Three or four days into my interim role as medical director (!) role, now thankfully a joint one with my colleague Mark, and I have combined clinical work with : staffing issues and conflicts about working practices and shifts, critical incidents and responses, campaigning to get DFID a to fund the continuing provision of laboratory services on site, issues about the practice of removing PPE, the supply of clean dry scrubs and wellies, the provision and delivery of food to patients, supply of sheets and other ward requirements, a WHO infection prevention and control re-inspection on safe working practices (which went very well), getting enough radios into the red zone so we can communicate with the nurses’ station, and more.

The most important area is working with the national staff, particularly the CHOs, to empower them in providing the continuity of care over time. We are asking them to hand over to each other, with the international Drs and nurses contributing. This way we can draw back in the Cuban clinicians who came here first but were partly pushed away when UK staff arrived. We are doing the handovers as a group bilingually, and I think the working relationships are improving. I enjoy working with the the Cuban staff, and they have a great sense of humour, flirting with the national nurses mercilessly.

Survival figures are improving. Since the ETC started providing IV fluids more aggressively, supported by laboratory services , we have seen a big improvement in survival especially in those coming in with diarrhoea, vomiting and resulting dehydration. Half of the patients have what is defined as an acute kidney injury, something taken very seriously for any patient in the UK. So with early fluid resuscitation we may avoid the worst of the illness developing.

Mahawa is better! Her ebola test was negative yesterday and she is now asking for and eating rice and stew, and whatever else we give her. I think many people will want to attend her discharge ceremony and I want a front seat.

Only 5 days to go for our group. More are coming today and will hopefully be up to speed by the time we go; this is why we need the national staff to take the main role.

So I came here expecting to be a nurse, quickly combined roles as nurse and doctor, and now have a management role. It reminds me of the old Tommy Cooper joke:
“So I was in my car, and I was driving along, and my boss rang up, and he said ‘You’ve been promoted.’ And I swerved. And then he rang up a second time and said “You’ve been promoted again.’ And I swerved again. He rang up a third time and said ‘You’re managing director.’ And I went into a tree. And a policeman came up and said ‘What happened to you?’ And I said ‘I careered off the road.’

Photos from the site: the staff canteen and the staff shelter.