December 6
When an ambulance arrives at the ETU they back into our triage holding area, the doors are opened and if possible the patient gets out on their own. If they cannot, a makeshift stretcher made of a body bag attached to large tree branches with thick plastic ties is used to carry them out. Everything must be sprayed with a 0.5% chlorine solution. We wash all day in a 0.05% chlorine solution. Bleach at the 0.5% or higher can burn the skin and cause respiratory problems so it is vital to keep this watched. Unfortunately, though, there are problems every day with people being affected by this chlorine.
If the patient needs assistance, a team from the ETU ward must don their PPE and assist the patient. Every person wearing a PPE has a buddy in case one of them has any problems such as the mask riding up and covering the eyes or the face shield sliding down and covering the eyes …or becoming overwhelmed and almost passing out. Every one of these things has happened to one of our team members in just the past few days. It is much like scuba diving where you have a buddy watching your back and, if one of the two is having problems, then both must go to the surface. If one of the buddies has any difficulty in the ETU, both leave together with one trying to keep the other out of trouble. The buddy team also has a sprayer moving with them.
The most troubling to me is when a mother arrives with small children or when children arrive after their parents have died. Just in the past two days we had a mother and her 10 month-old twins admitted; the mother is quite sick. Another mother arrived with a 6 week-old baby and both are sick. Another mother arrived with her 8 year-old daughter – both sick, and a 7 year-old boy arrived whose parents have died. Also admitted were a 7 year-old girl with bleeding gums whose parents have died and a 4 year-old girl who had been staying with her grandfather while the mother was being treated at our ETU. The child was tested and observed in the suspect ward at the government hospital Ebola center. On November 26th the 4 year-old went home with two negative PCR tests. On December 5th the mother became a survivor only to return home and find her daughter very sick. She arrived this morning at our center. Either she was not far enough along to test positive or she was exposed in the ward. Because she was a survivor, we asked if the mother could remain in the ward to help her daughter. It was decided by the experts that there was not enough data to allow the mother total exposure again as she might fall victim to Ebola for a second time. I am afraid the 4 year-old may not make it through the night tonight. Another child that arrived today was a 3 month-old baby. Baby John Doe was brought in by a WHO surveillance ambulance. They had gone to a village to check on another baby and then discovered this sick baby where the parents had died. The baby was brought in with no name or other identifying information. The patients most likely to succumb to Ebola are the very young, anyone over the age of 60, a pregnant woman, those who are immune-compromised or have another co-morbidity. The surveillance team found a woman survivor to carry the baby and bring her to us. We now have four babies under 6 months old who will hardly be touched and must be monitored in a very difficult environment. Ebola is leaving an extremely high number of orphans.
If a patient comes to triage and does not have a fever or does not fit the other criteria, they are discharged. They receive a letter which advises them to return if their condition changes and that PIH will pay for their transportation home since the ambulance is now gone. When a patient arrives who is confirmed, the intake paperwork is completed. They will be treated with standard admission medication. Malarial medication, iron, vitamins, and paracetamol (same as acetaminophen). The remainder of the treatment course will occur on the ward. A confirmed case will go directly to a confirmed ward, either wet (if bleeding, vomiting or diarrhea), or a dry ward if none of those.
If the patient is a suspect case they will be treated as if they have Ebola until proven otherwise. Patients are separated into wet and dry wards and also separated from each other. A person must have fever for three days before the PCR (Ebola blood test) is drawn. If positive they will be moved to the confirmed ward. If negative the test will be repeated in another three days. If still negative they will be discharged and will continue to be observed for at home for the next 21 days. If positive they will be moved to the confirmed ward.
With four large whiteboards we nurses in triage coordinate the movement of patients according to the lab results. Everything rides on those tests. When a patient gets well we re-test the patient and if negative they will be discharged.
Discharge is a wonderful ceremony. The patient will take a shower and be given new clothes and shoes. All personal items are burned including clothes, shoes, cell phones or even any money. The patient passes through the exit gate and is taken to the front entrance to triage. The World Food Program provides a 50 pound bag of rice, 25 pounds of beans and cereals, salt, oil, a blanket, a plastic container and chlorine tablets to purify the water as well as a bucket and soap. They are also given money for transportation home. Before they leave we have them tie a ribbon on our “TREE of HOPE” and then I always say “Bye Bye Ebola!!” We assemble as many nurses and people as possible to celebrate this survivor and they are given a certificate. It is this ray of hope from our “Tree of Hope Survivors” that helps us keep working through all the tragedy during the rest of the day. Our PIH goal is to have only a 10% death rate, which is possible if we can treat patients early enough.
Next posting: What is being done about all the orphans and what are some of the other duties in the triage area?
Please continue to pray for all our health care workers that they may remain Ebola-free and pray for these West African people who are an absolute joy to work with and who do not deserve such a horrific humanitarian crisis.
God Bless,
Lynn
No comments:
Post a Comment