I saw up to 8 critically ill patients tonight doing a round inside the red zone with the chief nurse, an absolutely incredible Serbian guy called Milos . Most of the population in Sierra Leone are beautiful, young, vibrant and fun loving, but desperately poor; the life expectancy at birth is 53.
Imagine a healthy 25 year old becoming close to death with pneumonia in the pre antibiotic era. You went into what was called a “crisis” of sepsis, and if you were lucky you pulled through. That is what Ebola is doing. I expect at least 2 to die tonight, but I thought this last night and nobody did. One died unexpectedly though today.
I’ve admitted a few to the centre now, trying to find out how they became at risk and it is all too obvious that the message about not having physical contact with Ebola sufferers or dressing and hugging the departed wives, husbands and children is almost certain to cause further spread, is not being taken on board. It must feel inhuman to ask the local Ebola burial team to come and take your closest relatives away without a proper goodbye.
The ethos of “Emergency” is to treat as vigorously as you would in Sheffield, or London or Glasgow , and so a large tent has 6 beds with machines that can monitor vital signs, deliver oxygen via concentrators, and insert central intravenous lines. Managing such patients whilst wearing PPE is unbelievably difficult. As soon as you put it on in this heat and humidity you sweat profusely whilst standing still, so after one hour you put your hands down and feel the sweat pour into your gloves.
The national staff (the local Sierra Leonians ) are very friendly and hard working , but i suspect there has not been enough time to explain in detail why infection control is so important, however our paramedic colleagues have been watching closely and gently encouraging good practice and are already having an impact. Several national staff are watching several members of their own family die.
J So we are all starting to settle in and will hopefully become more useful now that we can perform clinical duties inside the red zone. I do feel safe with the system preset. But remain paranoid about what my hands touch.
Over the next 2 weeks we need to develop systems that can expand this car from 22 beds to another 30-100 over time. It’s a tall order and I sense a lot of political discussions will be needed.