Welcome to the Ebola Treatment Unit – Now wash your hands

I keep intending to write about our week at the Department of Defense training, and I will…. Eventually.

However, I don’t really feel like writing about it right now.  So I’m to talk about the ETU itself, and how we got there.

We were originally supposed to be at our own ETU on November 16th, however due to construction, and that fact that Liberian infrastructure rivals16th century Turkey- the process has been delayed and delayed…and delayed some more.

We finished our cold training at the DOD on Friday the 14th, and were under the impression that we would start our “Hot” training at bong the following monday. Hot training would last another five days, and each day we would progressively spend more time in the hot zone. First we would do a walk through, then the next day maybe hand out food, the next day draw blood. Each day we would progressively provide more and more care until we were comfortable.

When we got home from our last day of cold training, we were told that hot training was cancelled. They couldn’t find any spots for us at the time.

For how long? They wouldn’t tell us, but it was looking like a week.

Now a week to explore the capitals of most countries is normally seen as a chance to go see the sites, try out the food, and have a good time.

Monrovia, sadly lacks any of these amenities . There is really nothing to do, I don’t know if the city has a bowling alley or movie theater. Well, actually I don’t know if there are any of those in the whole country. But that’s okay. I was alright being at the guest house  for a little bit, and we would always take short walks down to the beach or around the neighborhood if it became too boring.

On Monday, our fearless leader came in and announced that there was a sudden need for medical staff. A doctor and two nurses at the Bong ETU, and a doctor and two nurses at the Kakata ETU that was scheduled to open. Three headed off on Monday, and myself, Lucile, and another doc were to head out the next day.

I won’t lie at this point, I was pretty nervous. I know the reasons why I came, I came to help these people, and to make a difference, yet suddenly my own self preservation started barking. Are you sure you want to do this? Are you sure you can do this?  Why are you doing this? The whole night the thoughts swirled through my heads, I tried to distract myself by adding some movies to my laptop, and talking to my family back home. But the thoughts followed me to a restless sleep.

The road to Bong was long and often in states of Ill repair . The road went from being well paved and traversed at 60 mph to pot hole ridden dirt, crossed at 10 MPH, what could have probably been a hour, maybe hour and a half drive turned into four hours. We also had to stop at a county line check point to wash our hands and have our temperature taken.

Which was kind of nice to see that containment measures are still in place.

When we got to the ETU we got out and took a photo with the sign.

(There’s me in the back)

The ETU is tucked about a mile and a half in the jungle, through a winding dirt road filled with dips, blind turns, and hills.  The jungle swallows you up as you go in, you’re in it  You can easily forget the outside world, there’s no evidence here. Just a winding dirt road that could have been made hundreds of years ago.

Soon we make a turn and head up a hill
Blue buildings, two layers of chain link fences.  When we got out, renee walked us to meet the docs and nurses there.

When you first get there you wash your hands in a 0.05% solution and dip your shoes into a 0.5% bleach bath. You do this again as you pass through another gate.

The ETU is set up with the confirmed and suspected wards being in the back,  with the doffing area in the middle, and the donning area nearest the suspected side. The ground is covered in large rock gravel,  pipes with 0.05% and 0.5% bleach sprout up around the perimeter.

A few dozen stakes stand next to the laundry room  they’re used as boot drying spikes. And every morning you’ll spend a good amount of time trying to find a pair of gum boots that fits (43 for me).

The jungle surrounds and envelopes the ETU

We introduced ourselves to the staff. The Bong ETU is ran by the International Medical Corps, an American based NGO. They were all friendly and glad we were there. They gave us a quick five minute tour of the area, and sent us on the way to the guest house so we could unpack for the week.

My room for the next two or three weeks.

IMC needed us in there to help, they got hit with a good amount of patients and a good portion of their staff had departed on holiday, or their contract had ran out. So we were skipping the customary few days of hot training and just jumping into it. Outa- the frying pan into the fire sort of situation. Personally I was fine with it, I was tired of power point presentations at this point, and another week learning how to wash my hands might push me to psychosis.

So on Wednesday we headed for our donning and doffing training. The gear we actually use is different than the what we trained with for the World Health Organzation. While the WHO says its okay to have exposed skin, IMC protocols don’t allow it. Which, while adding a bit of heat, definitely makes you feel safer.

They also promoted me to “RN” when they wrote my name the exercise -When I told them I was a nurse. That’s okay, I only had to come to Africa and fight Ebola for the promotion.

Here’s the order of operations for donning the gear.

Gum boots
Two pair of Gloves

Tyvex or (God awful) tychem suit

N95 Mask

Hood with mask ripped open in the middle to allow you some air passage.

Another pair of gloves taped to your arms.

Waterproof apron.

