Tour through the empty ETU

Okay, so it’s been a couple weeks since the last update. Honestly there hasn’t been a ton going on. Were currently in “Standby” Mode. Which means the level of Ebola cases is so low, that we stopped triaging patients. We can open in an emergency, and our ambulance is still helping take potential cases to the nearest ETU in Ganta (About two hours north).

I did manage to get a video done and uploaded of how the suspect and confirmed wards of our ETU look. So, take a look.

Into the Hot Zone

The first time I stepped into the donning room I was pretty nervous. Alright, that’s a bit of a an understatement, my stomach was in my shoes, and each step of donning felt slower and slower.

We had some patients who were just getting admitted from triage, we were gonna draw blood and  check on some other patients.

Slowly, over the course of ten minutes, you put on your gear, it’s called Personal Protective Equipment, but we just call it PPE for short.

Each step is checked and double checked to make sure its on right. There’s always a couple nationals in there to help you tie your hood, defog your goggles, tie your apron and hood. It’s oddly reminiscent of Knights suiting up for battle.  You stand their and look at yourself in the mirror as layer and layer of protection is applied and checked by the nationals.

You cease being who you are as an individual and become an Ebola Storm Trooper. The uniform of mad men and women either brave or foolish enough to work here.  The nationals  write our names on our foreheads so we can tell each other apart.  They also write the time we went in on our arms. They do this so someone coming in can tell if you’ve been in to long and need to go out. It’s sometimes easy to lose track of how long you’ve been working.

This is also the only place in the whole of Liberia where you can shake hands and touch other. Once you go inside, you cant due to the  risk of putting Ebola on someone, the same outside, but for those few minutes you can shake hands, hug, whatever you want. You’re pretty well protected in your full body condom.

Your senses are dulled as the suit goes on. You are suddenly aware of how heavy your feet are, where the straps touch your head – the placement of the mask on your nose – if the mask is high too high, if its too low.

You have to fix all these things before you cross over. If your mask slips, if something is wrong and uncomfortable – you can’t adjust it. You can not ever ever touch your face once you cross that line. I made the mistake of having my mask to low one day, and couldn’t breath through my nose for over an hour. You only do that once.

Finally, as the sweat starts to come out, and you feel like an Asthmatic astronaut you cross the red line into the Hot Zone.

I took a deep breath before crossing that line. Here it was, the whole reason I had came to Liberia, and volunteered for this mission. All the worries and doubts and questions rose up and I anxiety coursed through my body. Man didn’t go to the moon to sit in the Lunar Module and wait did? Not after the journey he took, no he took those steps and did his job.

Standing in my own space suit, I crossed that line. All the self doubt and worry disappeared.

It was replaced with a very itchy nose.

The first day I was working with two other Nurses, a nurse practitioner who is our charge nurse, and another nurse who came up with me.

We only went into Suspect that first day. The building itself is Spartan, constantly wet concrete floors – your boots splash in small pools that gather throughout the building. The building is separated into individual patient rooms. On the confirmed side you can have three or four to a room, in Suspect you don’t want someone who might have Ebola to be in the same room with someone who might not.

The walls are are blue tarp, and the wooden framing is exposed, there are nails jutting out from the walls near the beds (for IV’s to hang from)

The patients each have a plastic mattress, and paper sheets as well an outlet for a cell phone to be charged. There’s  a bucket to urinate/vomit/defaecate into. If they feel healthy enough there are tables and chairs outside for them to gather at. The insects that can fly buzz around above, any unfortunate to be caught in a chlorine sprayers path lay dead on the floor.

There’s a light bulb in every room that’s always on. They have no pillows,  the bed rails can not be lowered  or the beds adjusted.  I imagine the smell of chlorine is nearly palpable.
We had a patient in Suspect that we would later admit, the Nurse practitioner went for a blood draw and missed, then she asked if the two of us would want to give it a try.

I nodded and said sure. He wasn’t a hard stick, but drawing blood from someone with Ebola was particularly nerve racking. One slip, one second of distraction and I could infect myself.  I had drawn blood on maybe a thousand people in the past, but none of them ever had Ebola.  I took a second to settle myself and got the stick.

Remember I said you can’t touch your face? For the first ten minutes I’m in the ward I have an incredible urge to scratch my face or adjust my mask or something. You just have to ignore it and focus on a task,  it does go away after awhile. However, the intense awareness of anything and everything on or around your face doesn’t. Even after your out of PPE, you’re hyper aware of anything touching you or near your face.

The amount of care we can offer is pretty limited. It is in my mind at least comparable to a battalion aid station in the army:

We Give IV’s (A lot of them)
We draw blood
We give IV Meds (Cipro, Flagyl, Ceftriaxone)
IV Pushs (Metrocploromide, Haldol, Valium)
PO Meds
Cleaning patients
Changing beds

That’s really… about it. They’re were two occasions where Foley’s catheters were put in, but they’re really quite rare.  The actual scope of nursing care is pretty limited.

