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 235px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="These handwashing stations are at the entrances to most buildings" class="size-medium wp-image-475" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender.jpg?w=225&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="225" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
These handwashing stations are at the entrances to most buildings</div>
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Our first day of World Health Organization training was today. It was clearly well-run and fascinating since I was able to stay awake for 8 hours of class despite some serious jet lag! We PIH-ers are just about the only non-Sierra Leoneans there, which is lovely because we get to interact with national staff, who have been fighting Ebola much longer than us and living the reality of this outbreak every day. Most of the Sierra Leoneans I’ve spoken with there have been working in ETUs for several months and are attending training for the third time. Since protocols change quickly as research and experience grows, they are encouraged to take the training again every few months. We of course all took advantage of the hand washing station before entering the building, and had our temperatures checked and recorded by the staff.</div>
<div class="wp-caption aligncenter" id="attachment_474" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; clear: both; font-family: Arial, Helvetica, sans-serif; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 235px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender1.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Washing my hands before entering training on Monday morning." class="size-medium wp-image-474" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender1.jpg?w=225&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="225" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Washing my hands before entering training on Monday morning.</div>
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Our first lecturer wished us all a good morning, and chided our lackluster response with, “That ‘good morning’ has Ebola!” We were reminded of the huge importance of infection control and prevention among healthcare providers, not only to keep ourselves safe, but because of the role it plays in public perception here. We were told that, “You have not come here to die,” which is always reassuring! At the beginning of the outbreak, hundreds of Sierra Leonean healthcare workers contracted Ebola due to poor infection control measures; 221 have died to date. To the public it seemed like the situation was hopeless: Why would you come to an Ebola Treatment Unit for care, when those who are caring for you are dying themselves? To put it simply, dying sends a bad message. Fortunately this perception has shifted as infection control measures and patient care have improved, but we as healthcare workers play an important role in continuing that momentum. Ebola survivors are also pivotal in instilling hope and proving that admission to an ETU is not an automatic death sentence. Because they are immune to the virus for an unknown period of time, many survivors have also been helping to provide care in ETUs.</div>
<div class="wp-caption aligncenter" id="attachment_470" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; clear: both; font-family: Arial, Helvetica, sans-serif; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 243px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender4.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="We see educational Ebola signs all over the city. This one reminds people that Ebola isn't a death sentence, and encourages them to call the emergency Ebola number early if they're ill." class="size-medium wp-image-470" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender4.jpg?w=233&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="233" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
We see educational Ebola signs all over the city. This one reminds people that Ebola isn’t a death sentence, and encourages them to call the emergency Ebola number early if they’re ill.</div>
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It has quickly become clear that habits I live with in the US will need to be broken ASAP. One of our trainers stepped into class this morning to let us all know that they had been watching us for 15 minutes, and we each touched our faces an average of 3.4 times per minute. Considering Ebola enters the body through our mucous membranes (eyes, nose and mouth), I’ll just have to learn to put up with the itch on my nose. We also don’t shake hands when we meet someone new; instead, we offer to touch elbows. It’s hard not to feel rude at first, but the stakes are too high to care really.</div>
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The basics are essential here: We all re-learned how to wash our hands today, the Ebola way. I’m certain I have never paid such close attention to a person washing his hands as I did at that moment. It takes a full minute, with maneuvers to make certain that we clean every centimeter of our hands. We practiced in a group, everyone nit-picking each other’s technique because it will likely be the thing that keeps us Ebola-free.</div>
<div class="wp-caption aligncenter" id="attachment_472" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; clear: both; font-family: Arial, Helvetica, sans-serif; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 225px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender3.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="The hand washing technique we'll use in the ETU" class="size-medium wp-image-472" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/fullsizerender3.jpg?w=215&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="215" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
The hand washing technique we’ll use in the ETU</div>
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Next we tested our ability to remove dirty gloves without contaminating ourselves. After dipping our hands in mud, we each SLOWLY removed our gloves, careful not to snap them and fling infectious material, and making certain that no part of the outside of the glove touched our skin. Our trainers inspected our hands and declared, “Quarantine!” to anyone with a speck of mud on their skin. It’s excellent practice for when our gloves will be covered with bodily fluids, and it’s no longer a game.</div>
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And finally, it was time for the infamous suits. We refer to them as Personal Protective Equipment (PPE), and we’ll need to know exactly how to don and doff them in order to keep ourselves safe in the hot zone. Today was just a test run, with trainers walking us through the correct procedure for putting on each item – rubber boots, suit, fist pair of gloves, hair cover, mask, face shield, hood, apron, and second pair of gloves. Another surreal moment, to be completely encased in the suits I’ve been seeing on TV for months. Between the mask, face shield, and hood, my visibility was incredibly limited and I struggled to hear what the nurse next to me was saying. We then took a lap around the building, getting a feel for how we would react to the PPE. My lovely African teacher acted as my buddy (everything in the hot zone is done in pairs), and kept asking me, “How are you doing, buddy?” every few minutes. It’s hot in there, for sure, but I didn’t feel faint or claustophobic. We’ll see in the coming days if that changes when it’s an hour and a half, rather than five minutes, that I have to work inside the suit.</div>
