Go Hawks!

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

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

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

“De pikin (pronounced pee – keen and accent on the ‘keen’) de suck bobie?”
Translation:  “Is the baby breastfeeding?”

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

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

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

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

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

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

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

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

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

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

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

Much love to all,