It’s the conditions that make everything a challenge. The suit narrows your field of vision, your hearing is dulled slightly from the hood.  You can’t listen to a stethoscope . We can’t use a BP for a blood pressure. Even palpating for puncture sites is difficult with three pairs of gloves on.

Supplies are an issue as well, if you don’t have supplies in the suspected ward, you just can’t walk out to the supply room and grab them. You yell over a fence until hopefully someone pays attention to you, you stand and wait for five minutes while they go get it, They then throw it over two layers of waist high fencing to get to you. Hopefully they have a good arm, or you wait all over again.

The heat is another factor inside those suits.  During the afternoon shifts it can hit 93*, and with humidity it feels around 110. Walking around in that normally wouldn’t be fun, throw on tyvex or god forbid tychem suit and suddenly you’re facing 100% humidity.  Every activity you do is slower, every step you take has to be for a reason.

Rolling a patient to clean them? Subtract some time you can be in there.
IV? More time
Even handing out PO meds gets you after awhile.  I force myself to walk slow and plodding along like Darth Vader to conserve energy.

If you can be in there for ten minutes or three hours there’s never any judgement for “tapping out” and leaving early. Utmost care and attention is given to your own safety. What would happen if you pass out in the confirmed ward? How exactly do they get you out?  Luckily the situation has never happened, but the risk is always there.

Weekend in Liberia

Planes are magical dream machines for me. Unless I’m on an international flight where sleeping would be the best thing to keep my time on track – I crash out. I zonk out. I’m done. I’m over consciousness.

I’m awoken by a thud and a bounce as the plane touched down in Monrovia. Landing you can’t really see much of anything, just green in the distance and a few houses.As we are slowly taxied to the air way I look right and to my surprise I see a bunch of Army tents, familiar tents.

i know those tents, that’s a combat support hospital. I use to help set up those tents.  And to it’s left I see two of these bad boys sitting on the ground. V-22 Ospreys. Two of America’s most expensive toys sitting on a runway that probably hasn’t been fixed since the 80s.

We get off the plane and head towards the terminal. For whatever reason, I’m first off the bus in our group and first to get our passports stamped.

There to greet us is our contact, Renee, and seeing me he extends his hand to shake mine. I respond instinctively. I mean, that’s just what you do when someone puts your hand out to shake it. It’s muscle memory. Except for when you’re here…It’s not.
“You fail. get back on the plane he joked.” and let out a hearty laugh. Soon we’ve grabbed our bags and are loaded onto two separate vehicles for the hour drive back to Monrovia.  As we leave the airport, there sits two burned out husks of planes with grass nearly overgrowing them.

30 feet next to it a sign reads:


They say that night vision goggles come in green because it’s the most shades of a color the human eye can discern, and driving through Liberia, I can start to believe that. The countryside is lush and rich with vegetation. There’s no smog in the sky.  Your eye can shift from grass, to high bush, to tree and witness half a dozen shades of green as you do so.

As we continued down the road, Liberian houses started appearing on the side. These aren’t houses in the American sense of the word, or houses in the Detroit sense of the word. Most of these are concrete block houses with sheet metal roofs and open air windows. There’s no pavement or side walks, just a reddish brown dirt that circles and coats everything.  Women with narrow brooms sweep dirt from piles of dirt to other piles of dirt, taking small bits of rubbish and waste with them. You can tell the houses that sweep the dirt from the dirt, and the houses that don’t.

These weren’t the tall buildings of Senegal, and it’s monuments to Africa. This was the Liberian monument to Africa, infrastructure reduced to it’s bare minimum after 20 years of civil war and fighting.

(For those who don’t know, Liberia was founded by American’s freed and escaped slaves that booked passage back to Africa and established a nation state. Well these American decedents where known as Amerio-Liberians and ruled at the expense of the natives from the foundation of the state in 1832 to 1980. In 1980 this man –

Samuel Doe –

took power in a violent coup. He ruled for 10 years before another dictator –

Charles Taylor – took over (That’s him with some child soldier guards)

He ruled until he was finally kicked out in the early 2000’s.

Neither of these rulers were particularly good. If you’ve ever watched Nicolas Cages film on arms dealing “Lord of War.” You’ll remember the scene with the crazy African warlord, the diamonds, and the golden AK-47s. These were all heavily based off Charles Taylor and his son.

Education, roads, and research were not highly important to either dictator, and the giant explosions that took down many of the buildings have yet to be fixed.)

You see buildings abandoned in every state of construction, from the first steps of construction to visibly damaged from conflict.  Driving to our house was an interesting experience. Liberian drivers use their turn signals to signal that it is okay to pass on one side or the other. Lines on the road are more recommendations then anything, and our driver was on more than one occasion only inches away from vehicles on either side.

The countryside slowly changed from green to more urban and we were in the city.

