Christmas Time in an ETU

Today marks one week of me being here. It’s funny looking back at my expectations and what I thought I would be walking into and what the reality really is. 

There are two sides to the Ebola Treatment Unit (ETU) where patients stay. When they are first admitted they go into the suspected ward. After their labs are drawn and we get results back, the next day, then they are either discharged home or to the hospital if they are sick with something else, or if their labs come back positive for ebola, then they are moved to the confirmed side of the ETU. There has been one 11 year old boy on the confirmed side since before my arrival. All the patients we have gotten in on the suspected side have all been negative for ebola thus far so they are here for less than 24 hours usually. The boy in the confirmed ward is getting stronger every day and is expected to go home soon. On Christmas Eve he was up dancing and showing off his moves.

The pace here is a lot slower than I was expecting. It’s a good thing, I know, meaning there are not as many cases coming in. When you come out of the unit, there is not much else to do until the next time you go in which can be many hours later. I’ve been talking with many of the national nurses and that has been interesting. Everyone here knows many people who have died from ebola and they have all been affected in some way. All the schools have been closed since the outbreak became severe, so many of the nurses who were in school are working here as nursing aids. A nurse I was talking with yesterday was telling me about how many families in his village were quarantined in their homes when someone in their family became sick. The community would have to bring them food and if a person died, the right people would come and remove the body. He was telling me about how he grew up as a child in the midst of the war, became a refugee and eventually moved back here when it was safe. The country was rebuilding and now this. It’s a difficult time for everyone. 

On Christmas Eve we had a celebration for the workers. Lots of preaching and dancing in full form. Lights and decorations and fake trees were put up throughout the ETU to make it festive. A good friend sent me this LINK which was my Christmas message this year. Also, take a look at THIS which a couple others sent me which I found really funny. You need to watch it to the end. I hope you all had a great Christmas and remember why we celebrate!

Arrival

After 36 hours of traveling I made it to Liberia without much hassle. My luggage even arrived which I’m told does not have often so I should be proud of that. I was pretty anxious on my flights here, not knowing what I would be walking into but as soon as the plane touched down my nerves were calmed. I had arrived and there was no turning back. 

Stepping off the plane I smelled it. I smelled Liberia. It’s hard to put into words what that smell is, but it smelled of Liberia. Before entering the airport, you washed your hands with bleach water and had your temperature taken. Only then were you allowed inside. I made it through and quickly found others with IMC. I shook hands with another newcomer and realized that was the last time I would be shaking hands here. Physical contact is not allowed as it can spread the virus. As we were driving down the road I had to laugh to myself. So many memories came back from seven years ago when I was here last. People with their hand out, shaking it to get a taxi. Driving at night, you are to flash your brights when you are close to the oncoming car so they know you are there (I never understood that). The large billboards which I remember having election information or condom use on them were now covered with information on ebola. 

Yesterday morning I went into the ebola unit for the first time. I was in there for about forty minutes and that was long enough for me for the first time. Getting suited up was a chore but there were many people there to help. Not the slightest skin could be showing. You had people to tie you, tape up your gloves, check and double check you were safe to enter. I appreciated that. It’s not because I am new that all the help was there, it is the way it is done, even for an experienced ebola nurse. It’s the same thing coming out of the unit. You stand with your hands up as you are sprayed with bleach water. Another person then tells you step by step what you do to remove your PPE, protective gear. After every step your gloved hands are washed with bleach water. When you finally have everything off and your hands are washed and boots cleaned, you change your scrubs. Drenched in sweat. Soaked. Many of the Liberian nurses would come out and not have a drop on them. Maybe my body will get used to this too, but for now, drenched sweaty scrubs it is. 

Ebola

Adding a post after so long can only mean one thing...

I am returning to the continent that I love and call home.

Since the Ebola outbreak started over a year ago, my heart has been breaking for West Africa. The fear and death and uncertainty that has overtaken that part of the world is overwhelming. When I think of West Africa, I think of the people. The hospitality, smiles, joy, love that the people have shown me during the three years I have spent there breaks my heart knowing what they are going through. I decided not long ago that I would move forward and apply to go and see what happened. I knew doors could open or doors could close but I decided I would keep moving until God told me no.

He didn't.