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The moment you remove your PPE is the highest risk time for contaminating yourself, so this skill is crucial. My buddy walked me through each step, as the support staff will do in the ETU. The motto is “There is no emergency in Ebola,” meaning that we do everything at a snail’s pace to ensure we are doing it safely. We remove each part of the PPE carefully, with a minute-long hand wash in between each piece. It’s a long process. I’m actually looking forward to getting more practice tomorrow; I’d like it to be muscle memory by the time I’m doing it in real life.</div>
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We wrapped up the day with a temperature check, the staff scurrying around to make sure no one left without recording theirs in the log. After a delicious dinner of rice, fish and plantains, I’m now off to bed to get a handle on this jet lag before more training tomorrow. Lots of love to all of you!</div>
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By the way, a PIH staffer told me that they get more volunteer clinicians from Washington than anywhere else. So way to go, Washingtonians!</div>
<div class="wp-caption aligncenter" id="attachment_471" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; clear: both; font-family: Arial, Helvetica, sans-serif; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/img_7280.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px; text-decoration: none;"><img alt="Our suits waiting for more training tomorrow " class="size-medium wp-image-471" height="225" src="https://wanderingaimfully.files.wordpress.com/2015/02/img_7280.jpg?w=300&h=225" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a><div class="wp-caption-text" style="color: #888888; font-size: 12px; margin: 5px; padding: 0px;">
Our suits waiting for more training tomorrow</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-31407042026159101962015-02-23T23:36:00.000-06:002015-02-23T23:36:43.355-06:00And We’re Off!<div class="entry-content" style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: 22.75px; margin: 0px; padding: 0px 0px 10px;">
<dl class="wp-caption aligncenter" id="attachment_457" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 235px;"><br />
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Our stateside training is complete, our passports have arrived complete with our visas just in the nick of time, and today we begin our long trek to Sierra Leone! I’ve utilized all my packing prowess and succeeded in whittling my belongings down to carry-on luggage only, which I’ll admit I’m pretty proud of! I even FedEx-ed my one set of winter clothes back to Seattle, and then sprinted back through the snow to the warmth of our hotel <span class="wp-smiley wp-emoji wp-emoji-smile" style="display: inline-block !important; margin: 0px; min-height: 1.2em; overflow: hidden; padding: 0px; position: relative !important; text-indent: 9999px; vertical-align: bottom; white-space: nowrap; width: 1.35em;" title=":)">:)</span></div>
<dl class="wp-caption aligncenter" id="attachment_461" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 310px;">
<dt class="wp-caption-dt" style="font-weight: 700; margin: 0px; padding: 0px;"><a href="https://wanderingaimfully.files.wordpress.com/2015/02/image1.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="My luggage for 6 weeks" class="size-medium wp-image-461" height="225" src="https://wanderingaimfully.files.wordpress.com/2015/02/image1.jpg?w=300&h=225" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="300" /></a></dt>
<dd class="wp-caption-dd" style="margin: 0px 0px 18px; padding: 0px;">My luggage for 6 weeks</dd></dl>
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When we arrive in Freetown, we will have a week of World Health Organization training complete with a mock Ebola Treatment Unit and survivors acting as patients, then real hot zone training in an ETU before we are sent to our respective assignments. It has been an absolute pleasure spending time with the rest of my group; there’s nothing like hanging out with a bunch of like-minded people who “get” why you do what you do, to really light you up. I think we are all itching to get started.</div>
<dl class="wp-caption aligncenter" id="attachment_457" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 235px;">
<dt class="wp-caption-dt" style="font-weight: 700; margin: 0px; padding: 0px;"><a href="https://wanderingaimfully.files.wordpress.com/2015/02/image.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="LOVE this kiddo on the wall of PIH's office" class="size-medium wp-image-457" height="300" src="https://wanderingaimfully.files.wordpress.com/2015/02/image.jpg?w=225&h=300" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="225" /></a></dt>
<dd class="wp-caption-dd" style="margin: 0px 0px 18px; padding: 0px;">LOVE this kiddo on the wall of PIH’s office</dd></dl>
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Partners in Health has taken great care of us and treated us like part of the family, which makes it easy to entrust ourselves to them. Yesterday we had a session with PIH’s occupational health doctor to discuss the protocol if we become ill in the field. PIH has not had any clinicians contract Ebola (knock on wood!), but it’s common to experience diarrhea or other illnesses that could mimic some of the symptoms. We’ll be checking our temperatures twice a day, reporting any issues, and isolating ourselves if necessary. Which I explain only because I think it’s interesting, not because I expect it to happen!</div>
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Of course, we have also spent plenty of time discussing the surveillance process that we will experience when we get home. I’ll explain a bit now, just to soften the ground for when it’s my turn!</div>
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Regulations for returning Ebola responders are set by the COUNTY in which they live. The CDC has guidelines, but states are not required to follow them, so it’s up to each county to decide how they want to do it – which is why some of our clinicians are being told they can’t leave their homes for 21 days (the incubation period for Ebola), while others have much more reasonable restrictions.</div>
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Unfortunately, some counties are basing their requirements on public perception, rather than actual science. I understand that people are terrified of catching Ebola, but acting on irrational fear rather than proven facts simply doesn’t do anyone any good. The fact is that Ebola CANNOT be transmitted by someone who is not showing symptoms. It is NOT like the flu, for example, which someone could spread to others before they even knew they were sick (by the way, thousands more Americans will die of the flu this year than Ebola, so if you’re freaking out about Ebola, get your darn flu shot). This is the exact reason that returning clinicians check their temperatures at least twice a day and monitor themselves closely for any symptoms. Even if we had somehow been exposed and contracted Ebola, we can’t give it to anyone else until we show symptoms.</div>
