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.