Hace lloviendo!!!!!!

Hace lloviendo!!! 

It's raining! And it's been raining!! All night Wednesday (it started before six pm and we actually watched the storm come down the town--we thought we had a few minutes before it arrives, poked inside a souvenir shop and seconds later the rain arrived! We sprinted to Jim's pizza from the store!) When we woke up Thursday it was still raining! Often clinics get canceled when it rains. Wednesday we traveled to Las Brisas de San Juan and the roads leading to that village are impassible in rain. They remain impassible for a day or two after a rainstorm actually as they are so steep, muddy, and curvy. Thankfully the rain did not start until long after we left Las Brisas! Praise God!

Each day we have seen about 150 patients, mas o menos. (More or less). Tuesday we went to Las Medias. Clinic setup there was interesting--the medical treatment team had to share a one room building with pharmacy! It was a little tight but it worked out. In that village, there is a gentleman who is in charge of the water supply--and he continues to deny water to 8 Chorti families. Please pray for a change of heart. He owns the house where the Bible study leader lived and held meetings. He recently demanded the leader stop holding meetings or move out. The leader would not stop holding Bible studies and has had to relocate. Please pray for strength among animosity and persecution for he and his family. 

Wednesday--we went to Las Brisas de San Juan. There are about 30 or so Chorti villages. Although this is only my second trip to Honduras--I remember going to Las Brisas six years ago. This village is frequently rained out of clinic and the men always wait patiently for all the women and children to be seen first. This time each family consisted of 4-5 children! But the men waited patiently for their turn. The Agricultural center (Ag center) works with this village and has taught terracing the land and they have done phenomenally with it. Words cannot convey the place they live--the sheer steepness of the slopes. Imagine standing on a hill planting corn. It is so steep you do not have to bend AT ALL to plant the next row up. It's incredible. 

How catastrophic landslides are makes much more sense when you look at the slopes. It would not take much water to erode the soil. 

They had several turkeys in Las Brisas. Eduardo bought one to bring back to his family. Around 11 am it looked like rain but thankfully it held off!!

Thursday we went to El Conal. It had rained all night and the rain continued. We made it to the village with a few auto problems and began to set up. And it continued to rain. And rain. It lighten for a few minutes every hour--but after each light spell it came back with more force! Thankfully we set up tarps and had a few covered walkways. We were packed in tight under the triage tent. The tent top kept needing to be emptied of water every 20 minutes or so. Hay mucho llueve!!! So much rain!! Often when it rains we have to leave:( Thankfully today was a close village with a decent amount of rocky roads (more traction!) and we were able to stay until we finished. 

One village to go!!

Honduras!

Sunday we attended a local church. The believers in this part of the world all pray out loud together when the leader begins to pray--which is an awesome and humbling thing to experience!! In my basic Spanish knowledge, I have a hard time understanding when one person is speaking. I cannot understand multiple Spanish voices--but how great is our God, that He can understand us in our myriad of voices!! He understands, He speaks our language, and He desires that we fellowship with him! 

The message was on Matthew 6:25-34; where God tells us not to worry about our lives and that He will provide. Monday we discovered that recently the pastor has been struggling to find work--and his message resounded even deeper the need to trust in God and believe that He will provide. 

Having our daily needs met isn't something you and I likely struggle with. For the Chorti, they do have to wonder where their next meal is coming from and when it will be. My usual "concern" with food is how soon can I eat again and what would I like to eat. 

We had our first clinic yesterday at Gotas del Sangre. (Drops of blood). This village in the past has lived up to that name, with the group hearing of several murders having taken place since our last visit. Thankfully, over the last few years that has improved. We saw 150 people!! I was amazed by their patience and politeness as they quietly waited to be seen by the staff. 

There was a mother with her child awaiting us as we arrived. Her young girl's left eye was almost swollen shut. How many days has the little girl suffered already? Is her vision already affected even if we can reduce the swelling over the next few days?

I saw another girl who had one eye smaller than the other-the actual iris and pupil were significantly smaller. I imagine she has no sight out of that eye. How do people treat her? She is four or five years old; how will people treat her down the road? 

We treated many for lice--and I was scratching my head as I fell asleep last night! Hopefully out of empathy--I'd rather not bring those critters home!

Generally people's blood pressures here run lower than my patients back home. I was shocked to take a young teenage girl's blood pressure and discover she has high blood pressure! We referred her to a "local" clinic (local--within driving distance however an extremely long walk for one without transportation) and I hope she is able to follow up. Getting pregnant will be quite dangerous for her---and is continuous treatment even a possibility for her?

We are off to another village; Las Medias I believe. Please continue praying!

Gratitude and a week of corn

Hi all.

I get the opportunity every July to tend to my parents' garden while they are away. Have you ever gardened? It is tough work, and I don't even do any of the tilling, fertilizing, planting, and other prep work that gardens require! All I do is keep it watered and harvest vegetables and fruit when they ripen. Some summers I'll blanch vegetables to prepare them for freezing, and also boil down tomatoes for salsa (which takes a significant amount of time, and at the end of the process, you are left with a far smaller amount of tomato volume then when you started!)

Anyway, on to the point. A few summers back my parents were on a mission trip to Honduras, working with the Chorti people group. The Chorti are direct descendents of the Mayan Indians and the majority of them are subsistence farmers. Remember learning that term in grade school? Many of our ancestors were subsistence farmers--living off the land and barely getting enough to feed their own families some crop seasons.

While my parents were away, the corn was going to ripen. Corn usually ripens all at once and has to be harvested, eaten or blanched then frozen within about a 7 day span of the first corn ear ripening. For my dad's garden, that means more than 100 ears of corn were going to ripen while he was away. The second day of this venture, as I walked to the garden I noticed many stalks down--and it looked like a hurricane or tornado had gone through the corn. The corn had been ravaged by squirrels, and I remember thinking of Adam and Eve and how they lived off the land--and how so many people in our world continue to live off the land and the utter devastation my family would feel if the corn was our only food and our livelihood. For the Chorti, a ruined crop generally means starvation. Several years ago, my church learned of the Chorti and "adopted" them as a people group. Over the last decade, the church has done at least two "food distribution" trips where several individuals fly down to Honduras and begin trekking through the mountainous terrain distributing food when their crops have failed. I am glad my church now knows of this people group's existence---because they still live in a world where a failed crop--be it from bad weather, droughts, animals...means zero food and zero income to buy food.

A few weeks ago I manned the homestead again--and we were in the middle of several weeks without rain. Thankfully, my parents live in a place where we can water the crops with hoses (far easier then hauling individual buckets from a watering hole a mile + away) and provide the corn, broccoli, sweet potatoes, etc; with the much needed hydration for the plants to continue growing and the crops to ripen. I was struck again with how blessed I am with where I live. Had I been a subsistence farmer like the Chorti, like many Sierra Leoneans, and like hundreds of thousands around the globe, this lack of rain would mean I and my family likely would go hungry.

I am grateful for the time I can spend in the garden because the manual labor can be quite rewarding. You get to enjoy the "fruits of your labor." Fresh corn, eaten minutes after it has been picked, is extremely satisfying. As are fresh peaches straight from the tree. But I am even more grateful that I am not a subsistence farmer and that I do not have to depend on the weather cooperating and the animal kingdom leaving my hard work alone just to keep food on the table.

http://freerice.com/
Ever heard of that site? Check it out! For every question you answer correctly, 10 grains of rice gets donated through the World Hunger Programme. It's like Trivia Crack--but instead of competing against friends, you are fighting hunger! :-)

In Loving Memory

I hesitated to write about this lady. But she was wonderful--and her story, what little I know of it, deserves to be made known. Her name was Mariama, she had a gorgeous smile and loved others. One day, about a month ago now, Carrie and I were walking back to our housing compound from spending some time in the Lunsar market (buying some vegetables, cloth, and cooked eggs), when we heard our names being called. We looked to the left and saw our friend Mariama, one of our national workers, sitting on the porch. She invited us over and introduced us to her small children who were busy playing with their cousins. The one was about six years old and the other about six months old. We talked to Mariama for a little while then continued on our walk.

