tag:blogger.com,1999:blog-32544866701518224032024-03-14T06:46:59.891-07:00Claire's blog on medicine, global health and lifeI have set up this blog to let friends and family back home know of my experience volunteering in Sierra Leone as part of the Ebola relief. I don't know how easy I will find it to regularly update it but it's always best to start with good intentions.Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-3254486670151822403.post-3744810447643867902015-05-01T01:25:00.000-07:002015-05-06T23:56:42.955-07:00The London Marathon - a great little finish to my time with King's Sierra Leone Partnership<div class="MsoNormal">
My legs have just about recovered but I’m still on a
complete high from running the London Marathon on the weekend. I was fully
prepared with all these little psychological tips to get me through the pain
and to spur me on when I ‘hit the wall’ but I didn’t need them. In between
spotting my amazing entourage of friends and family around the course, thoughts
of King’s Sierra Leone Partnership, Idrissa and my two team mates – Amelia and
Brendan (who ran all the way in his PPE, what a legend!) up ahead, certainly
kept the “fire burning”. I feel like my cheek muscles had just as much exercise
as my legs from all the smiling! Various people had said that the crowds would
be a huge help and that couldn’t have been more true. I felt tears prickling my
eyes as I crossed Tower Bridge simply knowing that all these thousands of
spectators were supporting individuals like me with similarly personal and important
causes, just like mine. So a massive thank you to everyone who came to cheer
and an even bigger thank you to everyone who kindly and generously donated to
King’s.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8ZCh9uRhA96GydKrYugYA1A8Lhan1Rw-9_JcMtrDY91vXtObhr5otEjseKT3UaaaVYORXW2oKHJ_cTJ0hV7wXkzSVWGY-nSZdZ2bmkrdO1W3GyF3jELuT-dWKGsUifFUNfLFDkbTR3w/s1600/DSC01558a.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8ZCh9uRhA96GydKrYugYA1A8Lhan1Rw-9_JcMtrDY91vXtObhr5otEjseKT3UaaaVYORXW2oKHJ_cTJ0hV7wXkzSVWGY-nSZdZ2bmkrdO1W3GyF3jELuT-dWKGsUifFUNfLFDkbTR3w/s1600/DSC01558a.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">At 10km when I took off the PPE. Brendan wore it ALL the way. Legend!</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZWJPpYojpzeoQf8Q2LZKsqhQOhlTUlYnJrqfMDbJzM37ec9bUrTCfAjBVNVIMPGFqQpXudqUx0G5cnjnYEV0uYNZNOAJU4DWPDo3-w_dlh5XgCnVXckVvogsgGxIaanK66vI0tywTFbM/s1600/S0087214.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZWJPpYojpzeoQf8Q2LZKsqhQOhlTUlYnJrqfMDbJzM37ec9bUrTCfAjBVNVIMPGFqQpXudqUx0G5cnjnYEV0uYNZNOAJU4DWPDo3-w_dlh5XgCnVXckVvogsgGxIaanK66vI0tywTFbM/s1600/S0087214.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">All smiles... Brendan, Amelia and I, together we have raised £17,279.38 (incl. Gift Aid) for KSLP. </td></tr>
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Sadly my time with
King’s has come to an end, for now at least. I’d love to be able to move on
knowing that we are safely post-Ebola but unfortunately that elusive status
still seems quite a distance away. It’s amazing how out-of-the-loop I feel not
living, breathing and working every moment in the office where at least someone
is talking about Ebola every day. There were 6 positive cases of Ebola in
Freetown last week, ending 22<sup>nd</sup> April. Despite the huge increase in
numbers of epidemiologists tracing every contact of a positive case, still more
than half the new cases in the week ending 15<sup>th</sup> April came from
unknown transmission routes. The ongoing vigilance of all the healthcare
workers and the country as a whole is so important, but has got to be fairly tiresome.