Two turns and we were pulling into our “Guest house”. Large concrete walls surrounded the place with barbed wire and shards of glass resting on top. It’s quite inviting.

I was pretty surprised when I walked in. The house is very modern with air conditioning, four bedrooms, and three bathrooms.  Davis and I would split a room and a bathroom in the back (Where I currently am sitting right now).

A few minutes after we came in, we were presented with food.

But wait, There’s more.

It’s astoundingly good. The fish and the rice have the right amount of spices in them that just make you come back for more every time. The fruit and salad are of the freshest variety, each bite just bursts with flavor. The bananas you see there, well normally I wouldn’t eat a green Banana, but these aren’t the typical American Banana, They’re of a separate species.

You remember those little terrible banana hard candies that you could get out of a machine for a quarter?  I do, and I remember them tasting nothing like a banana. These banana’s are what they taste like.

The females in our group have been staying at a hotel, so the house is just for the men, it also serves as our base of operations for the next week while we go through cold training.  Honestly we all feel spoiled again in this house, we have AC, we have food, yet we all expected tents. We were quickly assured that it is only temporary, and that we might be living in tents, or a hospital wing, and to enjoy it while it lasts.

We ran into a few issues. Our water situation quickly became a problem, the system was new and a massive leak formed in some of the out door pipes. We managed to get it working temporarily by syncing it together with some clothesline.

After a good nights sleep in a real bed, we decided we would go check out the beach. It was only around a mile away and we could see a bit of Liberia in the process. We took a dirt road that ran outside the side of the house.

It traveled down through a neighborhood. Walking through Liberia, you’re struck by two things:

  1. How incredibly nice everyone is- Good mornings and how are you doing’s
  2. The abject poverty that is apparent everywhere. In some of the more rural areas of the United States you can still find a few decent houses sprinkled amongst the poor ones. Not so much here – open air houses, with patched roofs, foundation and walls made of cinder blocks all held together by necessity. These people are poor.

That doesn’t mean that they want to live like that forever. On every street corner you’ll see little shops, or corner stands selling candy or gasoline in jars. The people here sell scratch off tickets, have a charging station for power, and even a PlayStation 2 you can play.

The Beach itself was gorgeous, looking out unto the water you can forget that you’re in Liberia. It’s the Ocean, uncaring and unforgiving. You could make out a fishing boat in the distance, and the waves crashed against the shore.

(Another history note – When Samuel Doe took power in 1980, he captured many government workers and executed them on the beach I’m standing here on)

(The pathway to the beach was fraught with danger and difficult crossings)

On the way back we stopped by a shop for a moment. When we walked in the owner directed us to turn around and wash our hands in the chlorine solution that stood in front of the store:

There was also a poster about the dangers of Ebola virus that hung next to the entryway:

The next day was relatively un eventful, we sat around, looked at slow internet.. The whole time speculating about what type of training would begin on Monday.

On Sunday I tagged along on a ride through the city.

Around a mile from our houses position, an Ebola clinic was set up around the burned out husk of Doe’s department of Defense building. A nice gut check to a Sunday morning drive. Sealed gates, high barbed walls. I can see why people would be afraid of a place like that.

You can still see the after affects of 13 years of devastating civil war. This use to be a world class five star hotel before it was destroyed during the siege of Monrovia.

One of the many efforts by the Liberian government to combat ebola is through a massive public outreach campaign, from the small posters above to giant murals hand painted on walls.

We stopped to talk to the artist and to see why he was out there.

His name was Duke Appleton and he is an artist hired by the Liberian EPA to paint these. There are around six artists that do all the murals in Monrovia.

Here’s some of his sketches that he goes off of. This one is towards the end, when the man is cured from Ebola.

He really believes in what he is doing – all of the artists there do. They have to educate the public, and help fight misconceptions about the disease in order to finally beat it, and murals like his are one way to do it.

But not the only way, through out the city there are large and small posters about the dangers of Ebola.

Part of my worry, and some of my other aid workers here, is that the population thinks that the threat of Ebola is over. That they think that it came, it went, and it disappeared. When people thought the same thing in Guinea and Sierra Leon it came back. Not only did it come back, but came back with a tenacity that no one predicted  I’m afraid that since the wet season is ending, people will leave the city and head back into the country, potentially spreading it to others.

For what it’s worth, a study followed two Ebola cases that effected lowland guerrillas, both outbreaks happened during the dry season, as the guerrillas were forced deeper into the forest for fruit. They would come into contact with fruit that had been partially eaten by infected bats. Could the same thing happen to humans? People heading deeper into the forest in search of food and bush meat?

As of now, people are out and about in busy markets:

Riding motorcycles together:
 And playing football:

It is nice to see the capital come back to life after a devastating outbreak ran rampant through it’s streets. With new cases still cropping up in the capital and around the countryside, and the surge of cases in neighboring Sierra Leon, you have to wonder if it’s too soon.