The same day I began to get sick, Mariama was also sick. Her story and mine are similiar yet have drastically different outcomes. We both started to feel ill and we reported it. We both sought treatment. Right now, in Sierra Leone, we initially test you for malaria and Ebola. Mariama and I tested negative for both. But Mariama continued to worsen...and we began to suspect something else, something almost as sinister as Ebola and far more common to West Africa. Mariama was tested for Lassa Fever, which is a hemorrhagic (bleeding) fever that is often fatal. The difference between it and Ebola, however, is there is a drug we can use to treat it--as long as it is caught in time and you are in a place where the drug is on hand. We sent Mariama to Kenema, one of the few places in the country that currently has the capability to treat Lassa Fever. She responded to treatment and began to improve. But then Sunday, two days after I was released from Kerrytown, we received the news you never want to hear. Although Mariama had initially shown signs of improvement; she was gone. Her six-year-old and six-month-old had lost their mother. Is their father in the picture? I don't know. It isn't atypical for the father to be completely absent. Carrie and I did not meet him the day we met Mariama's sweet children.

Pray for those tiny babes, friends. Pray for the children who are losing their parents to Ebola and Lassa Fever. There are so many more orphans now in West Africa. Please, do not forget them.

"Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world." James 1:27

Photo Friday (part 2)

 Beachfront of Freetown

A shantytown in Freetown--devastated recently by a cholera outbreak :-(

 Bureh Beach

View from Bureh Beach

Our ETC around Dusk

Photo Friday has Returned! (part 1)

 A view of our recently completed training center in Lunsar

 The "Mock ETC" at the Training Center

 Overlooking Freetown

 A Creole house

 "Minister" birds. Aka owner of the most obnoxious 

windpipes at 0600. I do not miss this bird at all!

There are billboards all over that speak 

about Ebola, many say "Ebola is real."

Sierra Leoneans can carry practically anything on their heads! They have incredible posture!

 Celebrating Valentine's Day in Sierra Leone (Med tent)

 Narrow bridge...that apparently is "beyond" its lifespan. I was happier when I was blissfully unaware that my life may be on the line each time we transversed this bridge...

Ebola Graffiti in Freetown

Hard to read because Dr. Jean and I saw this sign out of the corner of our vision and just barely snapped the photo in time! Reads: "Respect Ebola Survivors & Health Workers/They are our Heroes"

Returned to Work :-D

Sunday, the day I was supposed to be leaving Sierra Leone, I was given permission to leave housing. Did I leave? No! But just the knowledge that I now had the permission, the ability, the freedom to leave, was quite comforting. Makes me think of the elderly in the US that have their driver's licenses taken from them...and for those around the world who do not have the freedoms that I take for granted each and every day.

Monday I was allowed to work! I chose to work nightshift, as a nightshift would have been the last shift I was originally supposed to work before leaving Sierra Leone. I cannot describe how wonderful it felt to walk back toward the ETC, how nice it was to lift one foot then the other to have the sole of the shoe sprayed with the chlorine and to put the "gumboots" back on. I had thought that I wouldn't be allowed back at work before leaving Sierra Leone, and that had made me quite sad. It was wonderful to see the national staff: "Where have you been? Are you better? We thought you left without saying goodbye." It was wonderful to be doing what I came to Sierra Leone to do--fight Ebola alongside my teammates.

There was only one patient in the ward that was the same since I had last worked. All the rest had gone--some discharged, and unfortunately, some had died.

We had 14 patients again. The last day I worked there had only been 6. Seems the roller coaster is going to continue for awhile.

Our current 'outbreak' of patients that are testing Ebola-positive and subsequently dying are from one family. We believe the current influx of positive patients stem from one individual--a cured patient who had sexual relations and gave the other person involved Ebola,  which then spread to the individual's family which includes a 4-yr-old and a 16-yr-old. Ebola virus lingers in some body fluids, semen in particular, for up to three months. We have heard that there is at least one individual in Sierra Leone who tells women that "he has the antibodies for Ebola and if the woman agrees to sleep with him, she will be safe." No. She won't be safe. She will most likely contract Ebola and more than likely die.

Survivors are given several things upon being discharged from an ETC. One of the things they are given is a large bag of rice. Before passing judgment on either the survivor or the person who as yet does not have Ebola--place yourself in his or her shoes. You have 2-5 small children. You can't find work, you haven't been able to work in months. Your youngest child looks to be on the threshold of death if you do not find food. What do you do?

It makes sense that a person who is starving, literally starving to death, would be willing to exchange his or her body for food. There isn't an easy fix for poverty.

But while there isn't an easy fix...we cannot ignore the problem either, that benefits no one.

An Insider's Perspective (partially) part 2

I took two showers a day while inside high risk just to break up the monotony of the day. Was semi-pointless though-I had to put the same shirt and pants back on each time! My pants I chose carefully before going to Kerrytown; one day a few weeks back I had been doused with chlorine from behind the knee down to my foot and well, the brown material was no match for chlorine! My pants were quite bleached. Ironically, that day I got doused with chlorine on my leg was the same morning I had thought, "My clothes haven't been damaged by the chlorine near as much as I expected they would be! Ah life and the irony...

Thursday I spent waiting for 3 pm to come around which would mean my blood would be drawn. Spent the morning working on french braiding my hair then the early afternoon I began to work on dutch braids as well. (Starting to think I should make a list of "Things to do while stuck inside high risk" when you have limited things at your disposal!! Thursday I also called home and heard some familiar voices which was quite encouraging to my spirits.

3:30 finally arrived!! Now to wait till 7 pm...which turned into 9 pm. At ten pm I left my tent and asked across the fence for my results. I was told "My results could not be radioed across the compound for patient privacy," which in part, I understand, patient privacy is important, however, let's face it, the WHOLE compound will soon enough know my result. If it is positive, I will be relocated to the confirmed ward; if negative, I will be discharged tomorrow. Privacy is important, I agree, however, there are some things that cannot actually be hidden...

I was then told, "We will send someone inside to chat with you about your result." And I panicked. Beyond a meltdown. I burst into tears, stumbled back into my tent towards my bed and grasped my phone. By this time in the evening most of my colleagues were asleep-morning comes early and work doesn't stop just because one person gets sick. I called the nurse who had told me she would remain awake until she heard my result--and explained to her what had just transpired and the turmoil I was currently in. She calmly reminded me that we rarely saw a patient test negative initially then test positive. She reminded me I was no sicker--and that my chief complaint continued to be my sore throat. "Is sore throat a symptom of Ebola?" "No, no it isn't, but medical people tell patients bad news face to face!!! I was negative yesterday and my result was exclaimed across the fence! What has changed? Except that now there are three of us inside suspect?" My friend continued to re-assure me and told me to call her back as soon as I knew. I tried to sleep, Ha! But I was too concerned and far too nauseous at this point to actually rest. At 10:30 or so a medical team entered my tent. I didn't recognize them, but after all, the only part of them I could see was their eyes. I was told I was negative! My heart burst with the words of the doxology and I called several co-workers and sent a text to family back home.

Such relief. Thank you, Jesus, thank you. Friday, Friday I would be reunited with my peers. Monday I will be back with my family. What a tremendous gift.

Friday morning transport was arranged and I spent some time talking to my fellow suspect patients, both sweet women who had also had one negative but were waiting for their second result to come back/second blood test to be taken. They celebrated with me as I walked out of suspect (after my chlorinated shower and all my clothes/things got burned or chlorinated) The nokia phone, well, sometimes it can beat the chlorine and sometimes it just can't. The SIM card survived but the phone itself did not. I tried soaking it in rice...but no dice.

