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.
Saturday, January 31, 2015
Friday, January 30, 2015
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.
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
Thursday, January 29, 2015
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 :-)
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 :-)
Wednesday, January 28, 2015
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.
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.
Tuesday, January 27, 2015
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!
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!
Sunday, January 25, 2015
"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"
~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"
Friday, January 23, 2015
Even more photos!
Our one-size-fits-all scrubs drying
Triage
The small building is a shower; patients take a 0.05% chlorinated
water shower first then a shower with plain water. They leave their
clothes in the shower and are given new ones. Old clothes are
burned because almost nothing leaves the high risk zone.
WASH headquarters
My rigged up mosquito net
More photos!
A
A view of our kitchen
Where scrubs, boots, aprons, and green gloves are washed
Our pharmacy
Another photo displaying the two tables set up
outside of suspect and probable wards
A Picture says a Thousand Words
Family tent where patients can meet their families once they are discharged.
Our psychosocial headquarters
The two table set up outside of suspect ward
The donning area
Thursday, January 22, 2015
Mango Rains
My favorite sound in the world is rain on a tin roof...which I have actually never heard in the states, only abroad. Woke up this morning to a fairly overcast sky but the last several mornings have been overcast. This one was more windy then the other mornings have been, with the smell of an oncoming rain in the air, and shortly after I arrived at breakfast the heavens opened and the rain began. We are currently in the dry season, and there is red dust everywhere. I had asked a few days ago if it ever rained in the dry season. Today I got my answer! However it is a very early rain. Usually rain doesn't start falling again until February, and sporadically at that. They call them "mango rains" because the mangos begin to ripen shortly after the rains start.
It rained most of the morning and many of the roofs at the ETC are tin. (Except the tents, mind you). I didn't actually go in to the high risk zone today. I was responsible for assigning tasks and had to re-arrange the assignment more than half a dozen times before everyone was happy! This afternoon I was not in charge but I was assigned to be the nurse outside of the wards, the gopher nurse if you will. I am getting better at remembering names although I have many more to learn.
Today we got one admission. We have lost all but one of the women that attended the funeral last week. :'-( We also admitted the husband of one of the pregnant ladies we lost more than a week
ago. He was hiccuping when he came in and hiccups are a very bad sign with Ebola. His blood test results aren't back yet...but he has most of the symptoms of Ebola, unfortunately. I do not know if he has more children. I imagine he does.
We are seeing our patient census numbers dropping-we have 6 patients currently. We were able to discharge 7(!) yesterday, all Ebola-free. Several of them came in with malaria and left our ETC feeling and looking a good deal better. That was encouraging to see--especially since we haven't had any Ebola survivors this week. It has been a very trying week on our staff, and we got another positive Ebola result today. (Not the husband, his is still pending). But we will all be shocked if his result comes back negative.
Thank you for praying for us, please continue to do so. My cough is essentially gone, aided by the gift of rain which decreased the dust and the fact that I didn't get a chlorinated wash down at all today. Oh! I counted the steps! If you count all the handwashings which are quite frequent, it is about 25 steps to doff PPE. Useless trivia fun fact for your next dinner party ;-)
It rained most of the morning and many of the roofs at the ETC are tin. (Except the tents, mind you). I didn't actually go in to the high risk zone today. I was responsible for assigning tasks and had to re-arrange the assignment more than half a dozen times before everyone was happy! This afternoon I was not in charge but I was assigned to be the nurse outside of the wards, the gopher nurse if you will. I am getting better at remembering names although I have many more to learn.
Today we got one admission. We have lost all but one of the women that attended the funeral last week. :'-( We also admitted the husband of one of the pregnant ladies we lost more than a week
ago. He was hiccuping when he came in and hiccups are a very bad sign with Ebola. His blood test results aren't back yet...but he has most of the symptoms of Ebola, unfortunately. I do not know if he has more children. I imagine he does.
We are seeing our patient census numbers dropping-we have 6 patients currently. We were able to discharge 7(!) yesterday, all Ebola-free. Several of them came in with malaria and left our ETC feeling and looking a good deal better. That was encouraging to see--especially since we haven't had any Ebola survivors this week. It has been a very trying week on our staff, and we got another positive Ebola result today. (Not the husband, his is still pending). But we will all be shocked if his result comes back negative.
Thank you for praying for us, please continue to do so. My cough is essentially gone, aided by the gift of rain which decreased the dust and the fact that I didn't get a chlorinated wash down at all today. Oh! I counted the steps! If you count all the handwashings which are quite frequent, it is about 25 steps to doff PPE. Useless trivia fun fact for your next dinner party ;-)
Wednesday, January 21, 2015
Something Positive!
After yesterday's events, I needed to focus on something positive today. The current outbreak has been caused by the Zaire strain of Ebola, which happens to be the most lethal of the strains. We have had some patients survive, and several of the survivors have returned to help take care of patients, especially the younger ones. We will also occasionally use a survivor to go into the confirmed ward to help encourage the patients to keep drinking.
This morning, ABK and I were responsible for the breakfast meal pass. We had three small children in the suspect ward, one with his mother and two with survivor caregivers. The two caregivers had passed the majority of breakfast to the patients in suspect before we even finished donning-which was a tremendous help and enabled ABK and I to focus on the sicker patients in the probable and confirmed wards. I am so very thankful for the survivors!! The one caregiver is one of our survivors-I cannot imagine how traumatic it must be for her to go back into the confirmed ward to help our patients, but she is so willing to help!
The survivors work in shifts as well. They wear paper scrubs and paper scrub booties. They have to take a chlorine shower after each shift, because, while we believe they cannot contract Ebola* again, they could carry the virus to others on their skin. Hence the need for disposable scrubs and the chlorinated water shower after each shift.
*Addendum: we do not believe someone who has survived Ebola Zaire can contract it again but we do not definitively know this to be true. We also do not know if surviving one strain of
Ebola would help you survive the other types. The different strains do have genetic differences. There is still so much we do not know about EVD.
This morning, ABK and I were responsible for the breakfast meal pass. We had three small children in the suspect ward, one with his mother and two with survivor caregivers. The two caregivers had passed the majority of breakfast to the patients in suspect before we even finished donning-which was a tremendous help and enabled ABK and I to focus on the sicker patients in the probable and confirmed wards. I am so very thankful for the survivors!! The one caregiver is one of our survivors-I cannot imagine how traumatic it must be for her to go back into the confirmed ward to help our patients, but she is so willing to help!
The survivors work in shifts as well. They wear paper scrubs and paper scrub booties. They have to take a chlorine shower after each shift, because, while we believe they cannot contract Ebola* again, they could carry the virus to others on their skin. Hence the need for disposable scrubs and the chlorinated water shower after each shift.
*Addendum: we do not believe someone who has survived Ebola Zaire can contract it again but we do not definitively know this to be true. We also do not know if surviving one strain of
Ebola would help you survive the other types. The different strains do have genetic differences. There is still so much we do not know about EVD.
