Last Days

This is my last blog post from Kakata, Liberia. I will soon be headed home. Back to what I thought was covered in snow but just learned it has all melted and this makes me a little disappointed. I was looking forward to some down time in my house, painting my kitchen cabinets and watching the snow fall. Winter is not over so I can still dream of this happening.

I wanted to thank you all for your prayers and support during this time. One of my main reasons in wanting to come work at an Ebola Treatment Unit (ETU) is that I wanted to bring awareness that ‘Ebola is Real’ (the slogan for Ebola here in Liberia), and that ebola is still very active and is still causing havoc in West Africa. You would not know this by watching or reading the news because it is not there. Some people were surprised I was coming because they thought the outbreak was done since they had not heard about it on the news in a long time. It is still very active and although the numbers have decreased dramatically, there is still the fear that it could spring up again. Fear that people will become complacent and not be as vigilant anymore in not touching or watching what they eat or question why this person is sick or go to a funeral and touch the body. There are still people dying. There are still hospitals running off of fear of any patient who is brought in. Patients who are not getting adequate care in clinics or hospitals because at one clinic close to here, over 20 healthcare workers died of ebola. The fear is real and patients are dying because of this. 

Two nights ago I had my first patient death on my shift. In the last six weeks since being here, there have been about seven deaths although none from ebola. All from things we can not give a definite diagnosis to. This man came in very sick. He was admitted at eight in the evening and was gone by six in the morning. It is so hard to imagine dying in an ETU with no family or friends around. Alone. In a small room with grey tarps for walls. Poor lighting. Bugs flying everywhere from the quick dump of rain a day ago. This man was brought in pretty unresponsive although he would fight us when we were trying to get an IV line placed. We checked on him throughout the night but beyond giving fluids and a very limited amount of medications available, there was nothing else to be done. I tried washing his face but that made him more agitated. He was incontinent of thick, black, tarry looking stool. This would assume blood, but no way to definitively test for this. Checking the inside of your lower eyelid can also give you an idea of what your blood levels are. His were white which means he had lost quite a bit of blood, but again, no way to know for sure. (I have met many doctors throughout my time working in West Africa who can give a accurate blood count level by pulling down and looking at the color of the inside of the lower eye lid.) Because of his fever, possible bleeding, weakness, and patient condition, he was brought to the ETU under suspicion of ebola. I was called into the ETU early in the morning to confirm that he had passed. He had. The viral load on an ebola patient after death is extremely high and because we still did not know his status, we had to treat him as though he was positive. The sprayer sprayed him with the chlorine solution and we covered him with a paper sheet. There is a team who deal sole with patients who have died, so in the morning the burial team came in and put him in two body bags, spraying each with chlorine before taking him to the morgue. The county and family then decide together where the body can be buried as we do not have a burial site on our land. By the afternoon we received the blood results and the patient was not positive for ebola. That was good new for the community and all that had cared for the patient in his home and at the other clinic. The family will never know what exactly this man died from. Lassa hemorrhagic fever and ebola have very similar presentations so there is thought this could have been it, but we will never know for sure. 

Please keep praying for an end to this ebola outbreak. Not just here in Liberia, but also in Sierra Leone and Guinea. Pray for these countries as they will have to learn to deal with what comes next. How to move from a state of fear to a state of rebuilding the healthcare systems. Rebuilding families who have lost so many. Children who have lost both mother and father. Pray for those who have survived ebola and their continued reintegration back into their communities. Pray for healthcare that can meet the needs of the people they are here to serve. It’s heartbreaking knowing what can not be offered. 

I wanted to say hi the all the kids at Sandhill Elementary! My mom has been reading this blog to her students so I just want to say: read the news. Get good grades. Learn about what is going on in the world and see what you can do to make a difference in your own community…and give my mom a hard time. You are all very fortunate to be able to get the education that you do! 

Some More Pictures

The ETU from the water tower. Suspect ward on the right. Confirmed on the left.

One of the ambulances.

I got to hold an adorable baby!

A man mixing the chlorine in the water.

Rubber trees in the Firestone plantation.

Barracuda for lunch at the beach.

The Weather

What do you talk about when there is nothing else to talk about?

The weather.

It's good there is nothing to talk about. Yesterday Mali reached its 42 day period without any new ebola cases so it is considered cleared! Wonderful news! Last week here in Liberia, only 8 new cases in the country! Again, fabulous! There were even two days where there were no reported cases. We are still getting suspect cases in but nothing confirmed, which is great news for the country.

So, the weather is changing here. Up until yesterday I would have to wear a sweatshirt to the board rounds in the morning because it got so cold overnight. When I would work nights and come to check on things at 1am or 5am, the nurses and staff would be dressed in down coats and wool hats. A sweatshirt was enough for me. I enjoyed the change in temperature. Today, though, I went down for board rounds at 7am and by the time I got there I was already sweating. After rounds and the morning meeting I ran back to my room and got on weather.com. I actually found Kakata, Liberia! 8am and it was 77 degrees with 94% humidity... did I say it was at 8am???

I worked the morning shift today so I was dressed in PPE and in the unit by 8:30. Before I even left the dressing room, sweat was filling my goggles. Within fifteen minutes my goggles were fogging up so much that my only respite were the sweat beads running from the top of my goggles, clearing a way for me to see. Gross, maybe, but I was thankful for the sweat so I could see!

Ebola Sucks

Ebola sucks. 

