Third Installment with PIH

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

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.

Lynn's first days with PIH (Partners in Health)

December 1

Today I boarded a plane for Boston — the first leg of my journey to Sierra Leone.  This is a trip I have made several times a year for the past seven years.  But this time it is different.  Instead of traveling or leading a group as Executive Director and co-founder of Greatest Goal Ministries USA (GGM), I am traveling as part of a team of medical professionals with an organization called Partners in Health (PIH).  The founder of PIH, Paul Farmer, is the subject of the book “Mountains Beyond Mountains” by Tracy Kidder about his work with tuberculosis patients in Haiti.  He is also the chairman of the Department of Global Health and Social Medicine at Harvard Medical School.

As a new part-time employee of PIH I will have a one day orientation at their Boston headquarters before I head out. At this point in time I have limited information.  I do know that I will depart for Sierra Leone on Tuesday afternoon traveling to Newark, NJ then to Brussels, Belgium.  We will arrive on Wednesday December 3 about 7:00 pm in Sierra Leone.  I know that PIH had hoped to send 50 of us to Sierra Leone over a three week period.  I don't yet know where we will be working in Sierra Leone or how many will be on my team and traveling with me.

To prepare for this adventure I updated my vaccinations; yellow fever immunization is mandatory to enter the country and hepatitis, typhoid, Polio, MMR and DPT must be current.  This was all verified and a thorough physical examination form was completed by my primary care doctor and faxed to PIH.  Ten days later a physician from PIH reviewed my medications and health history.  He informed me that, provided there is no breach in protocol, I will be considered low risk upon my return.  This means I will have some movement restriction for 21 days.  I will not be able to go to restaurants, grocery stores or the health club.  I will also not be able to provide patient care at my nursing job until after my 21 day monitoring period is over.  I will need to take my temperature twice per day and I will be called for those temperature readings each day by a physician from PIH and one from our local public health department.

December 2

Orientation began at 8:30 a.m. in Boston at the Partners in Health offices.  Introductions started the program and we all soon discovered that we had traveled from all over the country.  There were about 14 of us in the room; six of us are headed to Sierra Leone and the other eight are going to Liberia.  My cohort consists of myself and another female nurse, two physicians and two male nurses.  We come from a variety of backgrounds, but we all have the same general reason for going to Sierra Leone — we know that someone needs to do this work, so why not us?  Aside from myself, no one in my group has ever been to West Africa.

The orientation consisted of an overview of the current situation in Liberia and Sierra Leone and a very general review of protocols.  Our safety was stressed again and again.  We were told that the maximum length of time in our protective suits is 45 minutes to 1 hour.  During that time we will lose an average of one and a half liters of water.  Therefore we must drink a liter of water before entering the suits and another liter after the work is completed.

December 3

Today we left Boston heading to Newark for our flight to Brussels. We were delayed by several hours which meant that we might not make out flight out of Brussels to Sierra Leone. However, the shuttle bus that was to take us from one terminal to another was in an accident and we were delayed again for another hour.  There were hundreds of us affected by that time, so most flights were held on the ground to allow us to board. We are now in the air headed to Sierra Leone.  Tomorrow (Thursday) we begin our Personal Protective Equipment (PPE) training at Connaught Hospital in Freetown.  This is called “cold” training and then after a couple days we begin our “hot” training as observers in an actual unit.  Once that is over we head out to our assigned Ebola center where we will be working for the next four weeks.

December 4

We arrived at the airport last night only to learn we would not be going to Freetown at all.  All our training will take place at our Ebola site.  We spent the night at the Lungi airport and this morning after breakfast will take our 45 minute drive to our new home.  We have been told to expect very rustic conditions.

Peace, hope, and love,

Lynn Pelton
Executive Director
Greatest Goal Ministries USA
Web: www.ggmusa.org

An update of Salone from the Journal of Syndey

From the journal of Sydney who has emailed us from Africa during her trip with Greatest Goal Ministries.

Thursday March 21, 2013  ……The survey……

We set out in teams of 4, 2 GGM folks, and 2 interpreters, to start our survey.  Fortunately, Kevin, the map guy, was in my group.  Good thing, because I could not look at the satellite map and have a clue where we were, much less where I was supposed to go.  But Kevin kept me on the right path, and literally, some of it was just a rocky path. We got quite a bit done.  It was really interesting talking to all the people and very distressing to see how so many have to live.  Using bushes for toilets, getting drinking water from streams, small children having to carry large, heavy bucket of water on their heads for long distances to bring water to their family, whether it came from the stream or from the GUMA pipe, (govt water supply).  People talked about the cholera epidemic that happened  here last fall.  They say they wash hands after toileting, but if your toilet is a bush, where do you wash?  Many of them, during the rainy season, put out buckets and bowls and collect rainwater.  No one we talked to today said they ever treated their water before drinking.  My interpreter, Augusta, said to me, “We are suffering.  We need help.”  To me, the big question is, how do we help?  The problems seem so overwhelming.  But that is a question for another day, I guess.