I was picked up via ambulance after being discharged, now no longer having to ride in the back! I was dropped off outside my room and took a non-chlorinated shower and changed clothes. (even though I had been given new clothes...the jeans I had been given were a little snug! Which is surprising because I was told by more than one person I lost weight while inside Kerrytown even though it was only three days. The staff there had noticed as well--Thursday night they gave me "Plumpynut" which is something we give to someone who is malnourished as it is packed with protein!!)
After my wonderful hot water and fresh water shower, I was overwhelmed by loneliness. I had no way of contacting anyone as my phone had been destroyed by the chlorine. I wasn't allowed to go to work as I still had a sore throat. I went in search of my buddy who I worked every shift with up until the time I got sick--because as it was Friday, we were both supposed to work nightshift. I found her in her room and we talked about an hour after she got over the initial shock of seeing me. She then got a hold of the nurse who had been keeping my family informed and I got my cell phone back. Thankfully the wifi worked long enough for me to text family and tell them that I was okay but most likely would not be allowed to travel on Sunday. The US was talking about med-evacing (evacuating) me home even though I was Ebola negative because they weren't sure I should travel commercially and because I am a US citizen.

Let that sit on you. Here I am, across the world, 'suffering' from a common cold, a common respiratory infection. The US is contemplating flying me home by private small plane which would be quite costly...meanwhile, dozens upon dozens of West Africans are dying of a catastrophic disease.

You are blessed with where you were born, friend, never forget that. And please, remember the people, the men, women, and children who are dying of Ebola. Remember their families. Remember their loved ones. Pray for those who are utterly isolated.

It was decided that I could travel once I was symptom free for 48-72 hours, and so, regretfully, I was unable to come home Sunday as originally planned. While I wanted to see my family, I understood that I didn't want to give anyone else my cold. I was most bummed by the fact that, as I wasn't leaving Sunday, I would now be traveling alone. Sunday another doctor was leaving, and we actually had the same flights up until we would part ways in Dulles. We had both been looking forward to traveling back to US soil with a friend for weeks.

As I still had a sore throat Friday evening, I wasn't allowed to leave our housing compound. Appreciate your freedom, friends. I think we only appreciate freedom once we lose it--I know I do. Through this whole week my co-workers were abundantly supportive-from calls, visits, chocolates; one loaned me her computer that she had uploaded disney movies on it for me, she also visited me daily and provided me with more sudoku puzzles...

I experienced in part some of the stigma our survivors go through. I was allowed to re-enter the community, but only partially allowed back because I wasn't allowed at work initially. While no one was truly afraid of me, at times I had felt like I had done the wrong thing by following protocol and going to Kerrytown.

I am thankful for the insider's perspective I received, and I am so very grateful to God that I tested negative for Ebola. It is a terrible disease and continues to wreak havoc on the lives of many in West Africa.

An Insider's Perspective (partially) part 1

Hello all, I apologize for my silence for almost two weeks. Several of us discussed media Monday a week ago and I decided not to blog until I was safely stowed away in my quarantine house, which I now am.

Monday, February 16th, I woke up with a sore throat. Throughout the day I took my temperature and it was in the 99.0-99.6 range. I had intermittent headaches and was tired, but as I had been up 26 straight hours over the weekend followed by four hours good sleep then awake again for a training session, of course, being tired made perfect sense. My immune system had clearly taken a hit. Monday is my off day, so I remained in my room and relaxed (well, as much as you can relax when you are slightly under the weather and nervous that at any point your temperature will spike). I read, I blogged, a friend volunteered to come over which I turned down--if I am coming down with something, no need to share it! That afternoon my temp hit 100.2; not technically a fever yet but high enough that it warranted notifying my supervisor. I reported all my symptoms and a doctor and our head nurse came to my room that evening bringing dinner and donned in light PPE to assess me. They maintained the two meter wide berth as per protocol. The decision was made to re-evaluate me in the morning. Throughout the night I took my temperature each time I awoke. At 4 am it was 98.3! Hurray! I am fine! At 7 it was still in the 98 zone but, as I still had a sore throat, I was instructed to remain in my room and continue to hydrate and rest and try to recover. The headaches continued to come and go. In the afternoon my temperature began to climb again--but the power was out and it was most likely 85-90 degrees outside. Around dinner time a few friends came over to spend time with me on my porch (again, maintaining their distance out of precaution) and they were a welcome break to the monotony of my day. My temperature rose above 100 again; again to 100.2. The decision was made that evening for me to go to Kerrytown, the 'ex-pat etc' as it is nicknamed. It is really the healthcare worker ETC. It has several more capabilities then the ETC I work at--for one, Kerrytown has a lab on site and not only tests individuals for malaria and Ebola but also does CBCs, BMPs, CRP, and oral/nasal swabs to check for respiratory infections. (CBC-complete blood count-essentially tells us if you are battling an infection or if you are anemic; BMP-basic metabolic panel-tells us what your electrolytes levels in your blood are which can help us tell if you are dehydrated; C-reactive protein-blood test that shows if inflammation is present). So, at ten pm Tuesday night, I was loaded up in the back of an ambulance and was on my way to Kerrytown; no longer the healthcare worker, now, the patient.

We arrived that evening and, even having a good idea what to expect after working in an ETC for five weeks I was nervous. Thoughts swirling around my head: "Why had I remained awake 26 hours straight over the weekend? That was dumb." "I am supposed to leave in 6 days!! Why did I have to get sick now?!" "Will I be able to go back to work or am I done?" "Think, self, think, did you have any issues with your PPE recently? Touch anyone while in the market that may have been sick? Did you wash your hands before touching your eyes?!" "What is my family thinking right now? I wish I could call them. I don't think I have Ebola...but I don't know why my temperature is higher than it's been..."

I had the local nokia phone with me but had left my US phone in the capable hands of one of my coworkers and requested that she keep my family and a few others informed of information as I knew how things were going. She graciously agreed, and was the recipient of a running commentary of my time in Kerrytown. I am so thankful for her--she kept me from freaking out the first day I was in there-kept texting me lyrics to various hymns. My other co-workers were also beyond wonderful--sending encouraging texts, sending me credit to the phone so that I did not run out and could continue contacting the outside world, and calling me to help me pass the time and to tell me about work--what I was missing, did certain patients get to go home, the national staff has been asking where I am...

We arrived at Kerrytown around midnight. My blood was tested for malaria at bedside-think fingerprick method. My bed was more comfortable than the one I had been sleeping on the entire time in SL! I was given a mosquito net, some water, some snacks, and disposable scrubs for pajamas. There was a camera in the tent that was on the entire time I was in there. I was told to "wave at the camera if you need anything." Umm...that's helpful, it is...but where can I change clothes?! I settled down for the night and tried to sleep--the waiting had begun.

Breakfast was porridge and a small sandwich with some kind of spread on the inside; both food items remarkably resembled what we serve at our ETC. Around 9 they drew my blood and did some swabs then left me alone. Now the wait for results had begun. I didn't take much to Kerrytown--anything that enters high risk is burned or chlorinated. I had taken the nokia, a small book of index cards, a pen, a printed out copy of Hebrews 11 (although only the first page...no idea where the second half of the chapter is!), the clothes I was wearing, socks in case my feet got cold, a few spare underclothes, and my malaria medicine since Wednesday was close.

I continued working on memorizing Hebrews 11 then played a few sudoku games on the phone. There are one hundred games...but the phone doesn't save your progress unless you immediately start the next puzzle after beating one...which I learned the hard way on puzzles 1 & 2..."Wait a second...this feels familiar...hmm, yep! I have solved this puzzle before!" And it won't let you skip puzzles. I wrote down a few of them that way if my progress was lost again, at least I wouldn't have to re-solve the puzzle from the beginning.

A doctor came in to assess me and asked me many questions regarding my symptom history and about how I was feeling presently. I begin to be quite curious--why is he asking these questions, what is he looking for, and what do I not yet know that he does? He then told me--all your blood work and your swabs are back except the Ebola pcr--all lab work is normal. I don't know what you have. Shortly thereafter he left the tent and I was again alone with my thoughts.