Yet there are little signs of hope, as my neighbour from Freetown sent me a
picture of her son in his school uniform on whatsapp, proudly going to school
for the first time in 9 months. Her words ‘really sister, I am so happy for
that’ emphasise the impact this deadly virus has had on all aspects of daily
life. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMs2OZuPjSuTyKMvKIpVZZ6cb763_0rCWLMiTVA28BDSTGXLZ95SQ0T1LlI1yOQ_icWult69mZg1e5iMHmFmdUNUyr_93doEq8b-XSbAKDW0UirpvP7DfXSY5nMJ9RZx6nfMKYQv29N34/s1600/IMGP3403.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMs2OZuPjSuTyKMvKIpVZZ6cb763_0rCWLMiTVA28BDSTGXLZ95SQ0T1LlI1yOQ_icWult69mZg1e5iMHmFmdUNUyr_93doEq8b-XSbAKDW0UirpvP7DfXSY5nMJ9RZx6nfMKYQv29N34/s1600/IMGP3403.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Leaving Party for Paddy, Aatish & myself in my house <br />
in Freetown with all the Isolation Staff from Connaught</td></tr>
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I can’t thank the other
volunteers in Freetown and the London office enough for all the support,
friendship, career advice, cooking tips, media training… what an amazing few
months! I have had a brief insight into knowing how intense it can be working
in an environment where you can see how much there is to do but can only make
progress one step at a time. I have the utmost respect for the volunteers and
staff who have the dedication to stay and help, especially now so many health
system strengthening projects are up and running (A&E, Mental Health &
Infectious Diseases, not to mention the IPC programme!). If you know anyone who would like to join the team, King’s are currently recruiting for a number of
positions including <a href="http://kslp.org.uk/get-involved/employment/">Country Director and Senior Nurse</a>. I also feel completely humbled by the dedication of the local staff who work
tirelessly day in, day out without the easy option of leaving when they feel
like they’ve had enough. Their commitment to working in the unit, not getting
despondent and seeing the end of Ebola is inspiring. All in all, I’ve met some incredible
people that I hope to stay in touch with and visit again in the not too distant
future. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdSOrkoHbSyva_Uf8_HU3Daq3mvD5fUhL_p8g_Vzfqjv3DkxhLLQzoAXoNo5XbhDCA1vkuP9ijlHUSi2jQiJzO97bU_PdDoJOpfMYFGYEiN6yH8z0bNVpKZTsGt3e-tuhd9wq_C4rSOIY/s1600/IMGP3407.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdSOrkoHbSyva_Uf8_HU3Daq3mvD5fUhL_p8g_Vzfqjv3DkxhLLQzoAXoNo5XbhDCA1vkuP9ijlHUSi2jQiJzO97bU_PdDoJOpfMYFGYEiN6yH8z0bNVpKZTsGt3e-tuhd9wq_C4rSOIY/s1600/IMGP3407.JPG" width="211" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Idrissa and I at my leaving party</td></tr>
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Finally, the last
word of my blog for now, is saved for Idrissa, whose words of ‘you are strong,
Claire’ followed me round the roads of London on Sunday. Amelia, who also
trained with him last summer, and I rang him from the post-race reception and
he simply squealed down the phone with excitement. This was how he must have
felt after completing the London Marathon himself last year. Thankfully, he
does have something to train towards now. Tom Boyles, the South African doctor
that trained me in using PPE when I first arrived in Freetown, has set up an
initiative to raise funds for Idrissa to train in Kenya in preparation for
running the Cape Town Marathon in September. Hurray! I will circulate the link
to the fundraising website when it is launched shortly. </div>
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Thank you to you
all for reading my blog. I have had some very kind words of appreciation over
the last few months. I’m not going to lie, I have not found it easy to keep it
up to date but I have appreciated the opportunity to reflect and share some of
my experiences. I don’t know yet whether I will continue to blog from England
or not yet, maybe it will be the next time I am overseas… we shall see :) </div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-42155658857767280082015-04-17T09:14:00.001-07:002015-04-21T02:46:29.851-07:00So what is IPC?<div class="MsoNormal">
I don’t think I have ever written, spoken or thought about
three little letters as much as I have in the last few months: IPC… Infection
Prevention & Control. Since mid-December I have been helping establish and
initiate implementation of Sierra Leone’s first ever National IPC Programme. </div>
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I think one of the most important positive outcomes of the Ebola
epidemic has been the general introduction of the backbone of IPC, hand
washing, into multiple aspects of people’s lives. In Freetown, as you enter hospitals,
shops, restaurants etc, you are often asked to wash your hands using the