Tuesday, January 20, 2015
When our patients don't get better :'(
Someone asked me what happens to our patients when they die. We send a team from Wash in to the ward fully donned in PPE. Everything around the person is washed with the 0.5% bleach solution. And the person is sprayed with the solution then placed in a body bag which is washed in chlorine. Then that bag is placed inside another bag and the outer bag is also sprayed down with chlorine. The body is then carried to the morgue where it will stay until the burial team can come. Next of kin is notified and the next time our psychosocial workers are in the village the person was from, the family is given a bag of rice.
The whole wash process after someone dies can take almost two hours. There is still so much about Ebola we do not know--but I believe all the experts agree that the viral load is highest in the body after a pt has died.
The whole wash process after someone dies can take almost two hours. There is still so much about Ebola we do not know--but I believe all the experts agree that the viral load is highest in the body after a pt has died.
Sabbath day
Sunday was Jasmine's and my first day off. I was stoked about a sabbath day. We heard rumor of a group of people going to Makeni which is where the other IMC ETC in Sierra Leone is located. That one is mostly staffed by nationals and NHS workers from the UK. (Many were on the same plane I was from Brussels a week ago). Jasmine, Dr. Matt, and I all caught a ride with the group going and thought we could pick up a few items at the grocery stores-Makeni is bigger than Lunsar and has 3 grocery stores (by comparison Lunsar has a gas station). However, while I knew yesterday was Sunday that didn't connect in my mind that everything would be closed...so, we did not go to the store. Our kitchen at the ETC isn't open at night-you have to bring snacks with you.
We did get a tour of the other site which included time in their lab which was fascinating. They explained the process of de-activating the virus then magnifying it to count viral loads. He also showed us several negative results and you could clearly see the curve on the positive result. Their ETC is fairly similarly designed to ours and has a little bigger bed capacity. They currently have fewer patients then we do though--Lunsar is in the Port Loko district which I believe currently has the most cases per day out of all the districts in the country-but Freetown, the capital, is in Port
Loko.
After we toured the site and realized everything in town was closed we returned and took it easy. The lady I wrote about Saturday--the lady struggling to breathe-she died last night before dinner :'-(
Thank you for praying for us. Thank you for praying for my health--my cold I came to SL with is gone!! Praise God!! It has been replaced by "chlorine cough" which seems like a dog's kennel cough to me. Many of us have it from the doffing procedure. It is much easier to deal with than the cold I brought with me!! :-)
I have been quite curious as to what the surface body temperature would be of staff coming out of PPE. A doctor I work with has been as well--she had been inside in the heat of the day over an hour, doffed, and took her temperature which was 101.5!!! I imagine prior to doffing it would have been even higher-doffing takes ten minutes at least and the chlorinated water is cold. However, there isn't a safe way to measure your temperature while in the high risk zone and I am not curious enough to try!!
We did get a tour of the other site which included time in their lab which was fascinating. They explained the process of de-activating the virus then magnifying it to count viral loads. He also showed us several negative results and you could clearly see the curve on the positive result. Their ETC is fairly similarly designed to ours and has a little bigger bed capacity. They currently have fewer patients then we do though--Lunsar is in the Port Loko district which I believe currently has the most cases per day out of all the districts in the country-but Freetown, the capital, is in Port
Loko.
After we toured the site and realized everything in town was closed we returned and took it easy. The lady I wrote about Saturday--the lady struggling to breathe-she died last night before dinner :'-(
Thank you for praying for us. Thank you for praying for my health--my cold I came to SL with is gone!! Praise God!! It has been replaced by "chlorine cough" which seems like a dog's kennel cough to me. Many of us have it from the doffing procedure. It is much easier to deal with than the cold I brought with me!! :-)
I have been quite curious as to what the surface body temperature would be of staff coming out of PPE. A doctor I work with has been as well--she had been inside in the heat of the day over an hour, doffed, and took her temperature which was 101.5!!! I imagine prior to doffing it would have been even higher-doffing takes ten minutes at least and the chlorinated water is cold. However, there isn't a safe way to measure your temperature while in the high risk zone and I am not curious enough to try!!
Monday, January 19, 2015
Medical Adjustments
This post may be more appealing to healthcare workers. In full PPE zero skin is exposed. Nada. Which means auscultating lungs, heart sounds, and bowel sounds is not possible, as you cannot hear well while under the hood. (Auscultating is the fancy way of saying listening and is usually done with a stethoscope.) There are no stethoscopes. That is a weird thing to get used to. You truly only have your visual clinical assessment skills at your disposal and your gut feeling. Well, we do take vital signs: temperature, heart rate, and respiratory rate. (Palpating heart rate is loads of fun for a full minute while double-gloves on the sicker patients that already have weak pulses...) We don't routinely take blood pressures cuffs nor do we use pulse oximetry often. We did have one lady with a recorded pulse ox of 85% in no acute distress, however, we have no oxygen to place her on. Zero ekgs (shows heart rhythm), zero CT scans, zero chest x-rays (CT scans and x-rays help us make decisions based on the results of the test). We don't have the ability to test blood chemistries and if we did it wouldn't change the course of treatment. We give IV fluids and some potassium in the IV fluids and encourage each patient to drink their oral rehydration solution (ORS). Think sports drink that does not taste sweet. We mix it with juice to try to make it more palatable.
We truly only treat Ebola and malaria at our ETC. We have discharged patients that clinically look sick--but we do not have a safe place to keep them nor the drugs they would need for chronic illnesses--i.e. hypertension. We can't treat TB and right now TB clinics are closed. We have gotten one clinic up and running half days so far but that is all for the local area. We can't keep Ebola negative patients that have chronic illnesses because we could expose them to Ebola while they are in the high risk zone. As you move through the 3 wards you may not back-track. If you place a patient in triage into probable you must stay in probable or move to confirmed, never back up the cement walkway to suspect. An ETC is meticulously run and full washes with 0.5% chlorine are down frequently by our WASH team. The outside of each ambulance is sprayed down upon arrival. Once all the patients are in triage-where we can take two at a time only, any others must wait in the back of the ambulance until those two are moved. If we believe one or both of first two are "probable" we will move them to a corner of triage and work on the next patient from the ambulance since you cannot return from probable, except to pick up another probable from triage.
Sorry, that was confusing. The goal is to avoid the possibility of cross-contamination.
Once the ambulance is empty, the inside is also doused in 0.5% chlorine, which is only stable in the sun about 12 hours, even in dark containers. We go through a TON of water.
We truly only treat Ebola and malaria at our ETC. We have discharged patients that clinically look sick--but we do not have a safe place to keep them nor the drugs they would need for chronic illnesses--i.e. hypertension. We can't treat TB and right now TB clinics are closed. We have gotten one clinic up and running half days so far but that is all for the local area. We can't keep Ebola negative patients that have chronic illnesses because we could expose them to Ebola while they are in the high risk zone. As you move through the 3 wards you may not back-track. If you place a patient in triage into probable you must stay in probable or move to confirmed, never back up the cement walkway to suspect. An ETC is meticulously run and full washes with 0.5% chlorine are down frequently by our WASH team. The outside of each ambulance is sprayed down upon arrival. Once all the patients are in triage-where we can take two at a time only, any others must wait in the back of the ambulance until those two are moved. If we believe one or both of first two are "probable" we will move them to a corner of triage and work on the next patient from the ambulance since you cannot return from probable, except to pick up another probable from triage.