Ebola is a terribly isolating disease. Once you get sick, others avoid you. They have to--else they will also become sick. When you are a suspect Ebola case, you are also isolated. You are treated as infectious and rightly so--you could have Ebola, we haven't ruled it out yet. Being on the other side of that isolation---sucks. You can't get away from the thoughts plaguing your mind. I at least could pray and sing and knew that Jehovah Shammah was near; I knew that Jehovah Rapha could heal me of whatever was going on. There are mountains all around Kerrytown; I began to sing the song based on Psalm 121:
"I lift my eyes up, to the mountains/where does my help come from? My help comes from you! Maker of Heaven, Creator of the Earth/Oh how I need you Lord, you are my only hope/You are my only prayer/And so I'll wait for you to come and rescue me/Come and give me life..."

Sometime after 3 pm, the doctor who had visited me that morning called my name and I left the tent. He was on the other side of the fence and said, "You're negative! Results are back! Praise God from whom all blessings flow! I began a flurry of calls/texts to update my co-workers and family. I then thought I would be released...but as my labwork had not provided a diagnosis, I needed to stay in Kerrytown until I was 72 hours past my first fever. 72 hours was 3 pm Thursday...which means my second result would not be back until late Thursday evening or perhaps night.

Now...to wait. Again.

Thankfully Kerrytown has a lab on site. Some of our patients have to wait 12-24 hours for a result, and sometimes that result is the ever-frustrating "indeterminate" which means it will be re-run but may need to re-collected. The time I had to spend waiting was quite torturous---I cannot imagine how discouraging it must be to receive an "indeterminate" result. Some of our patients believe we are collecting their blood to sell it or to find better ways to poison them--they are quite suspicious. Makes it far harder to develop trust when we have to re-draw their blood because we couldn't read the result of the first blood drawn :-(

This is a long enough post...I will write more about my adventures in Kerrytown soon.

Three Returned Home!

The 5-yr-old went home!! I wish I had worked Friday during the day--we discharged THREE from confirmed which may be our record of discharging 'cured' at one time. We sent the pregnant lady to the MSF facility-they have ultrasound equipment there. We also were able to discharge one of the ten-yr-olds! What a day of celebration!

However, Ebola seems to never allow us to celebrate for long. Just a few hours later the results came back for the patients from the quarantined house-positive, all three. We again have 4 in confirmed. The fourth one has been there for almost two weeks...we drew her blood Saturday and got a negative result back, her first!

Hard to believe I have only a week left in this country. I have had the opportunity to have several discussions about Isa with Muslims this past week. Pray that I will have more opportunities and that God will give me the words to say.

Challenge Two

Well, our wards have emptied out somewhat again. Wednesday morning we discharged the patients in suspect and probable and our total patients was 4. WASH went through and deep-cleaned suspect and probable. We currently have 4 patients in confirmed. Two of the four worry me, the other two look like they are recovering.

We are on the precipice of discharging our first pregnant patient, which is exciting yet challenging, because her baby presents a risk to the mom and the mom's family and community. From what we know about Ebola, her unborn baby most likely has Ebola and the viral load in the placenta is extremely high. Carrying her baby to term will be dangerous for her and for her community. The baby may die in utero--and if she starts to miscarry while at home, it is quite possible  that she will die before reaching the MSF treatment facility in Freetown because she lives in a rural area. We don't have the equipment to do an ultrasound to see if her baby is still alive--or an amniocentesis to see if there is Ebola virus in the amniotic fluid.

I believe in the sanctity of human life--and I want to save her baby--especially since we have lost so many young kids. But in saving her child, we may lose her, we may lose both, and we may lose others in her community. Ebola sucks.

Our 5-yr-old looks better from an Ebola standpoint. Saw him without a shirt yesterday and you can see the blatantly apparent malnutrition in his swollen belly and he has an umbilical hernia. He looks pregnant, he is so malnourished. He is eating well though. He is not talking at all, not to us, not to the caregivers...hopefully he will beat Ebola and will start talking again when he is back with his brother.

Thursday we admitted three patients from a quarantined house. The 21 day quarantine starts over each time someone gets sick. The government provides food but it becomes more difficult when the quarantine time is continually reset, and the quarantined do leave their quarantine if they have no food. I can't say I blame them. What's the point of staying in quarantine if your whole family starves?

I have another challenge. Recently the Southern Baptist IMB had a challenge to skip a meal and donate the money to the international missions fund. I challenge you to eat one meal of rice and beans (ONLY rice and beans, although feel free to add seasonings to the rice or beans) at least once a week---and as you eat your rice and beans, remember the third world. Pray for them. Take the money you would have spent on that meal and use it to feed the hungry--those hungry near you or those that are far away.

I think it was Ghandi who said, "There's enough in this world for the world's need, not enough for the world's greed." (May have both wording and author wrong, forgive me!)

“No, this is the kind of fasting I want: Free those who are wrongly imprisoned; lighten the burden of those who work for you. Let the oppressed go free, and remove the chains that bind people. Share your food with the hungry, and give shelter to the homeless. Give clothes to those who need them, and do not hide from relatives who need your help. “Then your salvation will come like the dawn, and your wounds will quickly heal. Your godliness will lead you forward, and the glory of the LORD will protect you from behind. (‭Isaiah‬ ‭58‬:‭6-8‬ NLT)

Highs and Lows

A co-worker and I admitted a lady this past week who was so very sick she would only rouse to her name. We could get zero information from her about how long she had been sick, whether she had been in contact with someone who is sick, or attended a funeral recently. All we knew is she was febrile, had a distended abdomen, looked dehydrated, and was breathing rapidly and shallowly.

We took her straight to probable, where her mental status quickly declined further and she was no longer rousing to her name. We got an IV line in her which was no small feat with how dehydrated she was! But our success was short-lived. We hooked her up to lactated ringers and she pulled out her line. "Noooooooo!!" We looked at her arms again--she desperately needed iv fluid. We saw one tiny vein in her forearm and hoped we would be able to get an iv in it. We did, and I sat by her for the entire liter holding her hand to prevent her from removing her second line. She needed another liter, but my buddy and I had been inside for 90 minutes in the late afternoon. The doctors rounded and agreed she needed more fluid and also agreed to stay with her while it ran in so we could doff.

We drew her blood. She died that night; a short 5 hours after we admitted her. Her lab work came back "indeterminate." We will never know what killed her. Ebola? Malaria? Lassa Fever? Small Bowel obstruction? Only God knows.

I have been off two days. While I was off, we discharged three patients from confirmed!! One was the 8-yr-old whose brother we lost and her aunt was negative. I would have loved to join her on her journey home, to watch her be reunited with her aunt!

We lost the one-month-old. Her father got discharged-I imagine he knows his wife isn't coming home by now. We now have six patients total. Hopefully our census will continue to decrease.


Praises: -We have had several discharges from confirmed!
-I spent a good thirty minutes talking to a Muslim about Isa (Jesus).
-My time here is waning which is bittersweet. I am looking forward to being home (although I am not looking forward to my solitary confinement!) But I will also miss the friends I have made here.

Please continue to pray for the people of a West Africa, momoh.

"Defend the Cause of Orphans"

I am hoping to have a few stories of cured patients soon, we have several that are currently on the mend. However, today I do not have one of those stories to share.

A few days ago three small boys came via ambulance. They were brothers, ages ranging from 5-8. The 8-year-old was the sickest of the three but none of them looked well. We learned from the ambulance driver that their dad had died but the driver didn't know what killed him.

He did, however, know that the little boys' mother had died of Ebola. We admitted them, started IVs, gave iv fluid, and prayed. Not wanting to separate the brothers, we placed them in beds side by side. That night, the 8-year-old died, which his brothers witnessed. The lab results came back the next day--he had Ebola as does his youngest brother. The middle one the test was inconclusive. We moved the youngest Saturday night to the confirmed ward. He walked there on his but his steps were slow. Sunday morning we went inside to give patient care and breakfast. I didn't have the heart to wake the 7-year-old. He was sleeping so peacefully, and being awake right now would be a living nightmare. I asked the caregiver, Zainab, if she would help him eat when he woke. She agreed even though her specific charge was a few beds away and far younger.

On to probable, where the man who lost his wife remains by himself. He has been alone in probable for 3 days now, ever since we had to move his baby to confirmed. He was looking better today, and was actually hungry which is a good sign.