Doors closed, but others opened and I kept moving and I'm glad I did because now I am about to leave.

I just got my plane ticket and will be leaving this Friday. I will be going to Liberia with International Medical Corps (IMC). They were featured on 60 Minutes a few weeks ago. You can watch the episode here.

I ask for your prayers. Prayers for those infected with ebola. Prayers for strength and grace in this journey. For safety and strong health. For strength in wearing the protective gear while treating the patients. Prayers for everything and anything God brings you to pray for.

I will update on here as I can. Thank you for your prayers and support.

Act of Faith

For many of the women we serve, coming to the center is an act of faith. On Thursday we discharged an old woman who had her fistula repaired and she is dry. In the clinic as we were doing her final discharge screening and education she told us it was difficult for her to come in the first place. She didn't have the support of anyone in her family or village. They kept telling her that the problem she has is not treatable. There is no help for her. It is pointless for her to even try. She has this problem for a reason so she needs to learn to live with it.

She came anyway.

I laugh thinking about it because she told us there are four other women waiting for her return in her village. They all have the same problem she did but they waited for her to come back and report what happened here. This older woman came out as a guinea pig to see what would happen to her. I have heard this before. Patients coming out, knowing others in their villages who have fistula. There has to be one brave enough to make the first step to come. For this one woman, if she goes home dry, the others will follow.

No pressure here.

The hard part is when a patient comes and she leaves wet. There are many reasons a patient can leave wet: a failed surgery, a healed fistula but the woman has stress incontinence, some women need multiple surgeries to be completely dry... When she goes home this won't be translated well. You are either wet or dry. If you are dry, others will come. If you are wet, they don't see the point in coming.

This patient is dry and she will go home and report what she experienced here. I am looking forward to the day I look out the windows in the clinic and see the four patients from her village sitting there waiting...

Dentist

Me and my dentist

I have never been one to really be sick. Never broken a bone. Never been hospitalized.

Never, until a year ago. 

In the last year I have: broken my pelvis, been to the emergency room in Sierra Leone, had X-rays, a CT scan, ultrasound, mammogram, MRI and yesterday I was able to add Niger dentist to the list. All of those things listed, except the MRI, were all done in West Africa. Someone told me today I should write a book about my medical experiences here. I don't have enough to fill a book but I have come away with some good stories.

It's always a good day when the local grocery store has chocolate. Not just any chocolate, but good chocolate. The Toblerone, triangular goodness that melts in your mouth unless you forget to put it in the fridge, then it melts in your cupboard. On Sunday I was enjoying my piece of chocolaty goodness when it became a bit crunchier than normal. It wasn't the grit of added sand that accompanies many meals here, this was like a rock. This was a big part of my tooth. Luckily it was one of my back teeth so you couldn't see it, but I wanted to gag when I felt this gaping hole with my tongue. Being a nurse my mind started racing. I was going to get an infection, then abscess, then major tumor. Luckily I live with missionaries who have lived here for a long time and knew of a good dentist in the area. He was able to see me early yesterday morning and June, Leng and Ashley all accompanied me on this adventure.

We walked right in to this small room that had a desk, a dentist chair and supplies. I was quickly told to sit down so I did. All I knew was that I didn't want anyone drilling in my mouth or doing anything that was not necessary. I didn't want any shots or teeth pulled. I can't believe my lack of French or Hausa after living here for almost ten months. June and Leng did a great job keeping me informed about what was going on. Yes, a large part of my tooth broke off but luckily it was a clean break and all the dentist had to do was fill it back in. Only a small amount of drilling to make it possible to add more cement to fill in the hole. It was even white. I kept my eyes closed, knowing Ashley was right there taking pictures and making sure everything was ok. I had to. The needle, which was never used, was sitting right at eye level tempting my fears. It was better to just close my eyes and pray it was all over soon.

All in all it was a memorable experience. The hole is filled and even though it is temporary, June had the same thing happen to her a long time ago and went to the same dentist and her temporary fix lasted a long time. I pray that is the same in my case as well. It is still a bit rough. The dentist apologized for not having a buffer to smooth it but it's not bad. All this for about $4.

Visit the dentist in Niger... check.

