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Wednesday, 7 January 2015

More on the Ebola Crisis from Rachel D-A

David Duncombe-Anderson writes:-
The latest round robin from Rachel – a bit graphic in places, but not too long now before she is home and safe.
Do read the link – a-day-in-the-life-of-an-african..... as it has a really positive ending.
Happy New Year!
Sent: Sunday, January 04, 2015 12:31 PM
To: undisclosed-recipients:
Subject: Christmas and Happy New Year
Hi guys,
So sorry not to be in touch but it's been really busy over the last week or so. Christmas was a very interesting time and thanks so much for your messages as they did make a real difference. I certainly haven't ever experienced anything like this past few weeks, that's for sure.
The disease - The main thing to report is how brutal Ebola is. I suppose that sounds pretty obvious but I have never seen something so cruel that brings in healthy, young and fit looking patients and within days or sometimes hours they are gone. Having been used to seeing horrible traumas and sick people nothing can prepare you for this disease and the impact it is having on this country. The other night I was talking to the WASH team and most were recent graduates reduced to working in an ETC whilst their country is put on hold - one an accountant, an electronics engineer and a few teachers who can't teach as schools remain closed. Many of our staff are separated from their families due to working up here in the ETC and one of my nurses has been thrown out of her house by a landlord who is unhappy that she works with people with Ebola. Keep thinking about the people here - they need to be remembered.

UK Nurse with Ebola – so the news that a nurse has contracted Ebola whilst out here has shaken us quite a lot. Our colleagues in Freetown worked with her so that brings it home to us that it could have been one of us.  If complacency or casualness towards PPE and doffing had begun to manifest  you can rest assured that this story has focused us entirely and doffing continues to be the most important aspect that we can get right.  That said, there are occasions where things happen that are out of our control. This last week has seen a few breaches in PPE for all of us – a breach can be a tear in a glove, a pair of goggles sliding off the face or something more dramatic like a fall.  I have had two breaches in my outside pair of gloves which is both annoying and scary - annoying because you have to leave the unit immediately and that may be right in the middle of your medicine round and scary because of the greater.Just to reassure you all though, in both cases my inside glove was unaffected and even if a tear had occurred to the inside glove I don’t have any cuts on my hands and skin remains a good barrier to the virus – in other words this is a very low risk breach. One of my national nurses was not so lucky this week – she had chlorine sprayed in her face whilst doffing, couldn’t breathe and then pulled her goggles and mask down. As she turned to wash her hands, she then tripped over and fell in a big pool of chlorine.  The protocol was clear and we walked her through the doffing process from there but it was very sobering and pretty frightening to her.
One of our colleagues working at Kerrytown, Freetown wrote this article which is such a great description of a shift here.
Anyway, I know that this sounds gloomy and yet there is real joy and laughter in each day. We have had our first survivors this last few days and the excitement and joy we feel when the patients come through the shower that straddles the high and low risk zones  (renamed' the shower of joy') is unbelievable. They come through the door in new clothes and having had one last chlorine shower they come out to an explosion of singing, drumming and dancing. It's hard to hold back the tears as the survivors start dancing for joy and seeing us close up without PPE on.
On fun - New Year's eve was one of the oddest and funniest I've had. I thought I would be heading to bed at about 9.30 as I'd just come off a late shift but suddenly the kitchen staff started shaking their stuff and to a combination  of soppy 90s film music and pounding Sierra Leonian worship music :
Happy New Year mi nor die oh
Tel God tenki for mi life oh)
we all whirled like dervishes and managed to stay up to the heady heights of 00.05. Tenki means thank you and this song, although predates Ebola has never seemed so poignant to people here.
So spirits are high and we have one last week with the team intact and then next weekend it starts to break up as some leave for the UK and a new team of 25 arrive from the UK and we start their training.
Thanks so much for the emails and so sorry that I have not been able to reply fully to you all. I will try and send one last email out in the next weeks but really looking forward to seeing you later in the year.
Big big love
R xxx

ps - and if you didn't hear it and still have a bit of time on your hands

Thursday, 1 January 2015

The Ebola Crisis

From: Rachel Duncombe-Anderson
Sent: Monday, December 22, 2014 9:13 AM
Subject: The ETC opens