On to confirmed. I always take a deep breath as we approach confirmed. What will I find upon entering? Will someone be dead? Who? How many? Will someone have fallen? Will our charges look better or worse than when I last laid eyes on them? Is my PPE still in place and protecting me from this dreadful disease? And, slightly humorously, can I still see well through my goggles or has the fog taken over?

Everyone was alive Sunday morning. No one had a fever in confirmed. I visited the youngest brother. He was sitting upright but just staring off into space. I gave him his breakfast but he didn't touch it. He didn't move. We finished passing food to everyone and I came back and sat down next to him and tried to encourage him to eat. He ate some but very little. He did drink about 2 1/2 cups water. He didn't do much for himself. In nursing school you are taught that children tend to regress in their developmental stages when they are sick or exposed to trauma. He meets both criteria. Psychosocial is going to try to find him a caregiver. Without one he will die; he will not eat or drink without encouragement.


Abba, Father, comfort the orphans. Comfort this small child. His elder brother was awake when I doffed and was standing at the front of the suspect ward, just staring. Will he see his only living nuclear family member again? I don't know.

Was reading Isaiah this morning and came across the following verse. Quite appropriate for what I witnessed shortly thereafter in high risk.

"Learn to do good. Seek justice. Help the oppressed. Defend the cause of orphans. Fight for the rights of widows." (‭Isaiah‬ ‭1‬:‭17‬ NLT)

On Food :-)

I wrote this post a few weeks ago and it mentions what our meals consist of most days. Thank you, Mom & Aunt Deb, for asking me recently what we eat! Both times I thought, "Huh, thought I covered that..." And I did, I just never shared it. My apologies!

Monday, January 19th, we had one admission before lunch. Jasmine and I were on the lunch pass and I got to draw blood on the admission! My partner was Joseph, a national nurse I hadn't worked with yet. He helped me explain to the patient in Temne what we were about to do.

As a group of four we continued on to the confirmed ward where we spent most of our time encouraging the patients to eat. There are four women right now and 2 of the 4 are fairly sick. I spent time with the oldest trying to get her to eat some. "Eat eat small small."

Dr. Andrew got off around 2 today and around 3 we headed back to housing which is just a few miles away from the ETC. IMC has several vehicles shuttling people from housing to the office or ETC or into the local town. Dr. Andrew and I decided to walk to town (20-25 min leisurely stroll one way, not bad!) and we bought some bananas (hurray!! Fresh fruit!!) and bought some hard-boiled eggs to add to breakfast which is 3-5 pieces of white bread, toasted. We have accrued a few jars of peanut butter, jelly, Nutella, and marmite that are communal and stay in the center of the biggest table.

We eat lunch most days at the ETC-which is beans and rice or cassava leaf, rice and fish. Quite spicy, even for my palate! And also quite oily, most things are cooked in Palm oil here.
Dinner we eat at the housing compound which is either fish & rice or chicken & rice. My first night here I chose fish and it came out with the head still on, which no doubt, I should have expected! It was delicious but bony. (I didn't mess with the fish head at all!) Since then I have eaten the chicken most nights.

(February 7th)
We had a Mexican meal few days ago. Someone had found buritoes in the local gas station/grocery store. That was a wonderful change to the usual chicken or fish and rice. I am hard-core craving a fresh salad though! We have had fresh pineapples and mangoes recently--so delicious!! And a Sierra Leonean found me apples in town. Apples do not grow here, they are imported.

Snaps Saturday

Sunset view from a friend's porch

Traditional Hut

The famous cotton tree in Freetown 

View of Freetown from Lestor Hill (and yes, the US 

Embassy is in this shot--can you find the tennis courts?

"Put your hope in God, for I will yet praise him"

Diving into the Psalms today. A friend and I have been talking about the psalms recently--the ones in the 40s: "Why are you downcast, oh my soul? ...put your hope in God, for I will yet praise Him..." And Psalm 88, the ending, "Darkness is my closest friend." The Psalms carry the whole spectrum of human emotion-and the Psalmists weren't afraid to be honest. Watching suffering sucks.
Watching children sicken and die is awful. We lost two last night alone, both quite young. We also lost one of the ten-year-olds the night before. One from last night was the one year old that we has discharged a week ago Ebola and malaria negative that came back to us with high fever and with BOTH malaria and Ebola. We all knew deep down we would lose her...but you have to hold on to the hope that you are wrong.

Hope. Such an important emotion. Most of the laments in Psalms have elements of hope in them (Ps 88 aside). Psalm 89 returns to hope. Hope is vital--hope is why we didn't tell the gentleman his wife is dead. He is holding on to the hope that she is coming--and until his health improves, we aren't going to deprive him of that hope.

Someone asked me what happens when our patients get discharged. When they are discharged from confirmed they are "cured," and we celebrate with singing, dancing, and djembe drumming. The cured person or persons get(s) loaded up in our ambulance and delivered back to his/her village. Psychosocial goes with them, and sometimes a nurse or doctor does as well. Yesterday two of our nurses went--but they didn't actually get the girl back to her village because the vehicle got stuck in a swamp on the way out! Two vehicles did initially...followed by the rescue vehicle...followed by the second rescue vehicle! So four total vehicles got stuck in mud (4-wheel drive, standard transmissions) and it isn't even rainy season yet!! Oh boy!

The reactions of a homecoming vary. Sometimes, the cured person has lost everyone in his to her family and comes back to an empty house. Sometimes the villagers don't want to associate with them because they are afraid the individual still has Ebola. Or they are afraid the person is cursed. Some homecomings are happier than that, but many are quite somber affairs. Every time psychosocial visits a village (I learned yesterday that anything under 50 houses is a village, anything over 50 is a town) they try to do impromptu education seminars about Ebola. It does exist, this person is cured & safe, continue to report the sick in the village so they can be treated...

Momoh (mu-mu) for praying for us. Momoh is thank you in Temne. Please continue to uplift the peoples of West Africa.

"The Pediatric ETC"

We seem to be a pediatric ETC right now, which is a special kind of awful given children do not do well with Ebola. We have 8 that are 13 or younger, and half of those are one year old or less. Hearing the babies crying Thursday afternoon was heart-breaking. We have survivor caregivers for them, but the fatality rate of the under 5s is extremely high. Two of the small ones are in confirmed, where we currently have TWELVE patients:(
Ebola is currently on the rise again. The surveillance teams identified about a dozen unsafe burials recently.

Just about every day I get asked if I am extending my contract. Most days I really want to--this disease needs fighters and needs to be stopped. But I also hear that March is one of their hottest months, and if so, PPE in March sounds horrific. This is their "winter" season, and 80-95 degrees is the "cool" part of the year. (It's all about perspective!!)

Thursday my co-workers shielded me graciously from high risk to help my cough; Wednesday I had gotten a face-full of chlorine during doffing and my cough got significantly worse. By Thursday evening, with just 24 hours away from the fumes, my cough was much better. It will be interesting to learn what the long-term effects of prolonged exposure to highly concentrated chlorine vapors are!

I wish I had more positive things to say about our ETC and our census. We are here to get the people with Ebola out of the communities, so that is a positive thing. But it is very hard to have so many children. Not that watching adults die is pleasant; it is horrific as well, but children...they should be playing football in the streets. They should be learning spelling and math and spending time with their families and friends and dreaming about their futures.


Some common names in Sierra Leone: Aminata, Mariatu, Mohamed, Ibrahim, Kadiatu, Abubakarr, Saliaman, my personal favorite (and the name I gave myself) Sadiatu, and Isata. I also like Philomena but I have only met one lady with that name. She is wonderful though!!

Praises: my health! My cough is better!
One of our newest nurses is a peds ER nurse! (I will not draw blood nor place an IV in a one month old! So grateful she is here and can!!
Prayers: continued opportunities to be a testimony of Jesus; to be His hands and feet
My co-workers as we take care of suffering children

Asante, friends. Asante.

"This is Africa!!"

