The first night shift from 8pm to 8am and another poorly child worrying me through the night. At handover Tom Fletcher had suggested we check the RDT or rapid diagnostic test for malaria, as this can often coexist with Ebola and confuse or worsen the picture. Once we had assigned tasks I went in with one of the Cuban doctors, to find the poor 6 year old Mahawa barely responding to verbal commands, very dehydrated and hard to assess. Our attempt to do the malaria test was thwarted by my rapidly steaming goggles meaning I could not have interpreted the result. We tried to get her 17 year old sister to help find out whether she was in pain and to encourage her to drink. Her sister, being well, came across and asked her some questions to no avail, then raising her voice, then raising her hand as if to hit her sister, at which point we stopped and asked her to get back to her own bed.
I tried another mask and entered again this time with Agnes, a young CHO, community health worker who has done a three year health degree in Freetown and who clearly knows what to do. We managed to get a finger prick sample and did the tests for both sisters, but again my goggles misted and Agnes had to finish off. Mahawa’s malaria test was positive , so the next thing I had to do was draw up the right dose of artenusal anti malarial medication, re-enter and inject into her bottom.
The Cubans have been here for a month and will be here for 6, with 21 days in country quarantine followed by 21 days quarantine at home, so they will not rejoin their families until June 2015. It’s a way of life for some; Thomas, one of the nurses told me he had been sent to Pakistan after the earthquake for 6 months, had spent 24 months in Bolivia after a landslide and 3 months in Haiti . They don’t get much of a choice and you cannot blame them for being moderately less enthusiastic than the UK NHS volunteers only deployed for 5 weeks. So they split the night shift into 2 and take their time.
Miguel, another doctor, saved the night for me by getting an IV line into Mahawa’s arm so we could start to rehydrate her properly. I’m hoping to see a much better result in a couple of days. The 2 year old Amadou had responded to this. In the morning a Cuban paediatrician came on duty. I think if we really organised ourselves we could do great work together. In the meantime I am using the Spanish Juliet and I learned from Irini, our wonderful (Greek) Spanish teacher, taught us prior to visiting Chile earlier in the year.
The big sister took her medication with some ORS this morning and promptly threw up on my right wellie! I watched carefully as the hygienist sprayed the wellie down with the ebola killer 0.5% chlorine. It apparently takes 6 microseconds to do its job, and certainly makes a good job of bleaching any clothes you are wearing, and we often have an end of shift cough from the fine spray during doffing PPE.
Back to the chalet along the paradisical white squeaking sands and blue sea. There’s a lovely breeze to keep things cool whilst I sleep as long as I can. I woke up refreshed and went for another bout of bodysurfing. It’s not all bad.
I had a rest day today (Thursday ) but went to do a morning shift as one of our team, Daxx, had been asked to help train the next NHS and national teams in PPE. So I went back to work in the same ward and saw Mahawa again. She’s a little more responsive and less dehydrated but still seriously ill. I think her malaria is probably under control but the Ebola is now progressing, as I had to change her nappy twice in the shift, and a little blood was oozing from a previous venous catheter site. I decided to start singing whilst doing procedures with her, and I think she responded a little more.
We are getting a bit more organised. Tom is leaving soon and was hoping an NHS consultant would be coming to provide the medical director role. Instead he has asked me to do this for the next couple of weeks as an interim. So having just got into the role I may be directing things. The other NHS staff seem happy with this, and it would give us a chance to negotiate again with the Cubans. I’m sure there is unused expertise in abundance there, they are lovely people and like teasing the national staff.
Am wandering back along the beach now to the place I share with Ben, a nurse. Hopefully we will see the crocodile on the way.