Ebola 3

Ebola 3

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.

image image imageimage imageSo 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.

First visit to the ETC at Lakka

imageApologies for the errors in the previous post, a conglomeration of entries from last week up to yesterday. I don’t think I can correct it but never mind. The image is from the beach yesterday.

Today we visited the 100 bed ETC at Goderich, literally across the road from where we are living. It’s huge, an impressive feat of civil engineering due to be completed under the management of the British army in a total of 31 days. There were hundreds of local men involved, so ebola has brought work and training opportunities. As the demand for materials increases, so local suppliers have increased prices. Given the way the economy has come to halt during the crisis, it’s no wonder some make an opportunity from it.

from there we were driven to the existing ETC at lakka, apparently built in only 4 days. It’s a construction of concrete floors with a mixture of solid and tented areas providing space for assessment and treatment in the”red zone” with all of the supporting functions outside this, the White and green zones. It is plumbed with the essential flow of 0.5% and 0.05% chlorine that kills the virus in seconds, areas to don PPE and to doff this, and areas for medical and nursing staff to organise the care. Each treatment tent has someone watching in from the fenced 1m separation distance, shouting orders and receiving information from the health car workers inside.

We watched as a suspect case was interviewed at the assessment area, again from the safe distance. He is a 45 year old fisherman whose neighbour had died of Ebola 2 weeks ago. It wa difficult even for the local speaking Krio to establish the full facts about how he may have acquired the virus. He was clearly unwell, breathing rapidly, was weak and hiccoughing, a bad sign in this disease. He was admitted and will have been put on a drop, given fluids, antibiotics and other medicines; we will see if the ebola PCR test for presence of the virus, is positive or not. Whatever he has, we know he is very sick, with bloods indicating kidney failure.

we talked about the different ways in which different health systems manage the same problem. Emergency http://www.emergencyuk.org/menu.php?A=001&SA=055&ln=En is an Italian organisation and its protocols reflect the patterns of care in that country. Given that few have much experience to say what is the best way to manage it, we are not in a position to question , as these brave and incredibly hard working people have been fighting the disease for three months now without any of the recognition we received on Saturday work at the airport.

The chief nurse, Milos, from Serbia , took us through their method of donning and doffing and we tried it twice. Just getting into the gear made us sweat profusely, and we saw people coming out of the red zone with soaking wet scrubs, so much so that they have to take them off and shower before putting on dry ones. We had a delicious spinach and fish curry and rice for lunch, one of the distinct advantages for the workers, the disease again providing a work opportunity for local people. We spoke to one pair of young men whose first job this had been ever, at the age of 17 and 19; I imagine this would not be a popular YTS scheme back home.

So back now to the house, for tea, for more discussion and hopefully a good sleep before we step up to more drills and actually entering the red zone.

ebola 1

I’ve just completed a 9 day course at the Royal Army Medical Training centre near York, accompanied by 35 volunteers from the NHS and another 25 Norwegian health workers. The NHS doctors, nurses and paramedics are getting ready to travel to Sierra Leone tomorrow for a 5 week secondment from their jobs, funded by the department for international development.
How did I get this far?
The UK response to Ebola is being run by UK-Media, an NGO based in Manchester. After registering my interest they interviewed me by phone and accepted me. I’m not sure how I talked them into it as I have no prior foreign working experience. They were asking about resilience, experience and expectation.
What followed was worry, about how Juliet would react, how our children, family and friends would react, how I was going to get freed from work, and would there be reimbursement?
The response has been overwhelming. Juliet is quietly calm and supportive, and would go herself if she was able, so that was the best start I could hope for. The children took a bit more adjustment but have been wonderful. Friends have been hugely generous, saying that if there is one person they know suited, it’s me. That explains why I am going, it’s about being compelled. None of the people I have come across at the course are courting praise. Many have spent months or even years of their lives working in the most difficult and dangerous places on earth, and come back for more.
The phrase from my working life that I keep coming back to is from my practice’s managing partner, Chris, “You have my total support”. He and the GP partners have been fantastic, even when I sat quietly whilst they rejigged the Christmas and
New Year rota. We will get reimbursed for locum sessions in my absence, but we all know it’s hard to find people able to fill in. My other job is as a commissioner at the NHS Sheffield CCG, being a clinical lead for acute care in the city. Ironically, it seems harder leaving behind the work there, as there is more reliance on me as an individual, but again the support has been unqualified . No doubt it would be hard to reject my request, however many others on the course had to push hard in their NHS trusts, and one had to leave the course as his trust changed their minds.
So those questions were answered and within 2 weeks, after all the goodbyes, I was sitting in a lecture theatre being told about the epidemic, about Ebola virus, and how to manage patients suffering from the infection whilst keeping safe. We’ve had talks on resilience from army “Padres” experienced in caring for the spiritual and emotional needs of soldiers, cultural awareness and an introduction to Krio, the language used by many in Sierra Leone at least in the west; it was strangely familiar to me having spent the first 5 years of my life in Trinidad. The reason is that the population of the Freetown area is derived from freed slaves and having just started listening to people talking, I can hear some of the words and intonation .

The other, crucial part of the training is about PPE, or personal protective equipment, about which I will probably bore any readers senseless. It’s how we put this on (“don”) and how we take it off (“doff”), and how we keep ourselves from becoming contaminated by body fluids, that will make all the difference between being a safe worker, and getting infected. What’s also important as I see it, prior to actually going to the ETC (Ebola treatment centre) is that by being confident about the safety makes us able to communicate more with patients who are severely ill and in pain, rather than being suited robots.

So we’ve now been through the media frenzy, about which you probably don’t need much information. I felt silly spending 10 mins being photographed, a picture attached to a so so article. I’d recommend the panorama documentary broadcast last Monday or Tuesday night 17th November . We flew yesterday evening and arrived this morning at 6 or so at the house we 11 Emergency workers will be sharing for the next 5 weeks. It’s hot and humid but we are comfortable with aircon in the bedrooms. Just getting acclimatised and will meet others working here tonight.