buckets of chlorine or sometimes ‘Detol’. The other day, I watched a family
enter a café, and the dad endearingly held up his small children one at a time
to wash their hands using the chlorine bucket before entering. This has got
to be one positive consequence of Ebola. </div>
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In the hospital setting, the changes to daily work have been
more visible and intrusive. There is now a generally unspoken understanding amongst
all healthcare workers that you should not touch a patient unless you are
wearing gloves. All patients who have screened ‘negative’ i.e. they don’t have
symptoms that meet the Ebola case definition, are met in A&E by an anonymous
muffled voice behind a barrier of PPE – a facemask, gown, double gloves, and
apron. This is the national recommendation within the recently approved
Standard Operating Procedures for ‘Basic Healthcare in the context of Ebola’.
It is just in case Ebola patients slip through the net of the screening process.
With the number of healthcare workers who have been infected and lost their
lives in the epidemic in the hundreds, just in Sierra Leone, it is completely
understandable that they must protect themselves as much as possible. But
what impact has this had on the human touch of healthcare? I certainly know
that it will initially feel bizarre, almost wrong, to touch a patient without
gloves on when I come back to working in the NHS.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOB_Smcf3G92_fJD-ZEvLIacReMY0h6jIBWJBdf3nZUQN_eU8g5wf7VSvSYy10J5Ea4HVl29A6wJ1xFE6Mv1YwibHuUkzyzy8jSvp6MgmdvJFt9Ni0Kw_jRdVBoi2onGs7xWfuj5SO8Q/s1600/Training.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOB_Smcf3G92_fJD-ZEvLIacReMY0h6jIBWJBdf3nZUQN_eU8g5wf7VSvSYy10J5Ea4HVl29A6wJ1xFE6Mv1YwibHuUkzyzy8jSvp6MgmdvJFt9Ni0Kw_jRdVBoi2onGs7xWfuj5SO8Q/s1600/Training.jpg" height="240" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small; text-align: start;">Interactive training sessions – IPC Focal Persons from each government hospital attended a 2 week training course in Freetown in March</span></td></tr>
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So I feel like I should explain a bit more about the IPC
programme I have been working on so much causing me to neglect my blog
(sorry!). It has been exciting to
be part of this programme from almost the very beginning. The Ministry of
Health & Sanitation has elected a National IPC lead person in the Ministry
and 25 IPC focal persons (mainly nurses) in the 25 government hospitals
in the country. Each focal person is responsible for setting up an IPC
committee in their facility and rolling out training for all healthcare staff.
Each focal person and hospital has an international mentor and partner
organisation (that’s where I come in with King’s) to help support the roll out
of this programme. The international mentors and the IPC focal persons attended
a two-week IPC training programme at the beginning of March. This was a great
opportunity to form working relationships between the mentors & focal
leads, and also share some teaching tips in how to engage classes in more
interactive style of teaching. I met so many incredibly determined and
passionate individuals, mostly women :) who are going to be the <i>tour de force</i> for
IPC in their hospitals. As IPC is a relatively new concept in Sierra Leone, my
hat goes off to these IPC leads who have a huge challenge ahead of them. And
yet the training course was full of optimism and momentum for change. Following
the training we are in the process of trying to organise training for all staff. At Connaught, this is nearly 800 people. </div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small; text-align: start;">Training – how to clean spills <br />in a non-Ebola hospital environment</span></td></tr>
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Oh sorry, I still haven’t really explained what those three
little letters mean… it’s basically all ways of preventing the spread of infection
between patients, from patients to staff and from staff to patients. It
includes everything from basic hand washing to making sure used needles are put
in ‘sharps boxes’ safely, segregating clinical (possibly infectious) waste
from general rubbish, to the provision of Hepatitis B vaccine for staff
prophylaxis (something that currently does not happen in Sierra Leone) and
appropriate use of antibiotics to prevent resistance developing. It really is a
huge topic and in a healthcare system that struggles to get enough gloves per
nurse at the beginning of the day, it’s difficult to know where to start!</div>
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What it is certain is that behavioural change, like making
sure nurses dispose of sharps safely <i>every</i> time, does not happen overnight.