Sorry, that was confusing. The goal is to avoid the possibility of cross-contamination.
Once the ambulance is empty, the inside is also doused in 0.5% chlorine, which is only stable in the sun about 12 hours, even in dark containers. We go through a TON of water.
Friday
From Friday: Sobering. Our pregnant lady with Ebola died today :'-( hard to see someone struggle so much this morning. She wanted to go outside this morning and I wish we could have taken her--but she was far too weak to move from the mattress on the bed to the mattress floor and would never have made it outside without all 4 of us carrying her in a stretcher. She wasn't able to do anything for herself today and passed this afternoon.
They record deaths but we counted her as one although she was pregnant. Which means the death total in West Africa is higher than the numbers show. Records are kept of the pregnant women who die but their babies aren't actually in the totals. Her baby has been showing less and less movement-can't do fetal heart sounds nor ultrasounds here, only palpating (feeling) for baby's movements and asking mom if baby has moved. Many of the staff speak Pidgin English here which I am slowly learning. Some of our patients speak Pidgin but most speak Temne, a local language.
Today was day three of "hot training." Jasmine and I went in this am to watch lab draws and Jasmine drew the last pt's blood and got it on the first try, difficult to do when double-gloved! We were in about an hour.
After lunch we learned 5 more patients were coming, two again stretcher-bound and very sick. The first one we didn't even triage the medical team just stretcher-carried her into the "probable" ward. My partner Isata and I were assigned pt care. We started in the first ward and we were supposed to go to all 3, however, my goggles began to slip into my eyes and I had to go doff. And as skin was exposed, I also got a wash of 0.5% chlorine to the face! Not so pleasant but better than Ebola.
As soon as the least bit of skin is exposed you must leave. My partner did one or two more things and also had a goggle problem-hers went too high on her head. We may have been inside 20 minutes when we had to leave. But again, we want to protect staff. We have to do "corner checks" periodically while in the unit. Your partner must be able to see all 4 corners of the hood underneath your goggles. If you "lose a corner" you leave because you are close to having skin exposed near your eye.
There should always be a nurse on the outside of the high risk zone to pass items needed to a table inside. It is hard to describe--there are two fences about two meters total distance and between each fence is a table. You lay the item needed-medicine, lab tubes, towels, pt admission bag (with clothes and a cup) on to the second table while wearing gloves making absolutely sure you do not touch the table inside at all. I do not understand the two table thing--because if you are inside you cannot reach across the fence at all. Which means if the item needed is on the outer table, you must wait in the sun in full PPE until someone outside can move it to the table inside. The two tables might be necessary for meal passes though as it may not all fit on one table. Rules are strict here which is actually reassuring.
I may have already said this but we have two common phrases in the ETC. "There is never an emergency with Ebola" meaning anything can wait to be done safely--Whether that means it waits 15 seconds, 5 minutes, or until the next round of staff come through in PPE.
The second phrase is "Slow, slow, safe, safe." Which is a good reminder because mistakes tend to happen more when you rush. You cannot afford to make certain mistakes in the high risk zone, it could cost you your life. Provide quality patient care and look after your fellow staff members. If 3 of us are in a ward together, and one is on the other side of the middle walkway, we will check on them: "Philomena!! You ok?!" "Yes, I am good, good. You ok?" "Yes yes."
In pidgin English, at least here, words are often repeated. And asking someone if they will wait a little bit for you becomes, "Please wait small small." Or if you are ok with waiting you say, "I wait small."
They record deaths but we counted her as one although she was pregnant. Which means the death total in West Africa is higher than the numbers show. Records are kept of the pregnant women who die but their babies aren't actually in the totals. Her baby has been showing less and less movement-can't do fetal heart sounds nor ultrasounds here, only palpating (feeling) for baby's movements and asking mom if baby has moved. Many of the staff speak Pidgin English here which I am slowly learning. Some of our patients speak Pidgin but most speak Temne, a local language.
Today was day three of "hot training." Jasmine and I went in this am to watch lab draws and Jasmine drew the last pt's blood and got it on the first try, difficult to do when double-gloved! We were in about an hour.
After lunch we learned 5 more patients were coming, two again stretcher-bound and very sick. The first one we didn't even triage the medical team just stretcher-carried her into the "probable" ward. My partner Isata and I were assigned pt care. We started in the first ward and we were supposed to go to all 3, however, my goggles began to slip into my eyes and I had to go doff. And as skin was exposed, I also got a wash of 0.5% chlorine to the face! Not so pleasant but better than Ebola.
As soon as the least bit of skin is exposed you must leave. My partner did one or two more things and also had a goggle problem-hers went too high on her head. We may have been inside 20 minutes when we had to leave. But again, we want to protect staff. We have to do "corner checks" periodically while in the unit. Your partner must be able to see all 4 corners of the hood underneath your goggles. If you "lose a corner" you leave because you are close to having skin exposed near your eye.
There should always be a nurse on the outside of the high risk zone to pass items needed to a table inside. It is hard to describe--there are two fences about two meters total distance and between each fence is a table. You lay the item needed-medicine, lab tubes, towels, pt admission bag (with clothes and a cup) on to the second table while wearing gloves making absolutely sure you do not touch the table inside at all. I do not understand the two table thing--because if you are inside you cannot reach across the fence at all. Which means if the item needed is on the outer table, you must wait in the sun in full PPE until someone outside can move it to the table inside. The two tables might be necessary for meal passes though as it may not all fit on one table. Rules are strict here which is actually reassuring.
I may have already said this but we have two common phrases in the ETC. "There is never an emergency with Ebola" meaning anything can wait to be done safely--Whether that means it waits 15 seconds, 5 minutes, or until the next round of staff come through in PPE.
The second phrase is "Slow, slow, safe, safe." Which is a good reminder because mistakes tend to happen more when you rush. You cannot afford to make certain mistakes in the high risk zone, it could cost you your life. Provide quality patient care and look after your fellow staff members. If 3 of us are in a ward together, and one is on the other side of the middle walkway, we will check on them: "Philomena!! You ok?!" "Yes, I am good, good. You ok?" "Yes yes."
In pidgin English, at least here, words are often repeated. And asking someone if they will wait a little bit for you becomes, "Please wait small small." Or if you are ok with waiting you say, "I wait small."
Thursday--many days later!
Thursday: Day two in the red zone or "high risk zone" as it is called. We had a low-key morning until we got our lab results back from Wednesday. We received 5 negative results and were able to discharge 4 of them! One has recovered from Ebola, the other three haven't ever had it. They will return to monitoring for 21 days. The fifth one is a boy who has been symptom-free for two and a half weeks but hadn't yet had a negative blood test. He did today!!! Watching him do a dance of joy was so great!! He will need one more negative test prior to leaving but will hopefully be able to leave Saturday or Sunday. [he did leave Saturday-I wasn't able to post this right away. He promised us he would "dance more than anyone else!" Did he ever!!] sobering though, his return to his home. He has 9 siblings and he watched his dad die in our ETC. :'-(
Four of us went into the high risk zone shortly before lunch Thursday to discharge the patients and check on our pregnant lady. We were in about an hour. We then doffed and changed scrubs and returned to the office where we learned we had 6 patients arriving in the near future; one in the first ambulance, one in the second, and FOUR in the third one. We had been told two of the four were stretcher-bound. We went back into the high risk zone after the first two ambulances, four of us, and triaged the four patients. Thankfully the two "stretcher-bound" were healthy enough to walk with two people assisting; although the one lady we half-carried inside.