Thankful

Last year when I was living in Sierra Leone my sister sent me a book called One Thousand Gifts. It was a great book that helped me changed my outlook on my situation there. It helped me find joy in everyday things I encountered. In the stressors I had, I was able to think about and notice the little things which caused me to see each situation differently. It helped me to persevere through some difficult times.

Last Sunday I decided to start a list. I have been making a list of things I am thankful for. It has helped me change the way I have looked at some of the situations I encountered this week. As I started writing this list I kept having an overwhelming urge to write a list of challenges this week as well. I didn't. I needed to focus on the blessings of my days. Yes, there were days I just wanted to come home and crawl back into my bed, turn on my ac and sleep, but when you take the time to stop and look around, you notice blessings in the midst of challenges. Here are a glimpse of things I have been thankful for over the past six days:

• Having a flashlight on my phone
• I have not gotten malaria this year
• Packing nyquil/dayquil when I came
• Purple flowers growing among the corn stalks being harvested
• Patients being discharged to the village
• Dead earwigs
• Bananas erupting from their pods on the pigmy banana tree
• Moringa trees growing larger
• Women returning on time for their surgical appointments
• Ants marching creating veins in the sand
• A newly hired nurse
• Long walks home
• Skirts that make you walk a step slower
• Receiving two roosters as a thank you gift inside the hospital
• A finished malaria policy
• Kosai
• Old patients returning dry
• Watching people harvest their crops
• Women pounding their grains
• Listening to country music in the car
• With the windows down
• At night
• Turning down country music and rolling up the windows while passing through checkpoints
• Water filters that make brown water drinkable
• Friends who will protect me from bats
• Two hens purchased for the roosters so we can have eggs
• Air conditioning in my bedroom
• Watching patients doing rounds on each other--on the fresh post-op patients to make sure they are ok
• Losing patients but then finding them sitting under a tree in the dirt behind the OR
• Training nurses to take over my jobs
• Nurses who work hard
• Rice and beans for lunch
• Learning a new word in hausa and using it appropriately 
• Just standing in the pharmacy (the only room in the ward with air conditioning)
• Being told I can go to Niamey with Ashley to say goodbye
• The way the young patients wear their gowns
• Having my massive set of keys reduced by three
• Excitement by patients who are brought into the ward for surgery 
• Bottle of some sort of sugared nuts
• Chocolate in the grocery store
• Buying a purple shirt at Wrangler
• Witnessing an ultrasound of a patient who did not know she was pregnant
• Showing this woman her child inside her womb
• Seeing the tiny hands, feet, spine and all four chambers of this tiny heart beating inside her

Family

Yesterday we had one of the largest clinic we have seen. 30 women in four hours. Most were new women we have not seen before and the majority of them were scheduled for surgeries this month. We have a very busy month ahead but it's exciting to have so many women who will be able to come through our doors. For now they will be staying in the village where the village manager will be starting her literacy classes. 

Today there were two women who came to the hospital. One was here a few months ago and had surgery but she needed to return for a planned follow-up surgery. I walked her out to the village and when we were half way down the path, to the point where the women in the village could recognize the patient I was walking with, claps and yelling started coming from the huts. Many of the women recognized this patient from before and it was like a home coming. There was even one who jumped up and danced down the walkway to us so she could carry her baggage and give her a huge hug.

I love how the women become a family to one another. So many of them travel from one fistula center to the next hoping for a permanent cure and they get to know each other. The one who danced down the walkway to greet this patient I was admitting knew her from her previous surgery done here. Even on the ward it is incredible to watch the women and how they interact with one another. Not just with each other, but with the nurses. Last night one of the patients walked around to all the doors making sure they were closed tight and locked before the patients went to sleep. Another is sick with malaria and just feels awful. The other patients come, carrying their catheter bags, to help change the bed and pads of this women. They bring her water and talk with her. We are not short staffed with nurses and we don't expect this of our patients. We have never asked the women to do this. They do it because they know better than any of us what they are each going through. I watched as an older woman helped a girl about half her age use a pot to pee in because she had an IV running. When a woman returns from the operating theatre, there are patients on the ward who will make their own rounds. They will make sure the women have water or someone to talk to since they can not move in bed because of the anesthesia. They love each other and care for each other more than I ever could as a nurse.