In and out.

I have been in the Bong ETU twice now.  We did a night shift last night and then got up and did a morning shift.   Yesterday was a group tour by Audrey, the nurse who has been teaching our training.  I can't say enough good things about her- good teacher, fun, VERY knowledgeable.  She's been here since the beginning of this ETU and plans to stay to the end.  I haven taken any pictures of this RTU because there is no secure place for us to put belongings, but if you want to see what it is like visually Google the Ebola Sixty Minutes segment from a few weeks ago.  It is the same unit.  The tour began with the grave yard.  This ETU is lucky to have land.  Burial is extremely important to the Liberians and the ETUs in Monrovia just don't have any, thus they have been cremating bodies.  This doesn't sit well with the Liberians strongly enough that folks have refused to go to the ETU for fear of no burial.  The Bong ETU has never had that problem.  There are somewhere around 130 graves to date down a long path cut into the jungle from the ETU.  The unit is not a quiet place but the graveyard is serene.  There is much care taken to keep the area spiritual, peaceful and honorable.  Families are invited to come to the burials so even though the bathing and preparing of the body is not possible due to its incredible viral load and, therefore, infectivity, the families can see the graves and, if they can get there in 24 hours, watch their loved one be buried.  

The ETU is a crazy place there was a lot of noise even at night.  There was a massive TV screen playing an angry, violent movie at a decibel level that made it hard to hear people talk.  It was an odd thing to have in an atmosphere of illness and hopefully healing.  The suspect ward has individual rooms in which the lights stay on all night.  No switches were installed.  There is no such thing as sterile, only relatively clean.  The units are made of rough 3x3 timbers covered with huge blue tarps.  The water system is rudimentary in some ways but there are dozens of spigots all supplying water pumped from the ground to huge water tanks on a high platform.  There are red ones for 0.5% chlorine (for equipment cleaning), green for 0.05% chlorine (for hand washing), and white which is pure water (for rinsing).  Everything is sprayed with chlorine constantly.  Every time you move in or out of a building or area you wash your hands in chlorine and dip (or step if you have boots on) your footwear into a big basin of chlorinated water.  And there is NO touching anyone.  Except if you have PPE on in the confirmed ward.  There you can touch, hug, shake hands as long as you are protected.  In the suspect ward the patients are separated.  In the confirmed ward they can socialize and visit.  Families stay together in one room.  

Today we participated more. We were led initially by Kelly, another totally kick ass nurse.  She was the nurse I reviewed in the 60 Minutes Segment.  After general instruction I went on rounds with a doctor and a Liberian PA.  It is imperative to have a national with you to ease communication. Liberian English has little use for vowels and so is fast and percussive sounding.  It is very hard to understand.  We rounded on the ten patients in the confirmed ward (there were no suspected cases when we went in).  It was confidence building to see the medical people in practice.  I can do this.  Today I am finally sure I will be able to do this medically!  Yeah!  Most of the patients are getting better.  There was one who looked worse to me.  She is still bedridden with some diarrhea.  She also has some Nairobi fly "bites" on her back.  Apparently the Nairobi fly is harmless until you squish it and release the toxins.  If that happens the toxins burn the skin and ulcers can result.  This poor woman must have gotten a fly in her sheets and rolled over on it.  

At the end of our time there two women came in by ambulance.  The ambulance is a pick up truck with a vented compartment in the back.  It never goes out after dark and never takes a trip long enough that it won't be back before dark.  The roads are just too treacherous.  These women were from Taylor Town, a community in which the epidemic was triggered by one man who got sick in Monrovia but was scared of the ETU there because of the cremation.  He came home to Taylor Town to recover and eventually die.  Since then this ETU has seen upwards of 40 cases from that community.  These particular two were the wives of two men who recovered and returned home.  We know that men stay infectious through the semen for 3 months after recovery.  Not saying that's how these women got infected if they turn out to be positive, but sex as a means of women's infection is growing in Liberia.

I enjoyed these shifts.  I will enjoy this work.  I had to leave the high risk area first before my colleagues today because the yellow plastic suit I had to wear was so much hotter than their white tyvek ones.  I made it out before having trouble, but not by much.  I have to say that everyone we have met in this work in training and at the ETU from the national sprayers and WASH guys to the nurses and doctors to the Country director for the NGO running the ETU have been fabulous- welcoming , kind, generous, patient.  There is a real feeling of team.  We are all here to try to beat this thing.  Sorry for the run-on, picture less diatribe, but I guess I had a lot to say.  Two more shifts and we go back to Monrovia.