We drew blood samples on two of the patients and started an IV then left. By that time we had been in 75 minutes which was brutal for me. I felt okay while inside but felt significantly worse within the hour. I kept downing water. If anyone reading this comes to a West Africa to work--bring a container of powdered Gatorade!!
The staff took good care of me while I felt unwell and I headed back to our housing quarters shortly thereafter, where I continued I re-hydrate then went to bed!!
Woke Friday feeling much better!
Four of us went into the high risk zone shortly before lunch Thursday to discharge the patients and check on our pregnant lady. We were in about an hour. We then doffed and changed scrubs and returned to the office where we learned we had 6 patients arriving in the near future; one in the first ambulance, one in the second, and FOUR in the third one. We had been told two of the four were stretcher-bound. We went back into the high risk zone after the first two ambulances, four of us, and triaged the four patients. Thankfully the two "stretcher-bound" were healthy enough to walk with two people assisting; although the one lady we half-carried inside.
We drew blood samples on two of the patients and started an IV then left. By that time we had been in 75 minutes which was brutal for me. I felt okay while inside but felt significantly worse within the hour. I kept downing water. If anyone reading this comes to a West Africa to work--bring a container of powdered Gatorade!!
The staff took good care of me while I felt unwell and I headed back to our housing quarters shortly thereafter, where I continued I re-hydrate then went to bed!!
Woke Friday feeling much better!
Saturday, January 17, 2015
"High Price to Pay"
"High Price to Pay"
We got five positive Ebola results back last night. Four of those patients were at the same funeral. A fellow nurse looked at me at shift change this am and said, "That is a high price to pay," in regards to attending a funeral:'-(
Thank you for praying for the people of West Africa. Please continue to pray for them. This disease...is awful. It is a terrible way to die. No one should die alone...but no one can stay in the high risk zone long. Our sickest lady is labouring to breathe. I stayed with her about 20 minutes this am after we gave meds. Her flesh is on fire-clearly evident with two gloves. I prayed over her and with her--I don't know how much se understood, she is so close to death. I wanted to stay with her longer but we were pushing an hour thirty in the heat of day and still had vitals to communicate to a nurse across the fence. No paper leaves the ETC, everything is incinerated. You take vitals on a sheet and the nurse outside has a sheet too which vitals are transferred orally to. It is time-consuming with the many language barriers because we are all from different places.
Please, please, keep praying for this disease to come to an end. It is horrific:'-(
We got five positive Ebola results back last night. Four of those patients were at the same funeral. A fellow nurse looked at me at shift change this am and said, "That is a high price to pay," in regards to attending a funeral:'-(
Thank you for praying for the people of West Africa. Please continue to pray for them. This disease...is awful. It is a terrible way to die. No one should die alone...but no one can stay in the high risk zone long. Our sickest lady is labouring to breathe. I stayed with her about 20 minutes this am after we gave meds. Her flesh is on fire-clearly evident with two gloves. I prayed over her and with her--I don't know how much se understood, she is so close to death. I wanted to stay with her longer but we were pushing an hour thirty in the heat of day and still had vitals to communicate to a nurse across the fence. No paper leaves the ETC, everything is incinerated. You take vitals on a sheet and the nurse outside has a sheet too which vitals are transferred orally to. It is time-consuming with the many language barriers because we are all from different places.
Please, please, keep praying for this disease to come to an end. It is horrific:'-(
Friday, January 16, 2015
Malaria
Malaria is extremely prevalent here. Wednesday a doctor used the term "cerebral malaria" which I did not know existed. It sounds bad because malaria can be awful and can kill you. And now the brain is involved. I am unfamiliar with the disease process of cerebral malaria. This I do know: the patient that we believe to have cerebral malaria was semi-conscious on Tuesday upon arrival via ambulance to our ETC. We gave him an IV antibiotic or IV antimalarial and Wednesday morning he was fully conscious and able to drink! We saw him while in the ETC and he was well enough to walk outside! Hopefully his second Ebola test comes back negative. The first one did.
I have been waking up over the past few days with a wretched taste in my mouth. The anti-malarial I am on is taken once weekly. Apparently most people take it on Mondays (Malaria Monday to help you remember!) but mine and one other nurse's are due on Wednesdays. I take mine in the evenings and as soon as the pill hit my tongue my brain went, "Ah-hah! The foul taste every time I wake up has been identified!!" Thankfully I am on dose 4 and only have to take them once a week. (Ten more, no big deal right?!) I about gagged but, remembering that the early symptoms of malaria and Ebola are almost identical, I swallowed that pill. I have no desire to leave Sierra Leone earlier than scheduled nor do I want to visit an ETC as a patient myself! ;-D
~praise God with me--Betty does not have Ebola! And we have discharged two from confirmed--which means they had Ebola but they are now cured! We have also discharged many this week that did not have Ebola. We treat malaria and Ebola at the ETC since the initial symptoms are quite similar; identical at times. We are unable to treat anything else just yet.
~Praise God with me that I haven't yet felt faint in the PPE. I am sure that will happen but I know how I feel when a faint is nearing (and now the reason I fainted once a semester in nursing school is clear: preparation for wearing PPE in an already warm environment!) It can take 10-20 minutes to doff gear. The trick is noticing when you or another worker is beginning to not be 100% and sending yourself or your co-worker out to the washing station to begin doffing pronto. As you remove each piece of PPE, you feel significantly better. And being sprayed with the cold chlorinated water while fully garbed actually feels fantastic! Picture running through a sprinkler on the hottest day in July or August and that is close to what it feels like!
~Continue to pray for my interactions with my co-workers.
~And pray for my up-coming interactions with Ebola patients.
Thank you for praying with me, for me, and for my family
I have been waking up over the past few days with a wretched taste in my mouth. The anti-malarial I am on is taken once weekly. Apparently most people take it on Mondays (Malaria Monday to help you remember!) but mine and one other nurse's are due on Wednesdays. I take mine in the evenings and as soon as the pill hit my tongue my brain went, "Ah-hah! The foul taste every time I wake up has been identified!!" Thankfully I am on dose 4 and only have to take them once a week. (Ten more, no big deal right?!) I about gagged but, remembering that the early symptoms of malaria and Ebola are almost identical, I swallowed that pill. I have no desire to leave Sierra Leone earlier than scheduled nor do I want to visit an ETC as a patient myself! ;-D
~praise God with me--Betty does not have Ebola! And we have discharged two from confirmed--which means they had Ebola but they are now cured! We have also discharged many this week that did not have Ebola. We treat malaria and Ebola at the ETC since the initial symptoms are quite similar; identical at times. We are unable to treat anything else just yet.