Friday, March 22, 2013    ……….Time in the clinic………

The end of a very long and hard week.  But also, a very good week.  We accomplished a lot, but it is such a drop in the bucket.  Because I have such a sunburn I did not want to be out all day doing the survey in the hot sun, so I stayed at the clinic.  My purpose was to do some observing of how things are going, what needs improvement, how to get better organized, etc.  I started off in the infusion room, because when I had been trying to save the dying lady, the supplies I needed to start an IV, weren’t all there.  Basic things, like gloves.  And because by that time it was a very urgent issue, people were scrambling to get me what I needed.  So, today, I searched around the clinic to figure out where things are.  We had been assured that everything was well organized, that even tho stuff was in boxes, the boxes were all labeled with the contents.  So I started my search for gloves, and after I had searched down keys to the different storerooms, I found 3 boxes labeled “gloves”.  The problem was, they did not contain gloves.  However, the four large boxes on a shelf I could not reach, and were not labeled, did contain gloves.  In fact, very little was labeled with what was actually in them.  TIA.  So Dean, the military guy, took over and actually got some stuff organized.

In the meantime, I was often taking care of medical stuff.  A 2 year old who had had 3-5 seizures on Wed.  She was the daughter of one of the men who has done some work around the hospital, so I was instructed by Lynn to be the one to see her.  Since she is not actively seizing at the moment, I did not want to give her anything, and we are not equipped to diagnose a seizure disorder.  So I sent her to Childrens.  I saw a tiny, tiny 3 week old whose parents brought him in because they said he was vomiting blood.  He checked out ok so we sent him home with instructions to go to the children’s hospital if it happened again. We had a pt with confirmed cholera.  I had to talk with her about where they get their water, where they go to toilet (poop), hand washing, gave her money to buy soap.  They use the GUMA water, so that should be ok, but they share a toilet with other neighbors.  That unfortunately could be a problem, and if they don’t use good hygiene there could be more cholera.  Not good.

The best part about being here always is the kids!  I love to see the precious babies in the clinic, even though my white face sometimes scares them.  I love how they come closer and closer and some want to touch my white (now fairly red!) skin, I am fascinated by how the moms can sling them onto their backs and with even the tiny ones that just seem to hold on, tie the babies into the sling on their backs.  When we are out and about, they are so fun to play with, and the kids walking back and forth to school like to slap your outstretched hands as they walk by.

Friday, March 22, 2013 ………..Dinner……..  

Dinner on the beach was its usual adventure.  We had two neighboring restaurants, and as always, I use that term lightly, competing for our business.  They were literally begging us, but we had to choose just one.  After we had placed our order, barracuda and chips for some, lobster and chips for the rest, a man approached and wanted us to look at his arm which he said had been hurt in an accident.  There was a grimy bandage covering his arm, so Lynn said we would look at it.  She had to walk back up to the house to get the first aid kit, then she and I took the dressing off, by flashlight, of course, and discovered a 4 inch wound that had been sutured closed.  It was a little swollen, and difficult to evaluate in the dark.  We debated taking the sutures out and draining the wound, but decided not to at this point.  I cleaned it up, covered it back up, and Lynn stared him on antibiotics and he is supposed to see me on Monday.  Of course we had a crowd around us by this point, and everybody now had something wrong that they wanted us to take care of.  Finally we just told them to see us at our hospital on Monday.  After doing all this, our dinners still hadn’t arrived, but it was very good when it did.  All in all, just another typical day in Africa! 

Come to our Thanksgiving Day 2012 Fun Run !!!

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 I would like to invite you and your family to join us for our third annual, Thanksgiving Day “Beat the Bird” 5K Fun Run/Walk at the Larson Lake Blueberry Farm benefiting the 501c3 that we founded in 2007, Greatest Goal Ministries USA  www.ggmusa.org
 

Can’t join us, please consider sponsoring the bird for $25.00 by heading to our web site and clicking on the donate button.  100% of the proceeds will be used at our NEW Lady Deborah Berewa Hospital in Sierra Leone.  

I just returned from 6 weeks in Sierra Leone and it was an incredible trip.  Jerry Staples, Sierra Leone in country Operations Manager and myself, had arranged a meeting with Her Excellency, H.E.  Sia Nyama Koroma , the First lady of the Republic of Sierra Leone.

We have been praying for expansion of our free primary care clinic and had decided to go straight to the top and see if there was a building with adjacent land that we could build a cancer center on as there is currently no cancer care anywhere in the country.  To our amazement I was told by the First Lady that I was the answer to her prayer.  

3 days later were given this building by the former Vice-President of Sierra Leone, Mr. Solomon Berewa.  The 24 bed hospital had been built in memory of his late wife in 2006.  It had never been opened.  

