CMF member Sam Dunnet is working as Staff Health Manager for Save the Children in Sierra Leone. Here are excerpts from her updates to the CMF International Facebook group.
November 10 – No touch policy
Arrived safely after an eventful but not unpleasant journey. Trying to get used to the ‘no touch’ policy – keeping a distance of 1.5m from everyone at all times – easier said than done! Everywhere you go – airport, office, hotel, supermarket, you have to wash your hands in chlorinated water and have your temperature taken with an infra-red, no-touch thermometer. The people in the office are friendly and there’s a good team but many are new and also finding their feet. There’s a high turnover.
November 13 – Building a plane while flying
Busy day visiting existing health facilities and finding out what is available for our staff in the event they get seriously ill. The take home message is ‘don’t get sick’! The private hospital only accepts outpatients – and only if they don’t have fever, vomiting, diarrhoea, severe headache or are seriously unwell (all potential Ebola symptoms). The UN clinic is only for UN staff. That leaves the only public hospital which is still open – and is also a holding unit for Ebola patients and therefore full of infection. Of course they are doing their best to separate Ebola and non-Ebola but in this context sometimes infection control is a nice theory on paper. I am working on setting up the GP clinic for the staff but there are limits to what we can do, especially with suspected Ebola. Our program has been described as “trying to build a plane while flying”. My job, it seems, is to provide parachutes for the builders…
November 14 – Schools shut
It’s strange driving around – there are no children going to school – they are just collecting water or playing at home. The schools have been shut for months now. Many people do not smile anymore. Thankfully we have a wonderful staff here though and they are working hard and smiling through, despite the challenges for their own families with the skyrocketing food prices and travel restrictions.
November 19 – Stigma and fear
I’m learning that stigma and fear are major drivers in this epidemic. I had a patient on the phone today (family of a staff member) with fever and enough other symptoms to make her an Ebola suspect. According to the protocol, I’m supposed to tell her to call 117 – the National Ebola hotline – who send a vehicle to collect her and take her to a holding centre for testing. My translator said ‘if you tell her that, she will just disappear, she won’t answer your calls, her husband will leave his work and disappear too’. This is because if a white ambulance with men in protective suits turns up at your house then your whole household will be stigmatised indefinitely, even if the test is negative. So what am I supposed to tell her? She might just have malaria… I cannot go to her house because she is an Ebola suspect and for the same reason I cannot bring her to our clinic. She cannot just go and have a malaria test because she might infect the health worker. I went to another lab today and found it was shut down. Too many lab techs have died. I am trying to purchase thermometers for all our local staff (550) but it seems the whole city has sold out! Plenty of challenges but we just do our best to keep going , keep cheerful and trust God.
November 21 – Soap and water
After wearing the Personal Protective Equipment for 2 hours today, I have renewed respect and admiration for the nurses, hygienists and burial teams who wear this kit day after day to serve their people here. It’s pretty sweaty but I coped better than I expected. Your face shield gets so foggy you can’t see anything and the sweat pouring down your face makes you long to wipe it. You have to wash your hands 12 times with soap and chlorine water during the decontamination process – tedious but crucially important.
November 27 – Diagnostic dilemmas
Just back from 3 busy, hot days at the Ebola Treatment Centre helping the GP there get the staff clinic set up so it is safe. Under normal circumstances you can do GP consultations under a tree or in a broom cupboard if necessary (!) but this is another story. First, the patient has to phone the GP and have a risk assessment done over the phone. If they don’t have symptoms suggesting Ebola (fever, headache, body pain, fatigue, sore throat), then they can come to the clinic and are screened by a nurse. Only after that can they see a doctor.
We have 300 local staff on site now and scaling up to 600 over the next month. Many are local subsistence farmers and have never seen a doctor in their life so they want to come just for the novelty and status of it and sometimes just invent symptoms! (Unfortunately, usually headache, fever and tiredness which seem to be universal…) You can imagine the diagnostic dilemma.
Malaria tests are now banned in primary care centres as it is too risky to do them, since the symptoms closely match Ebola and the test requires patient contact and blood. Even urine tests may constitute unnecessary risk so we are giving presumptive treatment a lot of the time. Plenty to work on.
November 30 – a message of hope
I went to an Anglican service in Freetown this morning. Church in the context of Ebola is a bit different: temperature check at the door; wash hands with 0.05% chlorine solution before entering; general nodding of heads rather than shaking hands; no Sunday school – children are discouraged from mixing. The clergy carefully and visibly washed their hands before distributing communion (no shared cup); extended and fervent prayer for the general situation and especially for health workers. In spite of the tragic stories that were shared of entire extended families being lost, the service was joyful and the message was of hope.