~Praise God with me that I haven't yet felt faint in the PPE. I am sure that will happen but I know how I feel when a faint is nearing (and now the reason I fainted once a semester in nursing school is clear: preparation for wearing PPE in an already warm environment!) It can take 10-20 minutes to doff gear. The trick is noticing when you or another worker is beginning to not be 100% and sending yourself or your co-worker out to the washing station to begin doffing pronto. As you remove each piece of PPE, you feel significantly better. And being sprayed with the cold chlorinated water while fully garbed actually feels fantastic! Picture running through a sprinkler on the hottest day in July or August and that is close to what it feels like!
~Continue to pray for my interactions with my co-workers.
~And pray for my up-coming interactions with Ebola patients.
Thank you for praying with me, for me, and for my family
Thursday, January 15, 2015
Wednesday-day one of hot training!
Jasmine and I have been in the red zone! And we are doing just fine!! No breaches of protocol to our knowledge. We stayed in the PPE for 45 minutes! Mercy!!! When you "doff" you are doused in 0.5% chlorine often. The fumes linger. I have been out of the ETC 4 hours now and can still smell a hint of chlorine! The doffing process includes multiple steps. Again, once they are more second nature to me I will count them. We went in with 6 ex-pat nurses; 3 of us were touring and 3 conducted the tour and gave meds while we were inside. And we admitted a very small child today and had to start an IV in her before dehydration sets in. Obtaining IV access is difficult on a dehydrated person, and the difficulty is significantly increased on a dehydrated pediatric patient. It is also hard to explain to one so young why the sharp pointy object is poking him or her and that you are causing temporary pain in an attempt to help make him or her feel less rotten. Peds are hard:-( I dread witnessing the first death of a child here. I have upmost respect for NICU, PICU, and pediatric oncology doctors and nurses! I could not do your job--and someone does need to! Thank you!! (Translations for the non-medically savvy: Neonatal Intensive Care Unit-NICU, Pediatric Intensive Care Unit-PICU, and, essentially, children with cancer. I couldn't do it. Thank you for the work you do!
We had to separate the small child from her mother which was heart-wrenching to witness. We have a few Ebola survivors that have offered to be caregivers for the small children. Our newest pt can't understand what Ebola is nor that she can't leave her area to enter another one. She is far too young:( And unfortunately, the very young do not do well with Ebola. We have had a 3-yr-old recover and more recently, a 3-month-old---but those two are the rare exception.
We had to separate the small child from her mother which was heart-wrenching to witness. We have a few Ebola survivors that have offered to be caregivers for the small children. Our newest pt can't understand what Ebola is nor that she can't leave her area to enter another one. She is far too young:( And unfortunately, the very young do not do well with Ebola. We have had a 3-yr-old recover and more recently, a 3-month-old---but those two are the rare exception.
Tuesday post two
You are never EVER allowed in the red zone alone. If there are only two of you and one has to leave, both leave. If you are starting an IV two people are present. If you are drawing blood, two people do that together. The only sharps allowed in the red zone are needles to start IVs and for drawing blood. Zero ampules and zero glass bottles. As needles put the health care worker at the highest risk for blood-to-blood transmission, they are never used with only one person present. IMC is very much about health care provider's safety first which may sound backwards to a "customer is always right mindset." However, prior to Ebola, Liberia had 51 doctors. We have lost 25 to Ebola. Now people are dying from diseases we could treat...if we could staff the hospitals. But when you slice the physician count in half--when 51 is far from sufficient for the entire country of Liberia--it severely limits what health care can be provided. I do not know how many Sierra Leonean doctors there are nor how many we have lost-but the hospitals, clinics, and school systems have all shut down because of the outbreak.
There are .05% containers of bleach wash everywhere. Absolutely everywhere! There are chlorinated baths to step into with the knee high boots in several places. To enter the center, your temperature is taken first. Then you are asked if you are sick or if you have any open wounds or rashes. If you have an open wound, you are not allowed inside. If you have a fever, you are further evaluated. Then you wash your hands with the chlorinated water. Once inside you find a pair of boots that semi-fit. Then you find a pair of scrubs. Again, they semi-fit. ;-) But it would be extremely difficult to have sufficient stock of every supply needed-and hey, they make drawstrings at the waist for a reason, right? :-D
Once you change into boots, you then wash your hands with chlorinated water. Inside the center which is gated with barbwire, there are 3 main sections. In section one is the pharmacy, office, cantina, restrooms, donning station, doffing station, changing rooms, entrance/exit and one side of triage. Triage is done in a building with a glass divider. One nurse or doctor is on the Ebola or suspected Ebola side in full PPE and a doctor or nurse is on the opposite side of the glass where charting can be done. The next building over is where donning PPE takes place. PPE includes 2 pairs of gloves, a Tyvek suit, a mask, a hood, goggles, and finally, an apron. Takes 10 or so minutes to put all that on! The only things that we re-use are the goggles, aprons, and boots. All are washed with 0.5% chlorine which is caustic to bare flesh-and apparently, quite combustible. I was informed of this property of 0.5% chlorine; I did not learn this tidbit from first-hand experience nor remember it from chemistry classes (my apologies Mrs. Hathaway & Dr. Pickard!!). Ebola is surprisingly easy to kill outside of the body. High temperatures and direct sunlight kills it which is abundant here in West Africa, chlorine kills it, soap & water kills it.
So why all the precautions? Because we cannot yet kill the virus inside the human body. It is a fragile virus outside...inside the body it wrecks havoc. The sicker one is with Ebola, the higher the viral load and the higher the chance of spreading the virus. And the higher concentration of virus at your initial exposure tends to determine whether you live or die. That is why so many healthcare workers have been lost. It is why the entire operation team died after operating on a patient with Ebola. Precautions are necessary--but the disease only merits a cautious, meticulous approach, not an-all out panic as we saw in NY and Jersey.
I am going to skip to section three. Section three is the "psychosocial" area. Counselors talk to the Ebola patients over a double fenced area and the two fences are two meters apart. This section is where families may visit as well. All visiting family members' temperatures are taken as well. If you have a fever, you are further evaluated.
Section two is the actual patient care area. It is divided into two sides and each side is further divided into two as well. There is the "suspected" quarter, the "probable" quarter, the "confirmed" quarter and the "convalescent" quarter. In suspected and probable you do not yet have a positive Ebola blood test. The results may not be back yet and you may have Ebola but we are not certain. The disease can take 72 hours to even be detectable in your blood and so you must have two negative tests 72 hours apart to be "Ebola negative." If you receive a positive result in your blood, you are placed in the confirmed ward, where you stay until you either begin to recover or die. Once you are no longer vomiting and having diarrhea, you are moved to the convalescent quarter. Patients stay here until they have two negative blood tests at least 72 hours apart. Once you have your second negative test, we celebrate your freedom and you take a final shower at the ETC. All of your clothing is thrown away as are your shoes. You are given a new set of clothes and a new pair of shoes and you are allowed to go back home :-)
This has been another extremely long post, I apologize, but I wanted to paint a detailed picture of what I am seeing. Our wifi works but is not strong enough thus far to upload pictures:( But don't worry!! I am taking pictures and I will have PLENTY of time in quarantine to upload them!!;-)
Please pray specifically for my interactions with Jasmine and Allison.
