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When we arrived in Freetown, Sierra Leone, health checks were being done on all passengers arriving in the country, as well as hand washing in chlorine, temperatures being taken and a health form filled in. Public health messages are handed out about Ebola in leaflet form, and as we travel around we’re encountering many road blocks where people are having their temperatures taken and hands washed. Along the roadside are numerous public health messages on billboards stating that Ebola is real, as well as messaging about Aids, anti-violence notices against women, and condom ads.
We are both well and are vigilant with chlorine hand washing, taking anti malaria medication and sleeping under nets. There is an Ebola culture of no social contact here; no shaking hands, hugging, or kissing as a form of greeting. This is difficult for the hostel staff as the people of Sierra Leone are affectionate normally.
The Red Cross medical team has just opened two triage tents outside Kenema Government Hospital, where Donna and I started working this week. Only expatriate staff who have undergone PPE (personal protective equipment) training with MSF (Medicine Sans Frontières) can work in the triage tents. We had our training at their 60-bed hospital in Kailahun this week which was fantastic. They only had 30 odd patients so the staff had plenty of time to spend with us to go over PPE , processes and procedures and we felt like we had a good look at everything and got comfortable wearing PPE. We wore PPE four times over the days, assisted with patients and took in as much as we could. MSF have had 400 expats working there since March without a contamination incident and have an excellent standard of precautions.
Wearing PPE or personal protection equipment is like doing your job wearing your own personal sauna. Not a single piece of skin is exposed. You wear scrubs underneath yellow overalls, a plastic apron, face mask, hood protection, goggles, two pairs of gloves and gumboots which are wet from soaking in chlorine.
You spend 45 minutes maximum in the isolation unit assessing patients, giving medications, assisting with feeding, hygiene and also declaring the deceased. The idea is to go into the isolation unit a maximum of four times per shift. It is very hot work and you are drenched with sweat at the end and need a recovery and rehydration period. We had some heartbreaking moments and other amazing survival stories.
The two triage tents outside the Kenema Government Hospital have been working reasonably well. The local staff are traumatised. This is a hospital that has lost most of its senior staff to Ebola due to poor understanding of isolation techniques. I had my first shift in there yesterday and I have a very real healthy dose of caution about working in Ebola country.
Each shift comprises of three expats with six national staff wearing disposable scrubs. We assess the patients over a fence with a 1.5m distance so there’s no chance of cross contamination. Not really a personalised service but a safe one for us.
Malaria sickness is a common problem here too. We have been refining the triage system day by day; for example prioritising under 5's and pregnant women, revising how the ambulance passes through the triage with patients who can or can or cannot walk. Donna has gone to the triage this afternoon, her picture is above of her in her disposable scrubs.
Opening hours will be 0800 to 1800 and they will be closed at night. Donna and I will be working on rostered shifts in the tents, where currently about 100 patients turn up a day – as the hospital continues to do surgeries, births and Caesarian sections. The triage tents will help support patient flow and identification of suspected Ebola cases. They will also ensure the hospital gets the right patients at the right time, providing reassurance and confidence for local staff.
It is not safe for us to work in Kenema Government Hospital itself. Twenty one of its medical staff have died and the staff who do turn up to work are scared, depressed and tired. As Red Cross are invited guests, the intention is to provide a supportive, positive coaching environment and to improve patient flow.
To date Donna and I have also read a lot about Ebola, helped to price medical supplies and assisted in planning for the Red Cross field hospital which should be open at the end of August. Our most treasured item is gumboots given to us by the Spanish team who are very well equipped.
Dinner just walked past the window on a lead looking very cute - later it will be BBQ goat.
Our aid worker programme is partly supported by funding from New Zealand Aid Programme through the Ministry of Foreign Affairs and Trade.