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Secondly, Ebola is only passed through direct contact with the bodily fluids of someone who is ill – it is NOT airborne. “Direct contact” includes physical touch but also contact with infectious droplets. The common confusion that I have heard is that Ebola could, in certain cases, be transmitted through a cough – so doesn’t that make it airborne? Not in an infectious disease sense. To clarify, for this specific example to happen you would have to be in close proximity to someone who is already sick with Ebola, and they would have to cough in a way that their saliva or blood landed in your mucous membranes (eyes, nose, mouth). The difference with airborne viruses (like a cold) is that the virus can hang in the air in a lingering cloud. So if I have a cold and I cough, you could walk through the room a few minutes or even hours later, after I’m long gone, and still catch my cold. That is not possible with Ebola. I know it seems like a fine distinction, but it’s an important one. I mean, you usually notice when someone coughs their bodily fluids onto you, and it’s easy to prevent, whereas you don’t have any idea when a virus in hanging in the air that you walk through.</div>
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Still don’t believe me? Let’s get real, and imagine how many more infections there would be, not just in West Africa, but everywhere, if Ebola was airborne. There’s a reason Ebola has been referred to as “a disease of caregivers”: most people who have contracted it have done so while taking care of someone who was ill. They don’t catch it walking down the street, or hugging their healthy friends. Family members and healthcare workers catch it while caring for someone who is very ill and losing a lot of highly infectious bodily fluids through huge amounts of vomit and diarrhea (sorry, non-medical friends!) Remember Thomas Duncan, the Liberian man who died of Ebola in Dallas? He was misdiagnosed and sent home with Ebola for DAYS. He lived with his family members while he was actively ill, and NONE of them caught it. If Ebola truly was airborne, how did they come out unscathed?</div>
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Another HUGE factor in the spread of Ebola which must be mentioned is the sanitary conditions in West Africa. Imagine caring for a family member who is losing liters of fluid through diarrhea and vomiting, in a hut with no running water or flush toilet or washing machine. Now compare that to the United States. Though of course I don’t know for sure, I would guess that Mr. Duncan’s family avoided close contact with him and washed their hands a lot, as any of us would do if our family was sick with anything. There’s a reason Ebola spread like wildfire in West Africa and was stopped in its tracks in America.</div>
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So please excuse the long rant, but that brings me to me. My plan is to live in my house with my husband for 21 days, see my friends and family, and (just to be extra safe) to refrain from swapping bodily fluids with anyone. It shouldn’t be terribly hard – I rarely lick strangers or uncontrollably release bodily fluids at the grocery store <span class="wp-smiley wp-emoji wp-emoji-smile" style="display: inline-block !important; margin: 0px; min-height: 1.2em; overflow: hidden; padding: 0px; position: relative !important; text-indent: 9999px; vertical-align: bottom; white-space: nowrap; width: 1.35em;" title=":)">:)</span> So let’s say, in theory, I’m at home with my family a week after I get home from Sierra Leone, and I develop a fever. I’ll immediately self-isolate, alert public health, and if I meet the criteria, I’ll be taken to a designated hospital for treatment before I am a risk to anyone. And fortunately I will have been keeping my bodily fluids to myself in the meantime anyway, so there’s no way for anyone to get sick. This is, by the way, all in line with the regulations that King County Public Health has set for me.</div>
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Questions about this? Ask me! It is hugely important to me to make this clear so that the public isn’t living in fear for no reason, and returning clinicians aren’t stigmatized.</div>
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Please feel free to impart this information on anyone and everyone! I know plenty of Ebola responders who are doing this work in semi-secret, for fear of how their friends and neighbors will treat them if they find out. I believe that is truly a shame, and they deserve better. While I completely respect everyone’s choices regarding how much of this experience they want to share, I’ve been very open about what I’m doing in the hopes that some simple conversations and education will turn the tide. If all of the scientific data doesn’t convince you, take a moment and really ask yourself: Do you honestlybelieve that humanitarian responders would put their lives at risk to save strangers on the other side of the world, and then come home and knowingly put their friends and family in danger?</div>
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There’s so much more to say about what we’re expecting to see on the ground, but I’ll report back to you when I’ve begun to see it for myself. I promise my next post will be more about what we’re DOING, and less lecturing <span class="wp-smiley wp-emoji wp-emoji-smile" style="display: inline-block !important; margin: 0px; min-height: 1.2em; overflow: hidden; padding: 0px; position: relative !important; text-indent: 9999px; vertical-align: bottom; white-space: nowrap; width: 1.35em;" title=":)">:)</span> We arrive in Sierra Leone on Sunday night but I’m not sure exactly when I will have internet access again, so hang tight for a few days!</div>
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To end on a happy note, I’ll leave you with this link that was shared with us in training: “The Boy Who Tricked Ebola”. He’ll put a smile on your face!</div>
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<a href="https://m.youtube.com/watch?v=9OQXZWz15_A" rel="nofollow" sl-processed="1" style="color: #19196a; margin: 0px; padding: 0px;">https://m.youtube.com/watch?v=9OQXZWz15_A</a></div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-47731794121266176952015-02-22T09:48:00.000-06:002015-02-22T09:48:25.484-06:00Ebola Response Training Day One<h1 class="entry-title" style="clear: both; color: #603913; font-family: Vollkorn, Georgia, serif; font-size: 38px; font-weight: 400; letter-spacing: -1px; line-height: 1.2; margin: 0px 0px 5px; padding: 0px; word-wrap: break-word;">
<a href="https://wanderingaimfully.files.wordpress.com/2015/02/img_0014.jpg" sl-processed="1" style="color: #19196a; font-family: Arial, Helvetica, sans-serif; font-size: 16px; letter-spacing: 0px; line-height: 22.75px; margin: 0px; padding: 0px;"><img alt="IMG_0014" class="aligncenter wp-image-447 size-large" height="518" src="https://wanderingaimfully.files.wordpress.com/2015/02/img_0014.jpg?w=690&h=518" style="border: 0px; clear: both; display: block; height: auto; margin-bottom: 12px !important; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 0px;" width="690" /></a></h1>
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I am officially an Ebola responder with Partner in Health!</h5>
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I arrived in Boston late last night and checked into the Holiday Inn where myself and the 11 other PIH clinicians are staying. I lucked out that I’m here with a friend, Glenn, another nurse who I met on a short mission to Belize last October. This morning, we piled on all our layers and braved the snow for the half-mile walk to Partners in Health headquarters, where we have pre-deployment training.</div>
<dl class="wp-caption aligncenter" id="attachment_448" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 700px;">
