Second Installment with PIH

December 5

We just spent our second day at the PIH Ebola Treatment Unit (ETU) and the government hospital Ebola treatment center.  My cohort is still in training.  There are about eleven expats that were here when my cohort of nine arrived.  PIH will be sending more teams every week.  The PIH ETU is free standing and the organization has complete control.  (A 'unit' is a structure exclusively seeing Ebola cases.  A 'center' is a series of units that have been constructed at a healthcare center or hospital.)  PIH has just started work at the government hospital's Ebola center and currently there is only one nurse and one infectious disease physician, both Americans, in addition to the national staff.  PIH's presence will increase, but for now they are trying to learn what is being done and then integrate within.  For that reason I am going to talk primarily about the Ebola unit.

Yesterday we observed the donning (put on) and doffing (taking off) of our PPE.  Today we actually put it on and removed it.  I received an accidental superficial cut on my inner forearm.  Until it heals I cannot enter the "hot zone".  After practicing, the rest of my cohort had a tour of the "hot zone" in their gear. I assisted in triage where I hope to be placed after training. The unit is set up with a triage area where an ambulance or vehicle can back in.  This area is constructed of thin tree logs nailed together and covered with a tarp.  It is about 3.5 - 4 feet high.  The triage nurses then assess the situation in their PPE, taking a temperature and asking questions about exposure.  Often it is a judgement call.  If admitted they will go to the suspect ward and a lab test called a PCR will be drawn.  It will take 2-4 days for the results to come in.  During that time the patients are separated and will wait in one of seven wards.  The attempt is made to keep them designated as 'wet' (known vomiting or diarrhea) or 'dry' (no vomiting or diarrhea).  Sometimes children are brought in alone, sometimes it may be obvious what should be done other times it is a judgement call because the protocol is not an exact science.

Here is an example that happened today:  A woman arrived by ambulance with a four month old baby.  The baby was not sick but the nursing mother did fit the criteria for admission.  What do you do?  If the mother tests positive and the baby remains with her, the baby will probably become sick and may die.  But where does the baby go?  The triage area is not sheltered from the sun and until a decision was made the mother had to lie on the ground with her baby and wait.  All patients are treated for fever with acetaminophen and preventative malaria medicine.  We attempted to call UNICEF about the baby, but we could only leave a message.  After three hours the decision was made to admit mother and baby.  There was no other choice.  But just as the name band was being placed on the baby, a representative from UNICEF arrived. With the mother's permission the child was taken by a caregiver. 

The stories are tragic but people are surviving.  Today we had five patients to discharge and tomorrow an additional five will be ready to go home.  Stay tuned to read more about what happens after someone is admitted as a suspect and then found positive for Ebola.  I'll describe what is it like to wear PPE and the celebration that happens for all survivors.  I'll also share stories about patients and what it is like to be working at the ETU.

Please keep the workers and people of Sierra Leone in your thoughts and prayers. The motto at our center is "Pee Ebola out of Sierra Leone," meaning that with basic nursing care and hydration people are surviving.  But there must be people willing to provide care and still be safe.