There will be trainings and more trainings and more trainings and bit by bit we’ll get there. The other thing that is very clear is that all the trainings
in the world are not going to achieve anything unless the systems are in place
for implementation. This is a huge project. There are funds available through two
different grants (USAID & DFID), in all government hospitals to improve the
Water, Sanitation & Hygiene (WASH) infrastructure. Needless to say, if a
hospital has no reliable running water then hand washing is going to be quite
difficult. All of the four hospital sites with which we have been working with have
differing degrees of complex infrastructural problems.<span style="mso-spacerun: yes;"> </span>We are lucky to have Gerard, a
volunteer Engineer, working with King’s since February who is going to help sort
a lot of these issues out. No pressure! </div>
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It has been
really interesting to sit in some of the ongoing funding and planning meetings
in the last few weeks. There has been a tangible shift and transition away from
the acute emergency phase of the Ebola epidemic and towards the long-term recovery into development
phase. <span style="mso-spacerun: yes;"> </span>What is also interesting is the
sheer number of international partners (UNICEF, UNDP, WHO, CDC, OXFAM and smaller
NGO’s like ours) all competing for funds and projects and the co-ordination
nightmare this creates. Even within the IPC world, there are parallel IPC
programmes which cover trainings in hospitals, in peripheral health units, in communities and also setting up IPC focal leads at the District level. I had read
that co-ordination of aid can be difficult but until now I had never appreciated
the scale of the politics involved in humanitarian, and, increasingly, development aid even at a ground level. Despite this, real tangible
improvements are achievable through this programme and it is with a heavy heart
that I am leaving Sierra Leone just when trainings & WASH projects are
getting going.</div>
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I am so pleased to have been part of this important step
forward in Sierra Leone’s health system but I need to hand-over to a fantastic team
of nurses who will carry on with this project for the whole year. I have met the most
amazing people from the Ministry, the co-ordinating NGOs, at King’s and the
IPC local leads at the four hospitals through this project. I wish them all
the luck in the world in their tremendous challenge of improving the country's healthcare system one step at a time, starting with IPC. </div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-36628463337442519742015-03-14T09:15:00.001-07:002015-03-14T09:15:57.386-07:00Heroes<div class="MsoNormal">
We hear the word ‘hero’ bashed around quite a bit out here.
I find it rather awkward – like we (although I’d much prefer to refer to the
local staff rather than us, international folk) have some sort of special power.
The British Embassy even cashed in on the term last week, hosting an “Ebola
Heroes” night of thanks to the UK teams involved in the response. It’s a shame
that the term, for me, has become overused and degraded somehow. When you
describe each and every Ebola worker as a ‘hero’ it gets a bit tiresome or we
all just get a bit arrogant which has got to be worse. <span style="mso-spacerun: yes;"> </span>I really don’t mean to undermine the amazing work that lots
of healthcare workers are doing here; entering the red-zone on a daily basis
takes a lot of courage. The recent news of a British military healthcare worker
infection reminded me of the ongoing risk we face. In fact, following that
news, I vividly dreamt I had Ebola the night before last and woke up in a cold sweat. That
used to be a fairly regular dream for me when I first arrived but I had
obviously come accustomed to the risk and possibly less daunted by the prospect.