<dt class="wp-caption-dt" style="font-weight: 700; margin: 0px; padding: 0px;"><a href="https://wanderingaimfully.files.wordpress.com/2015/02/img_0015.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Boston, the exact opposite climate from Sierra Leone" class="wp-image-448 size-large" height="920" src="https://wanderingaimfully.files.wordpress.com/2015/02/img_0015.jpg?w=690&h=920" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="690" /></a></dt>
<dd class="wp-caption-dd" style="margin: 0px 0px 18px; padding: 0px;">Boston, the exact opposite climate from Sierra Leone</dd></dl>
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I was especially excited since we had just learned that the person training us would be Kaci Hickox, who is a huge celebrity in my book. Kaci is the nurse who bravely fought her quarantine last year, after she arrived home from Sierra Leone and was detained at the airport despite having no symptoms of Ebola. With complete disregard for any science or facts, she was ordered to quarantine herself in her home for 21 days. She was vilified by many people who didn’t know the facts, but her taking a stand was extremely important to all of the Ebola responders who came after her. There is simply no scientific reason that a clinician with no symptoms should be quarantined. At some point I’ll be happy to go through the reasoning behind all of this, but I think I’ll save that rant for another day. Suffice it to say that Kaci stood up for her rights and therefore the rights of everyone returning from fighting Ebola. If America treats its humanitarian responders like lepers, it will only discourage people from going to help, and prolong the outbreak.</div>
<dl class="wp-caption aligncenter" id="attachment_449" style="background-color: rgb(233, 233, 232) !important; background-image: url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-top.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-right.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-bottom.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-left.png), url(https://s2.wp.com/wp-content/themes/pub/adventure-journal/images/sidebar-bg-right.png); background-position: 100% 0%, 0% 0%, 50% 0%, 100% 100%, 0% 100%, 50% 100%, 0% 0%, 100% 0%; background-repeat: no-repeat, no-repeat, repeat-x, no-repeat, no-repeat, repeat-x, repeat-y, repeat-y; clear: both; line-height: 18px; margin-bottom: 20px; margin-left: auto !important; margin-right: auto !important; margin-top: 0px; max-width: 100%; padding: 6px; text-align: center; width: 700px;">
<dt class="wp-caption-dt" style="font-weight: 700; margin: 0px; padding: 0px;"><a href="https://wanderingaimfully.files.wordpress.com/2015/02/img_0013-0.jpg" sl-processed="1" style="color: #19196a; display: block; margin: 0px; padding: 0px;"><img alt="Me geeking out with Kaci Hickox" class="wp-image-449 size-large" height="920" src="https://wanderingaimfully.files.wordpress.com/2015/02/img_0013-0.jpg?w=690&h=920" style="border-color: gray silver rgb(255, 255, 255); border-style: solid; border-width: 1px; display: block; height: auto; margin: 5px auto 0px; max-width: 97%; padding: 0px;" width="690" /></a></dt>
<dd class="wp-caption-dd" style="margin: 0px 0px 18px; padding: 0px;">Me geeking out with Kaci Hickox</dd></dl>
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It was pretty surreal to be sitting in the headquarters of Partners in Health, an organization whose work I have admired for years but never really thought I was qualified to be a part of. I’ve known of PIH since I read Mountains Beyond Mountains (a fantastic book about Paul Farmer, PIH’s founder) back in college. I’m so proud to be working for them because I feel that their mission speaks exactly to the two passions in my life that I have tried to bring together: healthcare and social justice.</div>
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I have to quote part of PIH’s mission statement, because it so clearly explains how I feel about the work we are doing. “Partners in Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair… At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone. When our patients are ill and have no access to care, our team of health professionals, scholars, and activists will do whatever it takes to make them well—just as we would do if a member of our own families or we ourselves were ill.” Awesome!!</div>
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Anyway, back to the task at hand: We spent the day learning from Kaci about the history of this outbreak and clinical care for Ebola. I’ll fill you in on some of it because I find it fascinating. This outbreak began in Guinea with a 2-year-old boy named Emil, who contracted Ebola after having contact with bats, which can carry the virus but are not made ill by it. In the next four weeks, all five people who had been in Emil’s household died – but Ebola was not diagnosed, and it continued to spread from there.</div>
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This isn’t the first Ebola outbreak, but it has been by far the worst. The first was in 1976, and there have been 25 other outbreaks between then and 2013. The death toll of all of those previous outbreaks COMBINED was less than 2,000. So far in this outbreak, over 9,000 people have died. There are many reasons for that: Ebola outbreaks have mostly been in Central Africa so no one was expecting it in Guinea, so it had plenty of time to spread before it was diagnosed. Previous outbreaks have also been contained to rural villages, but when the virus reached an urban area like the capital of Liberia, it was much harder to contain.</div>
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On top of all this, it’s important to point out that the problem isn’t just Ebola – it’s about Ebola showing up in an already broken healthcare system. For example, in one county in Liberia with a population of 400,000 people, there are only 3 physicians. Health systems in Guinea, Liberia, and Sierra Leone simply weren’t equipped to diagnose, treat, and contain Ebola.</div>
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The side effect of the Ebola outbreak is that West African healthcare systems that were already weak have completely collapsed. Hundreds of healthcare workers were infected and died before proper protective equipment was used, and most hospitals and clinics have shut down. Maternal mortality has skyrocketed, vaccination campaigns have ceased, and people are dying of common, normally treatable illnesses like malaria.</div>
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Fortunately, there are success stories within this outbreak. West Africa is not doomed to failure simply because it is in the developing world. When an Ebola case reached Nigeria, for example, only 19 cases resulted and the country has been Ebola-free since early September. Nigeria is an example of what a robust healthcare system can do, even in a developing nation. Which is where Partners in Health (and my team) comes in! Our goal is to help strengthen Sierra Leonean health systems, in addition to giving Ebola patients the highest level of care possible.</div>
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Well, this is a long post and we haven’t even left the country yet! I’ll stop so I don’t scare you all off before I even see a patient <span class="wp-smiley wp-emoji wp-emoji-smile" style="display: inline-block !important; margin: 0px; min-height: 1.2em; overflow: hidden; padding: 0px; position: relative !important; text-indent: 9999px; vertical-align: bottom; white-space: nowrap; width: 1.35em;" title=":)">:)</span> We have another day of training tomorrow, a free day on Friday, and then ship out to Sierra Leone Saturday morning!</div>
