Wednesday evening

I’m sitting in front of the sea, the waves thumping the beach rather than lapping. It’s a far cry from the ETC. I’m still doing my routine shifts but spending more time accompanying Tom at management meetings about the place. This is a different project, it seems, for NGOs used to humanitarian disaster and setting up field hospitals for trauma. It was suggested we describe it as a hospital in order to get a better idea of what the management requirements are.

The senior managers change over on a regular basis, as do the clinicians, making it hard to set a clear strategy, in addition to which the context of the illness changes. The place was set up to see suspected as well as confirmed cases, that is ones where the very accurate blood test is positive. However it has been successful over the past few weeks in expanding its capacity to treat confirmed cases but not accept suspects. In the meantime others have established “Holding centres” where suspected cases are kept until a positive test is obtained, or a decision is made to move them to a treatment centre. There is a constant business of adapting the site to the changing requirements, and frank discussions take place on a daily basis. These people show huge commitment and passion, which can spill over at times. So having escaped the constant preoccupation and angst that comes with being a GP commissioner for purely clinical work, I have been dragged into the same discussions in which each person has their own idea of what is best, and a compromise has to be reached.

We received between 6 and 9 cases yesterday and today, a pretty chaotic process in which ambulances arrive and we don’t quite know what to expect. On each day one patient was not on the list we had received, and tragically one man died on the trolley whilst we were deciding where to admit him; we did not even know who he was.

They vary from people only a few days into the illness without much vomiting or diarrhoea, to dreadfully ill people with severe dehydration and resulting kidney failure, unbelievable diarrhoea, vomiting, and confusion. Those working with the illness describe three types of presentation which seems accurate: those with mild illness consisting of fever , aches, and sore throat ; those with intermediate illness with D and V, liver and kidney involvement; and those with the most severe type, with the diarrhoea and vomiting complicated by confusion and sometimes bleeding. The third group rarely survive, and it is the second group that we try hard to keep alive until the immune response overcomes the infection and the viral load, that is the quantity of viral particles in the body ( probably billions).

Speaking of which, the 6 year old girl on my ward, Mahawa , seems to be turning the corner much to everyone’s surprise. Today I spooned a mixture of “plumpy nut”, a sort of peanut butter high energy goo, and full cream milk, into her in 3-4 teaspoon doses, asking the patient next to her to help out. We had to get blood from her femoral vein in the groin today, which must have been painful for her. So from getting ready to mourn her loss 2 days ago we could all be dancing at a discharge in a few days time.

Having not felt as upset as everyone seemed to think I would be by all this death and misery for the patients, it has crept up on me at times, I think more because of seeing small children afflicted. We often have conversations about staying longer or coming back, as 5 weeks of clinical work seems such a short time, a drop in the ocean of need here. However I admire hugely the physical and emotional resilience of those who have stayed in west Africa for longer, as the tide of cases is still rising and the scale of suffering has not peaked yet. I think I will have done this for as long as I can; as always this is probably affected by the knowledge it all ends in 11 days, and were it longer the feelings might be different.

Sierra Leone desperately needs doctors, as the absolute number is maybe only a two or three figure sum for 6 million people, and so far 11 have died from Ebola. They have invested in CHOs, community health officers trained to respond to people presenting with the most common illnesses here: malaria, typhoid, childhood infection and malnutrition. Many of these amazing young people want to become doctors, the barrier being cost: the fees are £2,500 per year, let alone the books and living expenses. I plan to find out more about what scholarship schemes are available, and will suggest to DFID a that this should be a focus if they have not developed a scheme already. I spoke to Mohammed, one of the CHOs, last night, asking him how he got the job. He had a call from the national CHO chief, informing him he was to be redeployed at an ETC. He describes this opportunity with great pride, but his mother threatened to lock him in the house to stop him!

So now to get the bus to the place where we eat. I’m looking after body and soul with a swim and a meditation session, but am also looking forward to the bottle of beer.

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