There’s nothing quite like a military personnel getting infected, with all
their resources and protocols, to realise you can never fully eliminate the
risk. </div>
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Talking about heroes of different kind… do you know who my hero is? A gentle, kind and fiercely determined young man called Idrissa. In
the depths of my despair about my marathon training a few weeks ago, I was
quite literally in tears in the office and Oliver asked what the matter was.
Oliver is the programme director of King’s Sierra Leone Partnership – an
amazingly pragmatic person and deservingly well-respected here. His response
was quite simply “well, you need a personal trainer”. Within a minute or two he
had rung a friend of his and fixed him to be my trainer.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgR9uwxMxXZEsb0apLUYfTRkHeFQvd68aK63bhUNEP0A7bHJ4Myqc8s9Cuwi5grYCgRE-TNzc1mstqgD0laNZjkX23jWUJ-_HT-9fH27PhhZXAwc-CvuTetCDXmU8cVCmQ_ThEft1ed2EQ/s1600/idrissa+and+me.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgR9uwxMxXZEsb0apLUYfTRkHeFQvd68aK63bhUNEP0A7bHJ4Myqc8s9Cuwi5grYCgRE-TNzc1mstqgD0laNZjkX23jWUJ-_HT-9fH27PhhZXAwc-CvuTetCDXmU8cVCmQ_ThEft1ed2EQ/s1600/idrissa+and+me.jpg" height="320" width="240" /></a></div>
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Idrissa Kargbo is not just an ordinary personal trainer.
He’s Sierra Leone’s top long-distance runner and at the mere age of 25 (or 24
or 26, he’s not quite sure of his birthday) he has a potentially exciting
career ahead of him. He was ‘spotted’ by an Australian girl called Jo (who used
to be the King’s media person) and through her own fundraising and the
competition money of winning the Liberia marathon he managed to get a place in
the New York Marathon in 2013 and London Marathon in 2014. In London, it was a super hot
day which suited him perfectly as he’s used to the heat in Freetown, he ran his
personal best of 2 hours 32 minutes. That happens to be the exact time I ran
the Great North Run (a half marathon!) during medical school. I have, since
then, done a half marathon in sub-2 hours (just: 1 hour 59 mins and 50 secs!),
but Idrissa really does run twice as fast as me. </div>
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For now though, unfortunately and very frustratingly, Ebola
has prevented him entering any international marathons this year. He also
doesn’t have the funds to pay for flights, visas, and competition entry fees. He barely has adequate equipment to run here - his Garmin watch, a gift from an British friend, broke a few weeks ago and he cannot get a replacement for now. The recent news of
<a href="http://www.theguardian.com/uk-news/2015/mar/10/jimmy-thoronka-sierra-leone-athlete-offers-help-arrest-visa-homeless">Jimmy Thoronka</a>,
the Sierra Leone Commonwealth Games athlete who ‘absconded’ in Glasgow last
year and a sadly similar story of one of Idrissa’s London Marathon co-runners
and friends, <a href="http://www.theguardian.com/sport/2014/apr/19/london-marathon-missing-mamie-konneh-lahun-sierra-leone">Mamie</a>, are both examples of the desperate lengths these individuals take to leave Sierra Leone but only to the detriment of their career. If only these
exceptional athletes could be recognised and supported by their own government
they may not have been driven to running away. It would be incredible if there were some way of securing long-term sustainable funding Idrissa's running career; he can only so far without any professional training; running the chaotic hilly streets of Freetown. If anyone reading this blog has any
suggestions of how to support Idrissa - please contact me.</div>
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Without a race to train for now, Idrissa seems happy enough to earn
a bit of cash from me and jog alongside my comparative snail-pace four times a
week. His love of running is certainly infectious. He’s always got a smile on
his face, even at 6am in the dark and I’m already complaining, “I’m tired” before even