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I want to tell you all how much your kind words have meant to me (whether via phone, Facebook, or in person). No matter how I may make it appear, it’s never easy to leave your loved ones and leap into the unknown (though it does always seem to lead to something amazing!) I simply could not do this without the support of my friends and family. Love you guys!!</div>
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By Emily Scott, VP One Nurse At A Time</div>
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-38384571223191286452015-02-06T07:24:00.000-06:002015-02-06T07:24:49.871-06:00Sue is coming home!<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"><br /></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnJy4CB637ZCzJksmMIuyS2TZWBklMUy9VwUljovVs93KpTng4oJa5sCjUzCsbTrvNoT3jxifkJkX366Zc5G5iKdNGmYfaF_Zi7KtMD9rtNiKRsFTfqJaJUVHFfW9d2sWkiVtcBi4D2V0w/s1600/WP_20150129_10_15_53_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnJy4CB637ZCzJksmMIuyS2TZWBklMUy9VwUljovVs93KpTng4oJa5sCjUzCsbTrvNoT3jxifkJkX366Zc5G5iKdNGmYfaF_Zi7KtMD9rtNiKRsFTfqJaJUVHFfW9d2sWkiVtcBi4D2V0w/s1600/WP_20150129_10_15_53_Pro.jpg" height="180" width="320" /></a></div>
<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">No, it's not an April Fools joke. Our patient load is so low all over Freetown, we're starting to dismantle our ETC. I think MSF Switzerland will continue to work with the survivors and do outreach/decontaminating homes, etc. But there is so much capacity in ETCs now, they are less than 10% used at this point in time.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">So I'm being sent home early along with 2 other nurses. Most of the doctors are also leaving in the next week, leaving 2 nurses and 2 doctors to do the closing down.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">I leave the hotel </span><span class="aBn" data-term="goog_586967708" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">tomorrow</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> night at </span><span class="aBn" data-term="goog_586967709" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">11 pm</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">, spend the night at the airport (remember the "ferry" we had to take to get here, well the last boat to the airport is at </span><span class="aBn" data-term="goog_586967710" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">midnight</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">) and arrive after a few stops to Geneva at </span><span class="aBn" data-term="goog_586967711" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">5 pm</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">, hotel by </span><span class="aBn" data-term="goog_586967712" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">6:30</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> and bed within minutes. Debriefings will be </span><span class="aBn" data-term="goog_586967713" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Monday</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> and dinner with my Congolese midwife buddy. Fly westward </span><span class="aBn" data-term="goog_586967714" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Tuesday</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> morning - Geneva to Frankfurt, Frankfurt to WA Dulles (for customs, immigration and CDC check) then onward to Seattle, arriving at </span><span class="aBn" data-term="goog_586967715" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">9:30 pm</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">. Very long few days to come, but then 21 days of hanging out, taking my temp twice a day - no isolation, no quarantine. I'm up for visitors and visiting. And food. And sleep. And walks. And adult beverages. And ....</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Very happy and excited to be heading home, feeling like I personally and professionally accomplished what I set out to do. And I think I contributed to the greater good of the Ebola effort and advancing nursing practice among the Sierra Leonean staff. It's been hard work, but fun, too.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Thank you all for your support and encouragement. I'm hoping to do a speaking gig in Olympia and if anyone knows of other venues, I'd love to speak about this experience and raise funds and awareness for One Nurse At A Time.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Much love,</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue </span><br />
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-79881777009584142282015-02-04T19:38:00.000-06:002015-02-04T19:42:12.666-06:00Ebola treatment center fashion, "Ebola is real be wear. God bless MSF"<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_PwaIEaXthliqf5OpSOGQm0uenabqzuGnWACImg8nVwUXTQOTOZsUeJdRAd6u_HTvtn8ekt3WcmdmswWFwLCfaY-F1NoTU3vq5Z9vYA_DUG1oZIJGTrQmPmXw09YSlIJLtszE6Rx9NdHP/s1600/WP_20150204_13_15_42_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_PwaIEaXthliqf5OpSOGQm0uenabqzuGnWACImg8nVwUXTQOTOZsUeJdRAd6u_HTvtn8ekt3WcmdmswWFwLCfaY-F1NoTU3vq5Z9vYA_DUG1oZIJGTrQmPmXw09YSlIJLtszE6Rx9NdHP/s1600/WP_20150204_13_15_42_Pro.jpg" height="320" width="180" /></a></div>
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<span class="im" style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Only 3 Confirmed patients now. 2 in Suspect, but low suspicion. Today the Convalescent tent was torn down and burned. The Oral Confirmed tent is empty and also ready to be torn down. Only 10 of the 30 Suspect beds are open; the others have orange fencing across the entry to not use. It really seems the outbreak emergency is over. There is a thought that Ebola may now be endemic in the region with smaller outbreaks on occasion or a case here and case there. If you take a look at the WHO website, you can see day by day numbers for all 3 countries - all down. And in Freetown, there is plenty of capacity now to care for Ebola patients.<br /> </span><span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">We had a period of 6 days with no new cases admitted, but then one by one they began to trickle in again. Few deaths which really helps morale for sure.</span><span class="im" style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;"><br /><br />2 of the expat nurses want to go home now. I was asked to stay, and of course, I said yes. My end of mission (when I sleep in my own bed again) is <span class="aBn" data-term="goog_1661708789" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">March 5</span></span>. In another week or so, there will only be 3 expat nurses and 3 expat doctors, so we might not be tripping over each other any longer! YAY!!!<br /><br />Just finished a successful IV/medications/how to start/how to mix/how to count drops per minute/etc. training - 4 days with 4 different teams. It's what I've been working on since I arrived, and now a consistent message for all. Another nurse is doing Nutrition training as well. And a team has been formed to interview and do health exams for Survivors. They say they love coming back to the ETC because we treat them like heroes (which they are) but in their communities they are shunned still. So far, one consistent thing is they all have shoulder pain. Not sure why.... lots of muscle damage from Ebola, so ..?