Not just the actual disease, but everything ebola has affected. The fear it has instilled in entire countries. The even further breakdown in an already fragile healthcare system. Villages lost by death. Families losing mothers and fathers, aunts and uncles, grandparents, children. Whole families lost. An entire village on one side of the street, gone. Families needing to be quarantined after a loved one dies—who will feed them to keep them quarantined? Who will meet their needs to keep them safe and in turn, everyone else around them? Stories of houses burned down out of fear. People getting forced out of villages from fear of them having the virus and no one being called to help. Found barely alive but no food or water for days. Stories of families hiding bodies or sick loved ones from fear of what an ETU does to whoever enters. A country that has a ‘Liberian hand shake’ and touches out of affection now has billboards saying, “No Touching”. It was, and is, a sign of respect and sharing condolences when someone passes to touch the body of the dead, to braid their hair, to be with them, and now it is known that a person who has died of ebola is even more virulent after death. Death breeds death if the body is touched. 

When a patient is brought into an ETU, we test and treat for ebola. All patients get malaria medications when they arrive, vitamins and a broad spectrum antibiotic to help other possible infections. That is it. That is all. There are other medications we can give for nausea, pain and IV fluids if needed, but the treatment we give here is ebola focused. We can’t do testing for electrolytes or lassa fever, another hemmoragic disease. In the three weeks I have been here, we have had three pregnant women come in. Anyone with unexplained bleeding is sent to an ETU. Pregnant women come in with vaginal bleeding. A full term mother was here my first week. She had not felt the baby move for at least a day. There is nothing that can be done until blood tests come back, and the blood test needs to be negative three days after symptoms start, meaning a patient could be on the suspect side of the unit for three days until their lab results come back. During this time diagnostic tests can not be done. Tests can not be run for other things. Ultrasounds can not be done to check the status of a baby. People are sick and dying while waiting for test results. This is awful to see. A mother with a baby inside that she knows is not moving and there is nothing that can be done until the negative ebola test comes back. Hospitals outside of the ETU will not take someone with ‘unexplained bleeding’ until they have a negative test. 

Ebola sucks.

It has been around for awhile, ebola. Small outbreaks here and there. This is obviously the largest one yet and what is so crazy is that still very little is known about what treatment is best. Should you force IV fluids? Should you not? Should you give this medication or that? One ETU does it this way and another does it like this. Whose mortality rates are better and is it because of the treatments given or is it because more patients at one ETU have patients who have to walk two days to get there while another has patients who can be admitted the same day? What is best? What is right? Are you doing more harm or less by doing this or that? What antibiotic is best to give? What type of IV fluids? Question after question and it seems like there is never a good answer. 

Some Pictures from an ETU

Me, ready to go in.

White: Clean Water

Green: 0.05% Chlorine

Red: 0.5% Chlorine

Doffing Area

Drying Boots

Merry Christmas!

Training

I’m currently in Bong, the other ETU about two hours north of Kakata. I’m not actually AT the ETU, I’m at the university that is housing everyone for the ETU. The trip up here was eventful. You might think that the road would be enough excitement with all the potholes and manoeuvring around  construction sites and anything and everything else in your way but we ended up with a flat tire. Our driver removed the flat and was unable to jack up the car anymore to put the spare on. Good thing he pulled onto the dirt. He ended up having to dig so the tire would fit. I’m up here for training for the next few days. They have just as many patients as we do… hardly any. It’s a good thing, but not what I was expecting. Hopefully this means the outbreak is decreasing. I went for a walk around the university today and met the French professor for the university. He was telling me that it should be opening next month along with the other schools in the country. I have been hearing rumours to this and hopefully they will be true! It’s crazy driving by so many schools and not seeing a single child at any of them. All schools closed and any large gatherings were forbidden when the outbreak got out of control. 

Here are some pictures of the ETU I am at:

Just kidding. I tried... many times to upload pics. Will have to be for another post. Internet is driving me crazy these days.

The girl I wrote about in the previous post is doing well. She still spikes fevers at times but overall she is doing well!

Happy New Year!

The 11 year old boy, Ujeh, who had been in the confirmed side of the ETU since I arrived finally got his negative blood results and went home! It was a time of celebration when he found out he was going home. Before his results came in, a 14 year old girl came in positive and we admitted her to the unit. Her mother died two weeks ago of ebola and she recently started having symptoms. She is a beautiful girl. I had no idea what to expect when I was suiting up in my PPE to meet the ambulance. This was the first confirmed ebola patient I was going to admit and Ujeh, even though he was positive, he didn’t look it. He had gone through the worst before I arrived and I did not witness that part of it. Although she was strong enough to walk, I could see the fear in her. Who wouldn’t be afraid, and yet a child, all alone. Her mother recently died of a disease killing so many and into her village pulled a truck, an ambulance. A truck with blue and orange tarps to form an enclosed area in the back. She was put back there alone and was being taken to a place she did not know, alone. Getting out of the ‘ambulance’ she was meet by a man spraying her every step and dressed so all she could see were his eyes. She rounded into the triage area and when I asked her name I was glad she could understand English. Patience. Her name is Patience. Such a beautiful name for this scared girl. After the initial triage we walked across the ETU to the confirmed side of the ward, the sprayer spraying every step. I learned she is in the fifth grade and likes math. The other nurse who was there and the sprayer were so encouraging to her and as we were getting ready to leave her the sprayer asked if we could pray with her. She said yes and we prayed. Walking out and leaving her in her room was hard. Ujeh was there which was good that she could see him better and about to leave well, but it was hard imagining what she was thinking and feeling. Alone in this large tent in a small room with grey tarp walls. 

I went in and saw her twice yesterday. She was not feeling well in the morning but felt better as the day went on. Her blood tests came back in the afternoon and it looks as though she is already improving.