After 3 meetings with the First Lady and 4 meetings with the former Vice President we went to work preparing the building with painting, cleaning, and renovation to the ceiling, electrical and water.  On Friday, Nov. 2 all parties, the Minister of Health, the First Lady, the former Vice President and myself, Lynn Pelton-President and founder of GGM had signed off on a 20 year Memorandum of Understanding with 1.5 acres of land available for a future cancer center. 

 

More pictures and information will be posted soon.

Fall visit to Sierre Leone

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October 10th

Hi all,

I apologize for the blog not being up yet. Days are full, the Internet is slow—when we have it. Jerry's house is the new S.O.S. children's home for the kids in his compound and beyond, and EVERY night I am the teacher. We average 12-15 kids, ages 8-20, and I give math problems, teach English and play jacks, board games or read stories, often until after 10:00 pm. Then we are up by 7:00 or before. I must admit that I am guilty of having brought all those children to Jerry's house, and he has enjoyed allowing me to have my time with them. They have all given me pictures, and they hang on the walls of his house. And, here’s the best news—they are learning and engaging. I’m having a blast!!!

I’m using Sandra Moreano's math book to teach the older ones at Jerry's compound, but I’ve also started math classes at the clinic’s educational center for the staff and any amputees or older students. We had 15 people last week and will hold class this Thursday and Friday. We are starting with place value and it has been going VERY well. I only wish Sandra or Brooke were here to help teach. I’m sure they would love it.

Big updates:

Healthcare

We met with the First Lady of Sierra Leone on Monday. Five of us were there: Jerry, Milton, Phillip and David. I brought along a gift bag with smoked salmon, Aplets and Cotlets and a couple postcards. The president’s birthday is this week and she was having a party. She said she would serve what I had brought. I told her that after the election when she had won I would bring a larger salmon as a form of congratulations. We all had a good laugh. She was a nurse from England before becoming First Lady and is working with Israel on a dialysis building at Connaught Hospital.

  

Disability Sports Association:

Yesterday the SL Deaf Team played against Gambia at the National Stadium. This was organized by the SL Deaf Association. GGM donated $250. The rest came from a grant and the SL government. GGM was asked to take gate tickets, as we were considered the most honest and trustworthy. All the staff participated. Mr. Campbell, the secretary general for the Paralympic Committee, informed me that I would sit with the Gambian Ambassador in the presidential area of the stadium. Along with that, I would be doing the KICK-OFF.

I was escorted to the field, chairs were brought for us, and we were seated next to the ambassador. We shook hands with the referees and met all the players. It was really quite exciting. SL lost 3-1 but it was a great game. The polio and amputee teams played a great match during half-time and our staff said that they heard people talking about this fantastic event. There were many journalists present but nothing in the papers today.

  

We leave to Makeni on Saturday with Mr. Campbell and others from GGM to sign up polio and amputee teams. We are expecting to form at least three teams from each group. Next weekend we will be in Bo and Kenema. Thank you, Werner, and Mel and Annie for all your work. The energy among the disabled groups is palpable and there is a new outlook. There were important people at the National Stadium, and word has it we are really being looked at, which could be good or perhaps bring new challenges. In any case, the disabled are starting to work as one body, and it is fantastic.

  

Cruise Ship:

Fantastic, fantastic! Go to Zeghram Expeditions sent a cruise ship off the west coast of Africa . The link below will lead you to an article written about GGM and the DSA soccer league.

http://www.zegrahm.com/press/press-releases/trace-west-coast-africa-zegrahm-expeditions

 Bimbola, a local SL resident, arranges for cruise ship passengers to see chimpanzees along with a stop to the DSA  soccer match. He said that once again passengers find their trip to Sierre Leone a real hghlight. He actually asked for more information as he was going to start including it as a tour stop for other groups. Once again we are seeing huge connections and positive responses. This is great.

I just want to conclude by saying the integrity and honesty of GGM is beginning to spread. God is using the people we are meeting and others to begin a change of heart. At a meeting with the amputee team the Flying Stars, they stated that the compassion being shown to the disabled is how Jesus loved His people and they are excited and ready to do everything in their power to do the same. They said they know they need to heal in their minds and we talked about a time to begin talking as a group about the past. I have difficulty finding the words to explain what is happening, but with Jerry's continual love and support and unconditional time, and the example set by our staff, there is a movement taking place, and all of you reading this are now a part of it. 

After four days without running water and a week and a half with a broken kitchen faucet, intermittent electricity, and a broken refrigerator, Jerry has almost gotten everything fixed. Because of heavy rains we have running water now, and hopefully we will soon have a new pump. But I love it all and at the end of the day Jerry and I just smile and comment on how much we love the Sierra Leonean people. We are in our second home!!!

God Bless,

Lynn

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