<br /> </span><span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">The president of Sierra Leone has promised to open schools again the second or third week of March. They have been closed since last July. And if you remember, we are working in the soccer field of Prince of Wales school. So by necessity, we have to shut down over the next month or so.</span><br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Unfortunately, I have to do another night shift </span><span class="aBn" data-term="goog_1661708790" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">tomorrow</span></span><span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">. </span><br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Hard to believe it was only 86 today and lower humidity. I swear we are all wilting by </span><span class="aBn" data-term="goog_1661708791" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">2 pm</span></span><span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">. A couple mornings ago, I had to make some copies on the laser printer - there was steam coming up from it as the paper dried in the heat of printing! Humidity has been above 90 with temps around 90. I think it might be - when there is no breeze, it's godawful hot.</span><br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Thought you'd get a kick out of the boots I found to wear today (pic above). The people are so thankful for MSF helping and attribute much of the success of stopping Ebola to MSF. Feels good. I try to spread the love, cuz it's every position, every person, no matter what they do, it all contributes to ending this outbreak.</span><br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Thanks to all who continue to write. I so appreciate the news from all of you and life in The Real World. Sad the Seahawks lost, but was able to sorta watch via Skype with Pete, Kenny and Sheila while I drank beer in my hotel room at </span><span class="aBn" data-term="goog_1661708792" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">2 am</span></span><span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> ... Kenny provided the play by play.</span><br />
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<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Hugs to all,</span><br />
<span style="background-color: white; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue</span>Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-50609257928217128992015-02-02T22:10:00.000-06:002015-02-02T22:10:57.632-06:00News from Sue in Sierra Leone. <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigv4x0AGsIF8KhYFXLaqZ3Wc6I3z1HsEdTp4yvONTYoKCzTle71y57daCg0ijrCR3f84Dtti02nTSJYY3aIhCXKJyx01njKNiT4M5eg3s_5Ilt94Tv2XjfrY9bWaY7LH78SoH4RMr2sRib/s1600/WP_20150128_07_39_33_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigv4x0AGsIF8KhYFXLaqZ3Wc6I3z1HsEdTp4yvONTYoKCzTle71y57daCg0ijrCR3f84Dtti02nTSJYY3aIhCXKJyx01njKNiT4M5eg3s_5Ilt94Tv2XjfrY9bWaY7LH78SoH4RMr2sRib/s1600/WP_20150128_07_39_33_Pro.jpg" height="180" width="320" /></a></div>
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Pic is of sunrise at 7 am over the ICU tent. So hazy in the morning from overnight fires, smog from vehicles and perhaps a bit of marine mist. Our ETC backs up onto the ocean.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">We went 6 days without a new confirmed case. Today we confirmed one - the 10 yr old brother of the man I sent you the smiling picture who was so grateful for himself and his siblings. We discharged his 15 year old brother today cured, but admitted his 25 year old brother into Suspect. I'm not sure why this family continues to be plagued - I'm assuming the house has been decontaminated and they are well off and educated, so not sure why we continue to get siblings infected ...</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">I was in Triage today and admitted 9 new patients. I think 2 or possibly 3 will be positive. No one looked especially sick, so hopefully they will all do well. If their symptoms have been for 3 days, one negative test sends them home. If it's been less than 3 days and the test is negative, they have to stay for another few days and retest before being sent out negative.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">So now we have 4 confirmed cases total. That's down from a high of about 50 when I arrived. So many national and expat staff per patient, we're all tripping over each other. Monday afternoon, they will announce national staff decreases and perhaps in a week or so, we'll also decrease expats. ASSUMING the decrease in new cases continues as is. Overall, all 3 affected countries have very few new cases and it seems the outbreak emergency may be over. There might still be the odd case here and there, and still a need for vigilance and surveillance and a place to appropriately treat. But MSF might be starting to fold up the tent and move on to the next crisis. </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">There is always another crisis.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">One thing I noticed that will make you smile. Remember I told you about the humidity here - well over 90%. Yesterday, I was making copies, slightly bleary eyed at 7 am ... The laser printer started to "smoke" - I first thought "FIRE!" from the poor quality electrical components here .... but then I realized the paper was so damp, when it went through the heat of the printer, it was steaming! Paper went in soggy and limp and came out crisp and dry!</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Thank you all for always sending your positive thoughts in this direction. These people need them so much. Life may return to "normal" minus many family members, minus nearly a year of school, minus nearly a year of salary for many where businesses, schools and medical facilities have been shut down ... I hope some of the "development" charities come to help rebuild what's been devastated by this disease. I hope the reflection and review process finds Lessons Learned that can be applied to the next disaster. I hope the statistics and studies and research can lead to cures and early detection and better treatment modalities. I hope we can avoid another horrific loss of life as we've seen with this epidemic. I hope the world stops thinking "If it's not my country/continent/people, I don't have to deal with it.". I hope drug manufacturers and vaccine producers and the FDA all work together for PEOPLE and not PROFIT. And I hope all of you will remain engaged and curious and interested in events beyond our borders, whether or not they directly impact you. If you can't go yourself, please donate to good charities who can. Support people who can. Stay informed.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Much love to all,</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue</span>Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-31389169360857890222015-01-28T23:53:00.000-06:002015-01-28T23:53:45.938-06:00CURED!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ilqMeETk3CS7We4CpjDAdnl0XKu9yjePPyECtfEiMBogI0zWyEJlpbx2JpJZnxSbogwP-dEn79e2Qg446btcXB8iL-wskbPhZlFLv61jOmSaCqugggjg9tdYYSPpuZoBVAERFQuKHCUZ/s1600/WP_20150128_11_23_18_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ilqMeETk3CS7We4CpjDAdnl0XKu9yjePPyECtfEiMBogI0zWyEJlpbx2JpJZnxSbogwP-dEn79e2Qg446btcXB8iL-wskbPhZlFLv61jOmSaCqugggjg9tdYYSPpuZoBVAERFQuKHCUZ/s1600/WP_20150128_11_23_18_Pro.jpg" height="180" width="320" /></a></div>