Depending on what time wifi allows me to post this, I may have already been in the red zone once! Jasmine and I will take a tour Wednesday morning. We will provide zero patient care-the purpose is for us to see the layout and spend more time adjusting to our own personal sauna;) I am not certain when our first real shifts will be. We have been told that if our PPE breaks (because gloves do tear from time to time) we are to leave the ETC immediately, doff all the PPE and re-don. If anyone starts to feel woozy or a begins to feel a fainting spell coming on, that person is to leave immediately, even if it has only been 5-10 minutes. As my trainer continually reiterates, there is never an emergency with Ebola. Any task you need to tend to can wait 10-15 seconds or even a few minutes. IMC's chief concern is personnel safety.
Jasmine and I were told that no matter how often you practice donning and doffing the first time you enter the red zone you are nervous and the reality of what you are about to do hits you full force. I got one dose of the weight of this disease when I walked away from my parents and down the gangway in Charlotte. A second dose hit when the plane landed in Guinea. I hear through the grapevine that their new cases each week are sky-rocketing:(
Things are better in Liberia but the fight isn't over yet. There is still much to do-and as Ebola lessens in Liberia there is much work to be done to get the healthcare system working again.
There are .05% containers of bleach wash everywhere. Absolutely everywhere! There are chlorinated baths to step into with the knee high boots in several places. To enter the center, your temperature is taken first. Then you are asked if you are sick or if you have any open wounds or rashes. If you have an open wound, you are not allowed inside. If you have a fever, you are further evaluated. Then you wash your hands with the chlorinated water. Once inside you find a pair of boots that semi-fit. Then you find a pair of scrubs. Again, they semi-fit. ;-) But it would be extremely difficult to have sufficient stock of every supply needed-and hey, they make drawstrings at the waist for a reason, right? :-D
Once you change into boots, you then wash your hands with chlorinated water. Inside the center which is gated with barbwire, there are 3 main sections. In section one is the pharmacy, office, cantina, restrooms, donning station, doffing station, changing rooms, entrance/exit and one side of triage. Triage is done in a building with a glass divider. One nurse or doctor is on the Ebola or suspected Ebola side in full PPE and a doctor or nurse is on the opposite side of the glass where charting can be done. The next building over is where donning PPE takes place. PPE includes 2 pairs of gloves, a Tyvek suit, a mask, a hood, goggles, and finally, an apron. Takes 10 or so minutes to put all that on! The only things that we re-use are the goggles, aprons, and boots. All are washed with 0.5% chlorine which is caustic to bare flesh-and apparently, quite combustible. I was informed of this property of 0.5% chlorine; I did not learn this tidbit from first-hand experience nor remember it from chemistry classes (my apologies Mrs. Hathaway & Dr. Pickard!!). Ebola is surprisingly easy to kill outside of the body. High temperatures and direct sunlight kills it which is abundant here in West Africa, chlorine kills it, soap & water kills it.
So why all the precautions? Because we cannot yet kill the virus inside the human body. It is a fragile virus outside...inside the body it wrecks havoc. The sicker one is with Ebola, the higher the viral load and the higher the chance of spreading the virus. And the higher concentration of virus at your initial exposure tends to determine whether you live or die. That is why so many healthcare workers have been lost. It is why the entire operation team died after operating on a patient with Ebola. Precautions are necessary--but the disease only merits a cautious, meticulous approach, not an-all out panic as we saw in NY and Jersey.
I am going to skip to section three. Section three is the "psychosocial" area. Counselors talk to the Ebola patients over a double fenced area and the two fences are two meters apart. This section is where families may visit as well. All visiting family members' temperatures are taken as well. If you have a fever, you are further evaluated.
Section two is the actual patient care area. It is divided into two sides and each side is further divided into two as well. There is the "suspected" quarter, the "probable" quarter, the "confirmed" quarter and the "convalescent" quarter. In suspected and probable you do not yet have a positive Ebola blood test. The results may not be back yet and you may have Ebola but we are not certain. The disease can take 72 hours to even be detectable in your blood and so you must have two negative tests 72 hours apart to be "Ebola negative." If you receive a positive result in your blood, you are placed in the confirmed ward, where you stay until you either begin to recover or die. Once you are no longer vomiting and having diarrhea, you are moved to the convalescent quarter. Patients stay here until they have two negative blood tests at least 72 hours apart. Once you have your second negative test, we celebrate your freedom and you take a final shower at the ETC. All of your clothing is thrown away as are your shoes. You are given a new set of clothes and a new pair of shoes and you are allowed to go back home :-)
This has been another extremely long post, I apologize, but I wanted to paint a detailed picture of what I am seeing. Our wifi works but is not strong enough thus far to upload pictures:( But don't worry!! I am taking pictures and I will have PLENTY of time in quarantine to upload them!!;-)
Please pray specifically for my interactions with Jasmine and Allison.
Depending on what time wifi allows me to post this, I may have already been in the red zone once! Jasmine and I will take a tour Wednesday morning. We will provide zero patient care-the purpose is for us to see the layout and spend more time adjusting to our own personal sauna;) I am not certain when our first real shifts will be. We have been told that if our PPE breaks (because gloves do tear from time to time) we are to leave the ETC immediately, doff all the PPE and re-don. If anyone starts to feel woozy or a begins to feel a fainting spell coming on, that person is to leave immediately, even if it has only been 5-10 minutes. As my trainer continually reiterates, there is never an emergency with Ebola. Any task you need to tend to can wait 10-15 seconds or even a few minutes. IMC's chief concern is personnel safety.
Jasmine and I were told that no matter how often you practice donning and doffing the first time you enter the red zone you are nervous and the reality of what you are about to do hits you full force. I got one dose of the weight of this disease when I walked away from my parents and down the gangway in Charlotte. A second dose hit when the plane landed in Guinea. I hear through the grapevine that their new cases each week are sky-rocketing:(
Things are better in Liberia but the fight isn't over yet. There is still much to do-and as Ebola lessens in Liberia there is much work to be done to get the healthcare system working again.
Wednesday, January 14, 2015
Tuesday-day two at the ETC! Post 1
Tuesday I met a new nurse, Jasmine, from Canada. I am so glad she came the same time I did! She has a six week stint as well and it will be nice to have a person to share the learning curve with! She and I "donned" (put on the personal protection equipment) and "doffed" (removing PPE) twice. I feel a lot better about the gear now--but man! That gear is HOT! We walked around in it about 20 min. 20 minutes is about all I can handle right now! When you "don" there is always a person monitoring you, You go into the "red zone" with a buddy. "Doffing" is monitored as well and someone gives you instructions step-by-step. That was refreshing to learn because there are many steps!! When I get better and develop muscle memory, I will count the steps!
