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."