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">I wanted to share this picture and story with you for a happy moment. This man came to us along with his newlywed wife. His mother had died of Ebola and he fell ill along with his brother, sister and wife. Unfortunately, his wife was severely ill and died in a couple days despite our and his best efforts. He and his sibling survived.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Today he was discharged CURED. He was elated and spent half an hour with us saying thanks, wanting pictures taken (I asked him if I could share his picture with friends and he said yes). He told us what he remembered during his illness: how hard it was to drink because he was so nauseated, but he knew ORS was lifesaving so he continued to drink. How afraid he was in the night that he wouldn't live until morning. How good he felt every time we went in and told him he was doing well and treated him kindly. He especially remembered me (I'm sure because the blue eyes are all that show behind the PPE) and that we'd saved his life.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">A very happy day. Unfortunately, some of them are so happy and dancing on their way out, only to find their homes empty, interior sprayed with chlorine and door locked, all possessions burned. No clothes, no mattress (foam pad), no money to buy new things. Some of the community councils are doing this which is probably going overboard, but in an effort to stop the spread.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Everything they bring with them into the ETC is burned. Cell phones (we can wash the SIM card in chlorine), belts, shoes, clothes - everything. Logistics buys clothes at the market and shoes so we try to outfit them in a dignified way for going home after a shower at the exit.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Today we have two little ones in Suspected that I admitted yesterday who are not doing well. One seizing all night despite a whole lot of valium IV. Both initially tested negative for Ebola, but symptoms began only 2 days prior, so they have to stay a couple additional days to retest. Probably malaria causing high fevers, but we're struggling to keep them alive long enough to get that second test - then we can transfer to the pediatric hospital, but not until we confirm it's not Ebola.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">A 17 yr old girl in ICU isn't doing well and a pikin of 8. Two others are OK and we moved one darling boy to Oral Confirmed. Poor dear was playing all by himself because the other children were too sick. He is now our resident doctor (he's 5) - started hanging his toys on the IV hook and pretending he was giving himself a drip. So cute. Should have gotten a picture of that.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Celebrate the good and move past the sad.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Love to all,</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br />
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-20964895180753370892015-01-26T23:30:00.001-06:002015-01-26T23:45:11.114-06:00More daily life in Sierra Leone...and Momo goes home!!<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Hi All, </span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> 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 </span><span class="aBn" data-term="goog_1755863742" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">tomorrow</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> 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.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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 :)</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;">And a prize to whoever can explain the choice of brand names for the latrine covers.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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. </span><span class="aBn" data-term="goog_1755863743" style="background-color: white; border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Tomorrow</span></span><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> 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..</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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 ...</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Wish I could have been there to cheer when Momo went home, but it was on my day off.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br />
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<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Much love, </span><br />
<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue</span><br />
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-58868677017335279532015-01-24T11:10:00.000-06:002015-01-24T11:10:20.871-06:00Another day in Sierra Leone - and some good news too<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Hi All!</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Plan for the day: </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">1. Sleep in.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">2. Go to "Super Market" - can't wait to experience a Sierra Leonean super market!</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">4. Skype with Pete in the evening (morning in Seattle).</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">5. Go to bed early and start 6 in a row before another overnight on Super Bowl Saturday (Go Hawks!)</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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. </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">A couple pics to share with you - one of a survivor hired as a caretaker to watch/feed/clean the pikins (small kids).</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEFKueS9iuNBgle7LyOZp8cX0mvc8lQ9r3pOFlycv8Y7PcThfcB42uMIIZ-T_vMJyfSL0-PfoD1OhPaqIvuhnCmGNrcYGiIeFYkoJ4gfZf1sBHFyeZzfphlimzv_GJE8LpOMkI0UTGFvmE/s1600/WP_20150118_08_50_15_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEFKueS9iuNBgle7LyOZp8cX0mvc8lQ9r3pOFlycv8Y7PcThfcB42uMIIZ-T_vMJyfSL0-PfoD1OhPaqIvuhnCmGNrcYGiIeFYkoJ4gfZf1sBHFyeZzfphlimzv_GJE8LpOMkI0UTGFvmE/s1600/WP_20150118_08_50_15_Pro.jpg" height="180" width="320" /></a></div>
And one of a ladder - there is lots of construction going on. Amazing these men can do hard physical labor in this heat.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0Dr2nmKk_hfet3PDEXnDck8GlDJRFCmc1vGMMyyPdAAb-ngTfyKMujyoLVGY2zDkcyxG7QFcrH8Xmiq4Wr5sPL4ZfxnlBxB8rtWAvdhw339DKnVpl0RHVmoBXiOanbubsHNOBSkgyA2kU/s1600/WP_20150114_14_49_44_Pro.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0Dr2nmKk_hfet3PDEXnDck8GlDJRFCmc1vGMMyyPdAAb-ngTfyKMujyoLVGY2zDkcyxG7QFcrH8Xmiq4Wr5sPL4ZfxnlBxB8rtWAvdhw339DKnVpl0RHVmoBXiOanbubsHNOBSkgyA2kU/s1600/WP_20150114_14_49_44_Pro.jpg" height="180" width="320" /></a></div>
<br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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. </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">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.</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;"> </span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Love to all,</span><br style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">Sue<div class="separator" style="clear: both; text-align: center;">
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</span>Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-58537412278001903512015-01-20T07:30:00.000-06:002015-01-20T07:30:12.065-06:00Go Hawks! <br />