More on Monday
The sun woke me bright and early Monday morning but I continued to rest until about 8. At 8:30 I was about to shower...when the power went out. Time to change plans! ;-)
I ventured out of my room around 9 am Monday morning, praying, "God, I can't do this without you! Please let me find an IMC worker!" About 100 yards from my room, I ran into Dr. Richard, who showed me where food is (key finding!) and where to get clean drinking water. (Thank you, Jesus, for an IMC worker!) He introduced me to Drs. Kristina and Matt and we ate breakfast together and they answered a barrage of questions. Then Drs. Richard and Matt took me to the guesthouse where I was given a local phone and a little more information. And had wifi that worked for a little bit! We then journeyed to the Ebola treatment center, which I was nervous about entering for the first time. I met several staff members, and one is from York, Pa! She played field hockey at Kraybill Mennonite and went to Lancaster Mennonite. And she knew a gentleman I grew up with that went to LMH!! "It's a small world after all...!"
I saw the layout of the center, found clean water (!!) and the health office.
Then several of the docs took me to downtown Lunsar where I could exchange money and buy some bananas:) One doctor's daughter works with a Christian organization in Freetown. I asked if he was a believer--praise God for answering my prayer request! I was hoping to meet one believer, and I did day one!! Dr. John has been here ten days and will be here the majority of the time I am here.
At two pm, I met up with Kelly, a nurse who has worked with IMC for 5 years. She was on the ground with IMC when we opened our first clinic in Liberia and has been working with Ebola since September. She is now one of the trainers. She began my orientation and about an hour later we learned one of our cooks from where we are staying is sick with vomiting, fever, and abdominal pain. We then went on an hour+ quest to try to locate her and get her to the ETC. Monday night several of us were on the edge--if she does have Ebola, that will be a big thing. Please pray for her healing-her name is Betty. We should know in a day or two if she has Ebola.
Well!! Thanks for reading such lengthy posts!!
Catie--would you believe the first constellation I found Sunday night was the Orion? I do have a friend from home!!
Jay & Isaac--I know what a Tyvek suit is now!! We use them each time we go into the Ebola zone.
Amber--they have laughing cow cheese here!!
My Tica family--they also have Nutella! :-)
CVRU buddies and Louann: THANK YOU for sending food along with me! I was so hungry Sunday night!!
medical friends: Some unofficial studying over the last 4 months leads us to believe the liver is the first major organ to go into failure. I believe that's why individuals with Ebola bleed so much:-( Also, and no one can explain this, but hiccups in an Ebola pt is an almost certain sign of impending death. Anyone have any ideas as to why that would be? Also, if a person can make it past day 9 he or she generally survives.
We have been unable to save the babies of pregnant women. Often, Ebola is a death sentence for anyone under 5, older than 60, and for pregnant women. The few women that have survived--we have lost the child in the womb, with the exception of one woman and her baby in Sierra Leone. She is several months along. We do not know if the baby will test positive for Ebola, if the baby now has immunity, or if the baby has had developmental problems since his/her mom contracted Ebola. We have lost all the rest :'(
The strain of Ebola we are fighting is Zaire. We believe if you survive you are immune for life but we aren't 100% sure. We also do not know if you survive the Zaire strain--if you would be immune to the other strains or if your disease progression would be less severe? So much about this disease we do not yet know, but we have learned a good bit during this current outbreak!
Praise God with me for a safe arrival with all bags, for meeting an IMC worker fairly quickly at both the airport and at base, and for friendly co-workers who are willing to answer the plethora of questions I have had!!
Please ask that I would recover quickly from my cold--I am coughing often which leads to headaches. Cough + a headache means I am one symptom away from being quarantined---even though I brought both my cough and headache with me from the US!
I ventured out of my room around 9 am Monday morning, praying, "God, I can't do this without you! Please let me find an IMC worker!" About 100 yards from my room, I ran into Dr. Richard, who showed me where food is (key finding!) and where to get clean drinking water. (Thank you, Jesus, for an IMC worker!) He introduced me to Drs. Kristina and Matt and we ate breakfast together and they answered a barrage of questions. Then Drs. Richard and Matt took me to the guesthouse where I was given a local phone and a little more information. And had wifi that worked for a little bit! We then journeyed to the Ebola treatment center, which I was nervous about entering for the first time. I met several staff members, and one is from York, Pa! She played field hockey at Kraybill Mennonite and went to Lancaster Mennonite. And she knew a gentleman I grew up with that went to LMH!! "It's a small world after all...!"
I saw the layout of the center, found clean water (!!) and the health office.
Then several of the docs took me to downtown Lunsar where I could exchange money and buy some bananas:) One doctor's daughter works with a Christian organization in Freetown. I asked if he was a believer--praise God for answering my prayer request! I was hoping to meet one believer, and I did day one!! Dr. John has been here ten days and will be here the majority of the time I am here.
At two pm, I met up with Kelly, a nurse who has worked with IMC for 5 years. She was on the ground with IMC when we opened our first clinic in Liberia and has been working with Ebola since September. She is now one of the trainers. She began my orientation and about an hour later we learned one of our cooks from where we are staying is sick with vomiting, fever, and abdominal pain. We then went on an hour+ quest to try to locate her and get her to the ETC. Monday night several of us were on the edge--if she does have Ebola, that will be a big thing. Please pray for her healing-her name is Betty. We should know in a day or two if she has Ebola.
Well!! Thanks for reading such lengthy posts!!
Catie--would you believe the first constellation I found Sunday night was the Orion? I do have a friend from home!!
Jay & Isaac--I know what a Tyvek suit is now!! We use them each time we go into the Ebola zone.
Amber--they have laughing cow cheese here!!
My Tica family--they also have Nutella! :-)
CVRU buddies and Louann: THANK YOU for sending food along with me! I was so hungry Sunday night!!
medical friends: Some unofficial studying over the last 4 months leads us to believe the liver is the first major organ to go into failure. I believe that's why individuals with Ebola bleed so much:-( Also, and no one can explain this, but hiccups in an Ebola pt is an almost certain sign of impending death. Anyone have any ideas as to why that would be? Also, if a person can make it past day 9 he or she generally survives.
We have been unable to save the babies of pregnant women. Often, Ebola is a death sentence for anyone under 5, older than 60, and for pregnant women. The few women that have survived--we have lost the child in the womb, with the exception of one woman and her baby in Sierra Leone. She is several months along. We do not know if the baby will test positive for Ebola, if the baby now has immunity, or if the baby has had developmental problems since his/her mom contracted Ebola. We have lost all the rest :'(
The strain of Ebola we are fighting is Zaire. We believe if you survive you are immune for life but we aren't 100% sure. We also do not know if you survive the Zaire strain--if you would be immune to the other strains or if your disease progression would be less severe? So much about this disease we do not yet know, but we have learned a good bit during this current outbreak!
Praise God with me for a safe arrival with all bags, for meeting an IMC worker fairly quickly at both the airport and at base, and for friendly co-workers who are willing to answer the plethora of questions I have had!!
Please ask that I would recover quickly from my cold--I am coughing often which leads to headaches. Cough + a headache means I am one symptom away from being quarantined---even though I brought both my cough and headache with me from the US!
Challenge Accepted ;-D
**I have a challenge for y'all back home. Try to be conscientious of how many times you touch your face in one day! We cannot touch each other nor our faces--at all! I touch my face: scratch my nose, itch my ear, rub my eyes far more often than I would expect! Try to count how many times you touch your face today** :-)
Tuesday, January 13, 2015
Africa arrival:-D
Hello friends!! I woke Monday morning IN Africa!! I was overwhelmed with joy because I have been asking God to send me to a West Africa since September--and here I am! He has granted me the desire of my heart (ps 37:4).