I am truly enjoying learning about Sierra Leonean culture. Kenyan culture too, the ex-pat nursing staff is mainly North Americans and Kenyans. Here are a few colloquial sayings in Sierra Leone that were entertaining to me:

"Only a courageous woman can fry a bunch of plantains without tasting any."

"Any man that uses his teeth to cut meat from pepper soup with his eyes wide open, is not afraid of anything, he's a witch."

"Any man who chew & swallow bitter kola without squeezing his face is capable of murder." (A kola is a nut from a kola nut tree and is apparently quite bitter though I haven't tried it).

I have also heard quite frequently, "This is Africa!! In Africa, we improvise!!"

Today (Wednesday) was a downer of a day. Our newest patient is extremely ill and the majority of our pediatric patients have taken a turn for the worst. And one report showed 21 new cases country-wide today.

Asante for praying for us. (My newest language lesson was in Swahili.) and thank you in Krio is "thankie," to which most people respond, "thank you too," even though they may not have anything to thank you for; it's almost an instinctive response. Sierra Leoneans are extremely polite. They raise their voices quickly but generally out of excitement not anger.

The Rescued

We discharged a patient from the confirmed ward Tuesday--he is cured! He never even got terribly sick. Ebola--some people get extremely ill and some people get slightly sick then within 3-4 days all their symptoms are gone. There is still so much we don't know about this disease.

We admitted 6 patients :-( Our enthusiasm of feeling like Ebola was on the decline was short-lived. We currently have 10 in the confirmed ward; that is the most since I have been here. The twins are doing semi-okay. They seem to be alternating which one is sicker each day. And we admitted a husband and his one month-old-daughter. It quickly became evident that he didn't have any knowledge of how to care for her besides holding her closely. He told us his wife was sick and coming in another ambulance soon. Once we got he and his daughter settled and doffed, we learned that his wife wasn't coming. When they picked the gentleman and his daughter up--she was dead. We didn't have the heart to tell him she won't be coming, too afraid it would take the fight out of him completely. Is that the right decision to make? I don't know. It's the decision we made all the same. I believe firmly in telling the truth, I do. But as he is already so sick...to tell him might be the proverbial straw that breaks the camel's back.  We placed a survivor caregiver in his ward to help take care of the baby.

Since confirmed has so many young children, the ward had 3 survivor caregivers there. A co-worker and I talked to them while we waited for our iv fluids to run (Sierra Leone is currently out of oral potassium chloride, so we now must administer it mixed in iv fluids but they must run over an hour, no less, and it has extended the amount of time we are inside high risk doing meds).

The one lady got Ebola in September. She lost everyone in her family. And in September we didn't have many ETCs in the country (ours opened December 1st) and the few that existed were overcrowded and understaffed, and IVs weren't started; we couldn't give meds because they just weren't there to be given. The other two women got sick and got better in October. One lost her husband and three of her four children. Her daughter lived--but only because she was not living at home at the time. The other caregiver lost her mother, her aunt, her uncle, her sister. So much loss. So brave, that they have been willing to take care of our patients. As my friend Cait said, "The rescued are now doing the rescuing."

And isn't that what Jesus has called us to do? Rescue, because we have been rescued.

Today, hold your loved ones close. We aren't promised tomorrow.

Grief and Waiting

They say grief comes in waves; you can be coping well and out of nowhere a song, a phrase, a smell hits you and the reminder triggers a wave of grief that slams into you full-force. Seems homesickness is the same. I haven't been homesick at all--we stay fairly busy at the ETC and see some graphic, terrible things that it has kept homesickness at bay. Grief has been a constant companion--but not homesickness.

After leaving work Sunday morning, I went to a Pentecostal church in town. The main church is in Nigeria, this one is a smaller branch. The service was quite different to what I am used to, and the Sierra Leonean I went with translated some of it for me. I can understand pieces of Krio (the name of the pidgin English here) but when people talk quite fast I get lost quickly.
The service was about 3 hours, and was quite joy-filled. Towards the end they asked the first time visitors to stand. Thanks to my skin color, i couldn't pretend I had been there before! Pretty sure I was the only "opoto" there (word for white man).

After the service, as we were walking out, I heard someone call my name. One of my co-workers, her nickname is Queen Esther, was there this morning! She works nightshift Sunday.

In honor of Super Bowl Sunday, I played football with some of the guys on the compound. At first I didn't know if I should play with them-do African women play soccer? Then I decided being the only girl hasn't ever stopped me in the past, and anyways, I can use the "I'm foreign and didn't know it wasn't acceptable" excuse.

Back to homesickness. It's Super Bowl Sunday, and while I do not avidly follow football, I do watch the Super Bowl every year, usually with family or friends. The fact that I am in Sierra Leone and not watching the Super Bowl with family & friends hit me hard--and suddenly, out of almost nowhere, a tidal wave of homesickness hit me.

After dinner we tried to find a channel that had it--and we found a feed out of South Africa that will play it--kickoff is at 11:30 pm Sierra Leone time. So glad I am off tomorrow!! It isn't quite the same experience--but I didn't think we would be able to watch it at all!

I talked to the nurses who worked today--that whole family of 4 came back positive:-( They are currently all still alive, but the twin ten-year-old girls are quite ill :'( We also had two others turn positive, one who is a one-year-old who we had for several days; she tested negative twice and we sent her to another facility where she subsequently became febrile and was returned to us. We drew labs again on her and she turned positive for BOTH malaria and Ebola. Scary, because she met our discharge criteria and one of our staff members held her (with gloves on but not in full PPE)  on the way to the facility. So, now we wait.

Pieces

Everywhere you live you give a piece of your heart, and you don't get that back. Pennsylvania has a piece of my heart, Costa Rica does, Tennessee does...and now, Sierra Leone does as well. My heart broke for this land when we heard the daily report of confirmed cases, 15. Only 15? That's fantastic you may think. And yes, it is fantastic compared to 100+/week we were seeing in December. However, we had been having less than 10 for several days. And those 15 do not include the 4 patients we admitted in Saturday that are displaying many symptoms of Ebola. Their results are not back yet, but vomiting and coughing up blood, bloodshot eyes, and high fevers are quite indicative.

We have workers called "Dressers" and their job is to help you dress in PPE then make sure you are safe safe prior to entering high risk. You have a once-over inspection before entering. And it is thorough. Two days ago my partner had the tiniest of tears in his outer glove. Our dresser caught it and he changed gloves. I am grateful for them and or their thoroughness.

WASH-the doffers (the crew that sprays you with chlorine as you doff PPE) have a hard job as well. Their job is to make sure Ebola does not leave high risk, and they help you remove PPE. We wear aprons over the Tyvek suits and the latch is near your right clavicle, but you are not allowed to look down to find it. You must rely on your doffer's directions. Sometimes the adhesive on the Tyvek gown rips. And when that happens, your doffer helps explain to you where the strings are so you can tear them. It must be so incredibly frustrating to watch us struggle and struggle, and not be able to reach across and assist, but they cannot cross the red line.

What questions do y'all have for me?
"Every day is a Monday in Ebola," and the days run together and are becoming routine, so I may not write about something you are curious about. Thanks for reading and for praying for us and caring about the people of West Africa.

Photo Friday

Slightly blurry but what some houses look like 

here; made from bricks baked in the sun 

Fire pit where most of our burning happens

Countryside

Landscape near Makeni

Everything is greener after the rain!

Stacks of bricks, ready for 

the next construction

Helping Others

As you work and live with people from other places and other countries, you are able to learn about their culture. I have learned a good bit about Kenya, Sudan, Lebanon, Canada, and a great deal about Sierra Leone. Working with the nationals allows you to get glimpses into their lives. And it makes the abject poverty of their country come alive. You can glibly read a statistic about the people in the poorest countries that live off of less than $2 US a day...but being here, I can see firsthand what that translates to. So much malnutrition for children and adults, and so much death in pregnancy-both the newborns and the mothers.

I've never been good at bartering. There is a bartering system here at the markets for buying items and you also barter to exchange money. You can call me a sucker, that's fine, it's true. But it is also true that if I wind up paying an extra dollar here or there--I can afford to lose it, much more so than the people here. There is so little in this country. West Africa was quite poor pre-Ebola. The fallout of this widespread outbreak is further reaching than we can yet know. The job market was poor pre-Ebola. It is almost nonexistent now. They do hope to reopen the schools in March.