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The good news: I got to sleep in til 9 today! <br />The bad news: I have to work a 12 hour overnight shift for the first time in 32 years.<br /><br />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. :)<br /><br />Your Krio lesson of the day (with a nod to Heather) :<br /><br />"De pikin (pronounced pee - keen and accent on the 'keen') de suck bobie?"<br />Translation: "Is the baby breastfeeding?"<br /><br />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 <span class="aBn" data-term="goog_322261096" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Dec 10</span></span>). 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 ...<br /><br />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!<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />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.<br /> <div class="separator" style="clear: both; text-align: center;">
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<br /><span style="font-size: 12.8000001907349px;">The second picture above is my daily notetaking sheets. Crumpled from sweat. By </span><span class="aBn" data-term="goog_322261097" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; font-size: 12.8000001907349px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">7:30 am</span></span><span style="font-size: 12.8000001907349px;"> 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.</span></div>
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<br /><br />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. <br /><br />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.<br /><br />Much love to all,<br />Sue<div class="yj6qo">
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Anonymoushttp://www.blogger.com/profile/14320125320156973442noreply@blogger.com0tag:blogger.com,1999:blog-4977013263193353655.post-83491874578643083812015-01-20T04:30:00.000-06:002015-01-20T04:30:02.361-06:00Reflections on a first medical mission<div class="MsoNormal" style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8000001907349px;">
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<b><span style="color: #1a1a1a; font-family: Arial;">-Approximately how many patients were served by your team?</span></b></div>
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<span style="color: #1a1a1a; font-family: Arial;">-580 patients were seen in the clinic over the course of 5 days.</span></div>
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<b><span style="color: #1a1a1a; font-family: Arial;">-What I enjoyed the most:</span></b></div>
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<span style="color: #1a1a1a; font-family: Arial;"> -How a team of professionals could come together to serve so many people in such a short amount of time – very fulfilling.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">-How humbling the experience was, giving me a new level of appreciation for the simple and important things in my life</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">-Learning of the vast cultural differences, but also seeing how we aren’t so different in many ways.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;"> -Brushing up on my Spanish!</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">-The feeling of fulfillment I had knowing we helped so many people, while also learning and growing so much myself.</span></div>
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<b><span style="color: #1a1a1a; font-family: Arial;">-What I enjoyed the least:</span></b></div>
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<span style="color: #1a1a1a; font-family: Arial;"> -It was hard to see the extent to which some patients’ conditions had progressed without getting adequate treatment. It was also difficult to try to manage patients the best we could within cost- and resource-constraints, while thinking of all the labs, tests, meds, follow-up, and therapies that we might treat the same patient with in the U.S.</span></div>
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<b><span style="color: #1a1a1a; font-family: Arial;">-What cultural differences I observed:</span></b></div>
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<span style="color: #1a1a1a; font-family: Arial;"> -The medical culture is generally quite paternalistic. Patients are told very little about their diagnoses and treatments are often inappropriate or poorly explained to the patients and families.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">-Women’s roles within society and family are more rigid, and this can impact their health: for example, they have quite a different culture surrounding birth, including who should be present/assisting and how they assist. They also most commonly work in the home.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">-Some of the folk remedies were interesting, for example, one patient mentioned that one relieving factor for his musculoskeletal pain was putting lemon juice on his head.</span></div>
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<b><span style="color: #1a1a1a; font-family: Arial;">-One to three examples of “memorable moments”:</span></b></div>
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<span style="color: #1a1a1a; font-family: Arial;">1. My most memorable group of patients were 4 generations of women/girls of the same family. One day I saw a young mother and her 3-year-old daughter. The mother had been having occasional seizures for several years, and had never been told what was going on! The next day I saw the “next two generations up.” I noticed a familial pattern of migraines and neuro issues. The family sticks in my memory because they were so endearing, and also because even though I couldn’t do as much as I wanted for their more complex issues, they were incredibly grateful (as were all the patients I saw!) for the migraine meds and other therapies that I provided.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">2. Watching the sunrise from the roof of the clinic before having breakfast and starting our day, hearing </span></div>
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the roosters crowing (and a turkey joining in, too!), and taking that moment to reflect. It was a quiet, peaceful moment I had just to myself, before the busy-ness of the day set in. From up there, you can also see all the patients lined up waiting to be seen that day and it really gives you quite a sense of purpose.<br />
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<b><span style="color: #1a1a1a; font-family: Arial;">-What impact the medical mission will have on your nursing career:</span></b></div>
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<b><span style="color: #1a1a1a; font-family: Arial;"> </span></b><span style="color: #1a1a1a; font-family: Arial;">-This was my first medical mission, and I have a feeling it won’t be my last! Here at home, I’ve already benefitted from a renewed perspective and passion for nursing. Next to that “warm fuzzy feeling” you get from helping those with limited access to care, the biggest takeaway, as an NP student, was the confidence I gained in seeing large volumes of patients with limited resources. In the Guatemala clinic, I couldn’t always make referrals I might have here, or rely on X-rays and other diagnostic tests to help me make certain decisions; instead, it was back to the basics with my history taking and physical assessment skills. Furthermore, we had a limited formulary to work with, so it meant working with what we had and being flexible. It’s amazing how much more confidence I have as a practitioner after working with such clinical challenges.</span></div>
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<span style="color: #1a1a1a; font-family: Arial;">--Nora Maynard</span></div>
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