Hi there gang,
Well after a week of a lot of action actually setting up an Ebola Training Centre (ETC) but with no actual patients we finally opened on Friday.  The hold up came about due to a variety of reasons but the main one was getting the wider team ready. 
National nurses  - nursing in Sierra Leone rarely involves washing or feeding as that remains the duty of the patient’s family.  There is of lot of passivity in terms of decision-making as I suspect that they are endlessly given tasks to perform rather than plan patient care.  This means that the nurses are definitely a mixed bag.  That said my team is enthusiastic and learning a lot – they are loving our mantra of DGE (Don’t Get Ebola) and feel passionately about wanting to help their country and their people. We have one Ebola survivor amongst us too which gives everyone some hope.
The WASH team (Water and Sanitation Hygiene) – if I’m honest these guys are the heroes – they do 80% of the work and are the people at the greatest risk during most shifts.  They meet the ambulance, spraying everything down as we receive the new patients, they are vital in our doffing process and I can promise you that when you have been in that PPE for over an hour and half you completely rely on them to talk you through getting that contaminated kit off you.  Finally, they do all the clearing up – the laundry, clearing up any fluids on the floor in the High Risk zone and also if any patient has passed away they are the ones who deal with it. They are in contact with the high viral loads at these times.
As you can imagine although we wanted to open on Wednesday there was no way we going to rush this if the Wash team weren’t ready and they weren’t but now up and running they are completely coming into their own.
I promised that I wouldn’t overdo it when I wrote but I want to tell you about a few patients we have. We now have 10 patients which in 3 days is a pretty good scale up in terms of our getting used the admission and the care process.
I am going to make up the names for confidentiality sake but we have Magda who is a 13 year old girl who has won all our hearts. She is tiny and physically doesn’t look older than about 9/10 years and we do have to resort to bribery when it comes to getting medications into her. I promised her a dance if she swallowed some tablets – it raised a faint smile but not the beam the team got for giving her some coke. Just getting some sugar into her is our goal as she refuses the Oral Rehydration Solution(ORS) but she is very weak and we aren’t hopeful. Her father denies that she has ebola despite his wife/her mother dying last week.
The second patient who has also won our hearts is Isaiah who is also young and has lost 6 members of his family in the last months. He sobbed on us today because he so wants to talk to someone in his family and he is alone in a 30 bed Probable ward.  The good news for him is that 1) his first test was negative today 2) we have managed to get some toys for him 3) and the psychosocial team are hunting for someone from his family so that he can be in touch with them. Once found they will give him a phone for him to talk to them and or arrange a visit from the family.  Psychosocial are amazing and work so hard to link the community with the patients.
Just as we were finishing our shift today a grandmother (38) arrived with her 23 day old twin grandchildren. Mum died 3 days ago and had been breastfeeding so although they currently have no symptoms we need to monitor them closely. They are absolutely gorgeous and of course in full PPE we can give them a lot of cuddling. There isn’t anyone who doesn’t want to have a bit of hug love.
Anyway all good here – this is a very cruel disease and I would ask you would think of Sierra Leone at this time. The cases in Freetown have quadrupled in the last week and there are still signs that we aren’t beating this thing.
Thanks again for your support. We still don’t have great internet so I’m sorry to those who have written little notes and who I would love to respond to but haven’t yet.
Big love and have a good few days in the run up to Christmas.
Ps the opening ceremony of the ETC was incredible. There was a Christian and then a Muslim prayer and then there was a song asking the Spirit of God to come down and beat Ebola. A few tears were shed.
PPS I just heard this morning that the twins died overnight - we had heard that they had tested positive but we didn't think it would be so quick. I guess they have gone Home. We're all pretty low
PPs - A radio 4 interview if you're interested -
  Prayer points
-       The six hour shifts are exhausting and we work six days in a row. Please continue to pray for energy and protection in our health
-       I found my first patient who had passed away today. The team ahead of me had just been with him alive but 20 minutes later he was gone. It completely shocked me and just need some prayers for strength as this is really one of the most cruel diseases I have ever seen.
-       That we might be able to engage in some way with the festive season – Jesus is here and many of my staff believe that or have a sense of the significance of the date but it is hard to feel that jolly and yet joy is possible.