I want Ebola to end, I am praying for it to end. But I also know that when it ends, many of our national staff will no longer have work. What will they do? How often will they be able to eat?

I do not know. I reiterate a few posts back--be thankful you were born were you were--with the ability to gain an education and, for the most part, find work. Was it easy? No, but it was still possible.

World Vision has a microfinance branch.* Several other organizations do as well. Micro-loans are funded by donations that go to an individual that wants to start or expand a business such as raising chickens or goats or selling clothes but needs a small (in the US mindset, but an unattainable amount in extremely poor places) start-up fund. The loans are given out with the expectation that they are to be repaid as soon as possible. Say you give $100 to a farmer in Kenya and he buys chickens. When he can pay it back, that $100 goes to finance another micro loan, still in Kenya.

It is easy to be overwhelmed by the needs around you in your work environment and in your neighborhood, let alone the needs around the world. The need is massive and daunting. It is also easy to go too far in the other direction, and to ignore the need completely. Too often I think we use Jesus' words, "the poor you will always have with you," to allow us to do nothing, because after all, we will not end world poverty. It's true, you and I will not end world poverty. But you and I can make life easier on someone else. Not with a handout, but a hand-up. It can be as simple as volunteering to babysit the single mom's children a few hours here and there. It can be giving $50 a month to a micro-loan and foregoing something, be it a few movies or coffee & ice cream. Or it can be far more long-term, and it can be becoming a foster parent or adopting a child.

When Jesus said those words about the poor, He wasn't condemning an extravagant gift here and there. There is a time and place to give a lavish gift. He was commending a woman** who poured expensive perfume on the Savior's feet hours before He died on the cross for our sins, and a few days before He rose again.

But taking care of the poor is mandated throughout the Old and New Testaments. During my quarantine, I am planning on doing a study of references to poor/widows/orphans in the Bible. (Biblegateway most likely already has a list of references, as I am sure a google search will show) I will list the references I find once I finish.

Unfortunately, there is a lot of money that has been poured into poor countries over the years that the poor never saw. Political corruption has kept the aid money from them. Research the organization before you donate. But please, do not turn a blind eye to the poor.

I didn't work today (I am working tonight) and a few of us ventured into the local town to exchange money and buy some eggs & bananas. The market is quite a sight to behold! Many vendors in small spaces, and many fruits, vegetables, fish...One of my co-workers wanted to find pineapples but we sadly did not find any today.

Praises: My cold is gone! And a co-worker from Kenya gave me his jar of honey before he left for r&r. Honey lessens the chlorine cough substantially!
I am mostly holding up physically. Felt slightly sick-ish this morning but I am feeling better. (No fever!)
Thanks to your prayers, encouraging words, and letters I am holding up emotionally without becoming callous to the suffering. Please continue to pray for the emotional health of our team.
Please continue to pray for the peoples of Guinea, Sierra Leone, and Liberia.

*http://m.worldvision.org/micro

**the whole account can be found in Matthew 26:6-13

To Whom Much is Given

As I finally fell asleep last night, the phrase in a verse in Luke 12 "to whom much is given, much is required," kept rolling around in my mind. Please allow it to simmer in yours.



We lost the husband this morning, he was gone before the sun rose. Such a fighter. He fought with us 9 days. I don't know how many days he was sick before he came to see us.

Sierra Leoneans are a friendly people and have a touch-oriented culture. Because of Ebola, they have had to limit physical contact which has been quite hard on them. They are also a cautious & suspicious people; and there are many myths believed about Ebola throughout the communities. Some people believe westerners inflicted this dreadful pestilence on them because we wanted to make money off of them by developing medicines they must buy to get better. It reminds them all too much of AIDS. With HIV, they were told to "limit physical contact and avoid body fluids, use condoms..." Sound familiar? Then extremely expensive drugs were made to combat HIV but they were initially quite difficult to acquire. Hauntingly familiar; their suspicions  make logical sense.

Also, there is a belief that the nurses who took care of one of the first Ebola patients stole his money and he cursed them before he died which is why so many healthcare workers have gotten sick.

There is another belief that the chlorinated water we spray is actually poison and that is why so many people are dying. And, as it is poison, that is why we wear the suits.

One individual may believe one or all of the aforementioned beliefs. Viruses aren't visible to the naked eye, only their effects are. Others do not even believe Ebola is real. I have seen a few graffiti signs around the community that say, "Ebola is real" and "Beware of Ebola."

Slowly the people are beginning to seek care earlier on in their sickness, and returning survivors to their communities has helped tremendously. But health literacy is quite low, and many survivors continue to be ostracized by their communities :-(

IMC hopes to help Sierra Leone rebuild their health care system but that will take time and tremendous effort. The country has to have zero cases for 42 days before it can be declared "Ebola free." During that time, we will be able to have training seminars in our ETC. We hope to convert it into a clinic when the outbreak is done. We have already started our seminars. Today's was on malaria. Dr. Jean and I hope to do one on pain management and palliative care soon.

Thanks, y'all, for your encouraging words and prayers. Thank you for lifting me up on the difficult days. It is greatly appreciated :-)

A Sense of Loss

Wednesday was a rough day on many levels. Per IMC policy, if you are doing a 3 month contract, you can have 9 days of r&r after 6 weeks. One of our nurses left Sunday & another left Wednesday night. While I am grateful that both individuals will have time away to relax and to spend with friends/family (although the us citizen can't actually go home because USA won't let her leave our country until the 21 days of quarantine are up, even to return to West Africa), I am also sad because I was close to both nurses, and now they are gone, albeit temporarily. And the goodbyes and the sense of their absence resonated deeply with me--because so many Sierra Leoneans, Liberians, and Guineans have said permanent goodbyes to loved ones over the past 14 months. Family and friends, whom, some of them, left their communities looking perfectly healthy...only to die of Ebola within two weeks or less.

Another reason it was rough--today was day 8 for the husband to be in the ward. If you can make it past day 7-8, you can usually beat Ebola. And he has been fighting, fighting, fighting, all the way. But 4 days ago he began to have visible signs of bleeding and spiking temperatures. One of our national doctors, a man who has been fighting Ebola since it began in Sierra Leone, said the other morning, "I have never seen a patient survive once he or she starts bleeding. But perhaps he will be the first, he is a fighter." And as days 6 and 7 passed, we all began to feel optimistic and wanted him to survive and recover. Not that we ever don't want patients to recover, we do, but we feel a special pull to him because his wife died---and circumstances surrounding her death will haunt my co-workers for some time. I am thankful I was not yet in Sierra Leone when she was in our ETC. For our staff, his surviving would be a bit of redemption since there was so little we could do for his spouse. He did not fare well through Tuesday night though, and when I saw him at noon he looked terrible and was no longer responsive, even to pain. The docs and I stayed with him at bedside as long as we could, perhaps 45 minutes. Then after shift change I went in again-because he is "actively dying" and I wanted to spend more time with him. Second time in high risk I was in close to two hours--and as WASH tends to fuss at medical for being in too long, I came out at two hours. (They are only trying to protect us, after all). He was still breathing but struggling to do so. We gave him morphine. The national staff is quite hesitant to give morphine because, from what they see of it, it causes death. (Cue Brian Regan: "Morphine?!! That's what they gave the guy in Saving Private Ryan right before he died!") We give it to the sickest patients, so it does kinda look like it causes death--but the whole palliative care modality doesn't exist here. And the ones who get morphine are usually "actively dying." I don't know if you have ever seen someone actively dying. It isn't easy to see--and there is no way to know how long the process will last. Humans are too different. I don't guess anymore because I am always wrong. I thought he would be dead at 3 pm; and he wasn't. I left him at 5 and came back at 6:30. His breathing was more shallow but his pulses remained strong even in his feet. (You can assess a person's blood pressure based on which pulses you can feel/no longer feel when you do not have a blood pressure cuff).

