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. 

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.