This could be the last message from Sierra Leone, though I might put a postscript in once I have uploaded all of my camera pictures back at home.
I’m catching the bus back to Freetown, for the most dangerous part of the whole trip: the nighttime boat trip across the sound to get to the airport. They offer you life jackets that have no means of fastening across the chest; it will be in darkness; and there is not a single navigation light in sight!
This morning I went to the ETC one last time to say goodbye to all he friendly Sierra Leonians, being greeted by many, “Dr Charles! With a big smile and the obligatory , “How are you?” It’s rude not to ask this in return. I also thanked the Cuban brigade. They have come right out of their shells now and are taking on more and more reposnsibility. Claire, a GP who has been working in he role of Quality Assurance, told me that the atmosphere was totally different in that the nurses’ station is now buzzing with national, Cuban and other international staff all working together. Three weeks ago the Cubans were hiding away in another area. So we might have helped this happen by drawing them into discussion. In the past two days when I have been leading the handovers, ( please note the correct spelling for the first time, no hangovers are really conducted at he ETC), members of the national team and Cuban team have spontaneously come forward with ideas for improvement. These are needed: this morning we started preparing a patient for discharge who was not yet ebola positive . Although she is well and will have a very low viral load now, it would have been very serious to put someone potentially still infectious into the discharge tent, shake their hands symbolically as a mark of confidence in their safety, and them send them back to their community. Their are a small number of names in supply, lots people with the name Fatima, Fatmata, Agnes, Obai, Mohammed, with surnames Foday, Kamara, Komora, Sesay. So it is common to have two patients with the same or similar names in one 10 bedded ward. We have to check the numbers obsessively.
Later I had another chat, or small lecture, on leadership, from the irrepressible and impressive Mr Tamba, the supervisor of the CHO’s. He is worshipped by them, and said his secret is to get into the ward and do he same work rather than just direct from a safe distance. I know this to be the case as he likes taking me into the red zone and giving me a dozen jobs to do, and I feel helplessly drawn into just obeying. However he calls me his brother, and when we had a dispute over one female patient who was wanting both of us as a husband, he said I could have her.
After more discussions about problems facing the unit, I headed for the discharge tent and watched a brother and sister go through the process. She looked about 14 but told me she was 20; he could have been 25 or 35. Both were clearly very poor, were thin even before Ebola, and both illiterate, as instead of signing a form they had their thumbs painted in biro and pasted a fingerprint. I did not see them leave, but left them smiling and clutching their certificates and $750,000 sierra Leonian dollars (£ 90). I wonder how the next few days and weeks are going to be for them. There is still a lot of cruelty toward survivors as people fear them.
It’s hard to leave now, but I’ve just had a swim and my head is thinking of Juliet, the children, family, home, the puppy and cheese.