My supervisor and I left him at 7:35 because we needed to doff before shift change-the national staff has a bus to catch and we didn't want to delay them. It was so hard to leave him. I hate Ebola, and I hate that so many die alone, isolated from their loved ones.

Another reason today was hard--we had 4 admissions in 3 ambulances over several hours. My supervisor found out about the fourth pt, a pregnant lady, shortly after I left high risk for the second time. At this point in the day almost everyone had been in twice and a few three times. She graciously agreed to join me and I quickly gulped down O.R.S. (And yes, the taste is pretty terrible) and 2 liters of water. We were told we had 30 min to an hour before her arrival. They then updated us a few min later with "They are still thirty minutes out," only for us to hear the ambulance siren two minutes later. Time is relative here ;-)

We got our new patient settled and spent a little time with her then we moved on to the confirmed ward to check on our dying patient and to relieve the nurses who had passed dinner meals. They were giving iv fluid and couldn't leave because the pt receiving the iv fluids is not oriented and she has to be monitored while receiving fluids so she doesn't rip her iv out.

Several of our new patients are quite ill. And the one is an aunt & caretaker of one of our patients in the confirmed ward. When she goes outside her 8-yr-old niece sees her and cries incessantly because she wants her aunt--but her aunt is currently Ebola negative and cannot go to her niece without putting herself in great danger of contracting Ebola, something the 8-yr-old cannot comprehend. All she knows is her aunt won't come through the double fence to be with her.

We have a movie projector and we show films at night that the confirmed and probable patients can watch if they are well enough to go outside. I didn't recognize the film tonight but the patients seemed to enjoy it.

I can't help but wonder if the husband would have done okay if we could have given him a blood transfusion. He is such a fighter, but he has lost so much blood. The disparity in health care grieves me. If I were to contract Ebola, I would be air-lifted out, given interferon and transfusions, potentially blood products from survivors and would be given every thing we have tried thus far that could potentially help--because I am from a first world country. He isn't, so he is essentially on his own. We give iv fluids but no transfusions, not yet. We don't have interferon here. Today, praise God that you were born where you were and that you have had things like basic health care and nutrition from a young age. We lose so many kids to malnutrition here. And I am not saying poverty doesn't exist in the states, it does. But there are still hospitals and a working health care system, sure, it has flaws. But it is the grace of God that you were born where you were, that you are literate and able to even read these words, that you have electricity and clean drinking water from the tap and, for the most part, 3 meals a day. That are well-rounded meals, not just carbs because they are cheap and satisfy initially. But protein. And if your meals aren't well-rounded, it is usually within your means and ability to make well-rounded choices. Thank God for how He has blessed you. You could have been born in a time or place where maternal and pediatric health is low and lost your mother at childbirth and you could have died before age 5.

The Difference 45 Hours Can Make

My current schedule is "long day, long day, long day, night, night, off, off." And goodness, can a lot change in two nights off. Sunday when I left at 11 am (after a paperwork fiasco) we had 5 total patients. We admitted 4 Sunday and 7! on Monday. Monday we lost one of the Sunday admissions. The majority of them came in quite sick. We lost a 4 yr old this morning who was "co-infected" with Ebola and malaria. With either Ebola or malaria, the 5 and younger do not do well. With both, survival is close to nil :'( we got many results back today; 6 positive Ebola cases. 2 of those 6 we have already lost. On the happier side, we were able to discharge the one lady remaining from the funeral today! She is cured!! She danced and danced. Funny creatures, we humans are. When one person begins to improve, the others see it and their morale changes. The husband may surprise us yet. Another woman is on the mend. She has had one negative test and we drew her second one today.
On the converse side, however, when one significantly worsens or dies, it again changes morale and we tend to lose more:( Like the oldest lady of the 4. She was doing so well...then her friend died and she died shortly thereafter:'-( She surprised us all. She had been eating  bananas and drinking the O.R.S. like a champ! But she gave up once her friend died.

I think Ebola in West Africa will continue to ebb and flow for awhile. We heard yesterday of a family of about 40 near our other ETC site that actually hid the body of a child who died of Ebola. That site has had less than 5 patients for almost 2 weeks. But now, they are seeing several come in from that family. It's so hard...because the majority of people that enter the ETC-the confirmed ward-do not leave cured. And the ones that die-there isn't closure because we cannot open the body bags to show the family.

There are tents behind the ETC where families can come to visit their family members...but their family members have to be well enough to get outside and well enough to be able to speak audibly across the two meter distance. It is difficult for some of the family members to get to the ETC. Some live in extremely remote villages. The medical side of me understands the danger of Ebola and the need for caution and safe burials and isolation & quarantine; but the human, family-oriented side of me recognizes how much I would want to see my family if I was sick or if they were sick, especially if I or they were essentially handed a death sentence of a disease that kills quickly. And closure is huge in the grieving process. But then, my grandfather always said, "If you don't visit me when I am alive, don't bother when I am gone."

On a different note, and my family will appreciate this: we don't get many vegetables (a reoccurring  theme I have discovered in my travels) and tonight, we had some! But they were sugar snap peas!!! But don't you worry, family, I ate them all! I guess a need to have vegetables in my diet (and the drilled in from a young age "you eat what you are served!") overcame my loathing of sugar snap peas!

"You should see the stars tonight"

"You should see the stars tonight/how they shimmer and shine so bright/against the black they look so white/coming down from such a height/to reach me now, reach me now..."
~David Crowder Band

That song is always in my head when I look at the stars. I spent the last two nights working nightshift and, although we still have some lights on at the ETC, the night sky is stunning to behold. So many stars, so much beauty. Brings to mind Psalm 8: "When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, and the son of man that you care for him?" (‭Psalm‬ ‭8‬:‭3-4‬ ESV)

Nightshift is a completely different pace than Dayshift at the ETC. We do not take any admissions after 6 pm. We do not to blood draws as the decreased light increases the risk of an accidental needle stick. We operate with far fewer staff; 5-7 nurses, still two doctors, and a skeleton crew of WASH staff. (WASH stands for something but I currently can't recall what. The 'w' is water though;) And the 's' is sanitation.
Friday night I went inside high risk with the first round which is between 8:30-10:00 pm for meds and "TPR" (temperature, pulse, respiratory rate). I thought, "The sun is down, surely the PPE will be less toasty to be inside." Nope, wrong! As soon as I fully garbed I realized how wrong I was...we were inside about an hour/hour twenty with the IV fluids we had to give. We cannot leave any hanging unless the next medical team is following directly behind the med team because it is too risky of something happening to the iv site without supervision.

Oh, the husband came back positive for Ebola. He is currently our sickest patient:( He is extremely sweet and kind--and is so very sick. The staff tell me his wife was the sweetest patient. We lost her just a few days before I came. We encouraged him to drink some more but he did not want to eat anything.

After the first medical team, the doctors round, about 11 pm. Then no one goes inside high risk until 5-6 am when WASH changes the chlorine in the buckets. Another medical team goes in between 6-7. We had 8 nurses on Friday night and I only had to go inside once.
At six Sarah and I were the gopher nurses. Between 1 am-5 am most staff find a spot to take a nap. I was able to talk to my parents, sisters, and nieces via FaceTime while on nightshift! Such a tremendous blessing!!

Saturday we got results back that our last remaining woman from the four that attended the funeral is Ebola negative!! She will have one more test before we can say she is cured, and after that she will be released. Our other lady is steadily improving. The husband is a fighter but he is still extremely ill.
Saturday my assignment was the 6 am patient care round, and boy, does it sure get cold around 3 am!!! I was not prepared for that Friday night!! Saturday I planned better and brought a blanket! Putting on PPE at 6 am actually feels good because it is still chilly. 4 of the 5 patients are stable and can take care of themselves, so my partner and I spent time with the husband and came out of high risk after about 30 minutes. Then all we had left to do was wait for the on-coming shift!

"Cuz I've got nothing of my own to give to you/but this light that shines on me, shines on you/and makes everything beautiful again"

Lyrics from David Crowder Band's "Stars"