Goggles. The goggles were a challenge at start, fogging was a big issue with the WHO training, turns out that some dish soap on the inside gets rid of the issue completely,

For those wondering how you get out of all that? Well there’s a process for that as well.

Stand in 0.5% basin for 30 seconds to disinfect boots. Sometimes when there’s a person in front of me, I just stand in the basin for awhile, even if it’s been sitting in the African sun for four hours, it’s cooler than you. You can almost close your eyes and pretend your bathing in the purifying waters of Lake Minnetonka.

Step into Doffing area.

Hold up your hands and wave them like you just don’t care (You could be covered with Ebola, so care and don’t wave them)

The sprayer will spray a 0.5% chlorine solution from neck down, on your hands, apron, legs, and boots. Then you turn around and they get the other side.

Next you wash your hands in a 0.5% solution

Remove the tape from your gloves, and take off your outer layer of gloves.

Wash your hands.

Take off your water proof apron. This part can be a bitch, trying to find the tucked away hidden string that magically causes the apron to fall off you is hard, and on one occasion I just had to push the apron off me and step out of it.

Place the apron in barrel of 0.5% solution

Wash your hands

Bend slightly forward , grab your goggles from the front and pull them off your head. Dip your goggles THREE times (no more, no less) in a 0.5% solution, then toss them through a hole in the wall into a bucket of chlorinated water.

Wash your hands.

Now comes the hood, The hood has three ties in the back, and one at the bottom of the hood that wraps around in front of you. You can untie the strings, but wet gloved hands have terrible dexterity, I always end up just ripping them.  Once all the strings are ripped, you bend forward slightly and grab the back of the hood, pulling it forward and off your head. Then you throw it away.

Whats next?
What the do you think is next?
Wash your damned hands.

Now comes the suit. The suit has two pieces of tape on it, one that closes a flap over the zipper, the other over your collar. You “Pop your collar” by peeling the tap off, then pop the tape down the front of the zipper.

Wash your ha…NOPE! (Guys thought you were getting it by now right?)
Now the sprayer sprays the newly exposed area of suit. Which at times can suck, since they start at the top, some 0.5% chlorine can hit your neck and face. This can cause some pretty severe skin irritation and burns. Luckily Mr. Beard protects my face and neck from such a chlorinated attack.

Now you unzip, starting from the top, making sure not to touch the inside of your suit when you grab the zipper at the very top.  Unzip it all the way down to your nether relms and then you…

WASH YOUR HANDS YOU FILTHY SAVAGE.

Once that’s done you

Reach on the inside of your suit, making sure not to touch the outside, and pull it off your shoulders. Then you kinda shake shimmy the suit off you. Basically you do the Bernie out of your Ebola suit.

Pulling your hands through it, make sure you only touch clean to clean, or dirty to dirty.  Now, pull your suit down your legs, touching only the inside.  Yeah, down to your boots, but don’t actually touch the boots while you do it.

Now, stand up and pull your boots out of the suit, this part can be a little tricky to, first you step forward, then you step back, then you lift your leg up, try to step on it with the other foot. Every time I do it, I feel like an idiot, I’m trapped for a good minute trying to step out of the suit, until finally I manage to pop my boots free.

Kick/slide the suit forward a few feet. The sprayer then gives the Ebola suit another chlorine bath, drowning any remaining ebola’s hopes and dreams in tidal wave of chlorinated goodness.

Now wash your hands.

At this point your wearing two pairs of gloves and a mask, so the next step is to carefully take off the outer layer of gloves.

Now wash your hands again.

Lean forward and pinch the front of your n95 duck billed mask, pull it off your head and throw it away.

(Pictured is a n95 Duck billed mask)
quack quack
(Quack Quack)

Once that’s thrown away you wash your hands again.
Now you take a step towards the sprayer, and stand at attention. He/She sprays the the front side of your boot

you turn to the left, sprays that side of your boots, (Reverse Reverse!) You turn to the right side and that side is sprayed.
Then you turn away from them, where the back of the boots is sprayed, then you lift up one boot behind you and its sprayed, take a step back and the other sole of the boot is sprayed.

Now you’ve crossed over to the “Clean side” of the doffing area. You take off your last pair of gloves and throw them away.

Congrats you’ve ma…

YOU WASH YOUR HANDS AGAIN

This time with no gloves on, and a 0.05% solution. And normally a good 45-60 second process

(Minus the soap and water part for us)

Next you stand in a 0.5% solution for another 30 seconds as you exit the doffing area.

Right next to the station is some piping with pure water and 0.05% solution. I always cover my face/arms/neck with a good amount of 0.05% solution. Then rinse it off with pure water.

Congrats! You survived donning and doffing!

Now go enjoy a coke.


(Me right after I doffed, notice the moistness)

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