I arrived late Sunday night and almost everything they have told me about my arrival was different! But it has all worked out. I was picked up by a different gentleman, I didn't have to take the ferry, (yay $40 saved!) and he took me to Lunsar straightaway! The accommodations are nicer then I expected :-D (on my first mission trip, my youth pastor Roger Eng advised me to have low expectations. That way, you aren't disappointed and everything above your expectations is a gift you are thankful for! Thanks, Roger!) I have a room to myself (which has A/C when the electricity works which is spotty at best), running water, and I can actually flush the toilet paper! (If you have been to a third world country, that's huge!! Especially since the last time I was abroad it took a week to break that habit--sorry about that, friends and family!;-)
It also has a water heater that is not a "widow maker" like in Honduras or Costa Rica. A widow maker heater is a heater that is suspended directly above your head and is where the water comes out-I was told if you touch it you will be zapped. Makes taking a shower far more intense!
I have met several of the American and Sierra Leonean staff--their names have been difficult for me to pronounce because they say them so quickly and most of their names are several syllables long!
More on arrival: once I deplaned in Freetown, I had to wash my hands in .05% chlorine before entering customs. After passport control I entered a line for a health screening and a temperature check,complete with the thermometer gun (I have been here two days and my temperature has been taken upwards of a dozen times! I am so grateful I have spent the last year and a half in open heart recovery--we do our temps in Celcius there. After clearing customs I found my checked bag (praise God for allowing it to make to SL when I did! I traveled from Brussels to Dakar, Senegal, then Conakry, Guinea, then the final stop in Freetown. Thankfully we did not deplane at either stop in between. I am told that if you come to a West Africa via Casablanca, with the weight restrictions on the planes, it can take ten days for your bags to arrive! Yikes! I always pack a few changes of clothes in my carry-on, but not usually enough to go ten days! (Although it would be pretty neat to say I have been to Casablanca!)
As my driver was leaving Sunday I asked what I was supposed to do Monday, as he was the only IMC worker I had met in the country. (I met 14 workers from the UK, Belgium, and Bulgaria but those individuals are doing a 6 week stint in Makene, our other location. My driver told me to, "Just relax." I expected to hit the ground running, but I will gladly spend some time resting Monday!! I didn't sleep much on the planes-I can rarely sleep on planes:(
If you have traveled anywhere with me, you know that one of the first things I do is unpack, even if it is a short trip. At midnight Sunday I began trying to rig up my mosquito net. As the Boy Scout motto is, "Be prepared, I had brought a rope, several bungee cords, and several carabiners. To my utter amazement, there is close to nothing to hook rope or string to! Rigging up the net took about an hour because, by this time, I had traveled 26 hours and been awake close to 30 hours! Not exactly fully functional! I kept wanting to quit but every time I would think that, a mosquito would land on the net. Excellent motivator!
Will post again hopefully soon!!!
I arrived late Sunday night and almost everything they have told me about my arrival was different! But it has all worked out. I was picked up by a different gentleman, I didn't have to take the ferry, (yay $40 saved!) and he took me to Lunsar straightaway! The accommodations are nicer then I expected :-D (on my first mission trip, my youth pastor Roger Eng advised me to have low expectations. That way, you aren't disappointed and everything above your expectations is a gift you are thankful for! Thanks, Roger!) I have a room to myself (which has A/C when the electricity works which is spotty at best), running water, and I can actually flush the toilet paper! (If you have been to a third world country, that's huge!! Especially since the last time I was abroad it took a week to break that habit--sorry about that, friends and family!;-)
It also has a water heater that is not a "widow maker" like in Honduras or Costa Rica. A widow maker heater is a heater that is suspended directly above your head and is where the water comes out-I was told if you touch it you will be zapped. Makes taking a shower far more intense!
I have met several of the American and Sierra Leonean staff--their names have been difficult for me to pronounce because they say them so quickly and most of their names are several syllables long!
More on arrival: once I deplaned in Freetown, I had to wash my hands in .05% chlorine before entering customs. After passport control I entered a line for a health screening and a temperature check,complete with the thermometer gun (I have been here two days and my temperature has been taken upwards of a dozen times! I am so grateful I have spent the last year and a half in open heart recovery--we do our temps in Celcius there. After clearing customs I found my checked bag (praise God for allowing it to make to SL when I did! I traveled from Brussels to Dakar, Senegal, then Conakry, Guinea, then the final stop in Freetown. Thankfully we did not deplane at either stop in between. I am told that if you come to a West Africa via Casablanca, with the weight restrictions on the planes, it can take ten days for your bags to arrive! Yikes! I always pack a few changes of clothes in my carry-on, but not usually enough to go ten days! (Although it would be pretty neat to say I have been to Casablanca!)
As my driver was leaving Sunday I asked what I was supposed to do Monday, as he was the only IMC worker I had met in the country. (I met 14 workers from the UK, Belgium, and Bulgaria but those individuals are doing a 6 week stint in Makene, our other location. My driver told me to, "Just relax." I expected to hit the ground running, but I will gladly spend some time resting Monday!! I didn't sleep much on the planes-I can rarely sleep on planes:(
If you have traveled anywhere with me, you know that one of the first things I do is unpack, even if it is a short trip. At midnight Sunday I began trying to rig up my mosquito net. As the Boy Scout motto is, "Be prepared, I had brought a rope, several bungee cords, and several carabiners. To my utter amazement, there is close to nothing to hook rope or string to! Rigging up the net took about an hour because, by this time, I had traveled 26 hours and been awake close to 30 hours! Not exactly fully functional! I kept wanting to quit but every time I would think that, a mosquito would land on the net. Excellent motivator!
Will post again hopefully soon!!!
Saturday, January 10, 2015
This is the day that the LORD has made :-D
The day has come! In just a few shorts hours my parents and I will head to the airport and the adventure will begin! I am so thankful for my church family, my work family, and my blood family for all the outpouring of support over the last few weeks. I am so grateful that as I go, your prayers go with me. I discovered two songs by Selah this week and I will include the lyrics to the one in this post--it has been weighing on me all week. Enjoy the lyrics!
Thank you, prayer supporters, for praying and seeking God's face. Take care, and I will miss seeing you in person!! :-)
He said come,
Anyone who wants must deny himself,
Take up his cross, follow me
No matter the cost
Be my heart, my hands, my voice
How are we living for Christ
How are we living for Christ
Following him we will sacrifice
But are we willing to die
God gives the strength that it takes
And he knows the price that you pay
The life you’ve been called to, will not be in vain
So don’t be afraid, don’t be afraid
When you are shackled in chains
Imprisoned for sharing his name
If you should suffer for righteousness sake
Don’t be afraid don’t be afraid
Whoever wants to save his life will lose it
Whoever wants to save his life will lose it
Whoever loses his life for my sake will find it
Whoever loses his life for my sake will find itThank you, prayer supporters, for praying and seeking God's face. Take care, and I will miss seeing you in person!! :-)
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