setting off! He has some pretty fantastic stock phrases, “Keep going, keep the
fire burning” or “You are strong, Claire”. Yet at other times, he’s perfectly
happy to bring attention to the fact that I do run, in fact, really slowly! The other day, he insisted very sincerely, that on race day in London, “all you need to do is find
a really old man, and run behind him all the way”. Ha! Thanks Idrissa. He meant it so endearingly and so wants me to cross that finish line ‘strong’ but
telling me a run like an old man isn’t particularly encouraging! I am so
grateful for his support though as I know I couldn’t motivate myself to get out
running four or five times a week without him. </div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxmBpy3ZhhAURI4iX_Mo5t8K_9DvJsMx8TWwdCrn0cWWWwglEb90cO9lzzwlrHQD0UPQmrtM9cWvzCGp_GOtgR70CCXFjsScJX0yU9Zt6vvtL5ivRCAkWAifUTT5bLbAvMoLpGxlIUak/s1600/idrissa+text.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxmBpy3ZhhAURI4iX_Mo5t8K_9DvJsMx8TWwdCrn0cWWWwglEb90cO9lzzwlrHQD0UPQmrtM9cWvzCGp_GOtgR70CCXFjsScJX0yU9Zt6vvtL5ivRCAkWAifUTT5bLbAvMoLpGxlIUak/s1600/idrissa+text.jpg" height="320" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">I should add a little disclaimer - my 3 mile run (15 mins pace) was a serious crazily steep hill training session!</td></tr>
</tbody></table>
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The race is 6 weeks tomorrow. I ran a half-marathon this
morning in just over 2 hours and actually felt remarkably good, both mentally and physically.
The plan is to scale-up distances over the next 2 weeks until our last training
run together on the 30<sup>th</sup> March when he wants me to run 20 miles. Eek,
‘keep strong’… </div>
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Please sponsor me: <a href="http://www.virginmoneygiving.com/canclairerunamarathon">www.virginmoneygiving.com/canclairerunamarathon</a> –
all funds raised are going to King’s Sierra Leone Partnership. Thank you.</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-71497843205476549142015-03-01T07:47:00.000-08:002015-03-01T07:47:02.275-08:00What is a safe and dignified burial?<div class="MsoNormal">
I warn you this is a rather bleak and factual blog entry… You
may have seen or heard on the news that all burials in Sierra Leone are
required to be ‘safe’ during the current state of emergency. This is certainly
meant to be the situation – but what is a ‘safe’ burial and how does it differ from
any other? What is the impact of the change in burial practice on bereaved
families? What can be done to help give a dignified burial?</div>
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<o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwxCdO7pJzoEbjOk0WFsKAxbTB_HjD2eKyaF6-RbpOGBr-6IfNsjN6nNjB5fBHbDs25E_gEVurmxxCmwmzOsaa017LyuTd5g6oNgzPYT0-ikbM03wYd7J9jwy5I6rm91Ow_Z3dNW1wlGg/s1600/burial+14.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwxCdO7pJzoEbjOk0WFsKAxbTB_HjD2eKyaF6-RbpOGBr-6IfNsjN6nNjB5fBHbDs25E_gEVurmxxCmwmzOsaa017LyuTd5g6oNgzPYT0-ikbM03wYd7J9jwy5I6rm91Ow_Z3dNW1wlGg/s1600/burial+14.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Trevor</td></tr>
</tbody></table>
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I was lucky enough to meet the perfect person who could
answer these questions; Trevor works for Concern Worldwide and manages the
Kingtom Cemetery, the largest cemetery in Freetown. Kingtom is situated right on
a small headland in the centre of the city’s coastline. Originally named after
a tribal chief by the same name, Kingtom has had a cemetery for many decades but
since the start of the outbreak it has become the most important site for
‘safe’ burials.<span style="mso-spacerun: yes;"> </span>The daily and
overall organisation of the cemetery by Freetown City Council and Concern Worldwide
has been key in preventing onwards transmission from Ebola corpses, which are
extremely contagious and thought to be one of the main causes of transmission.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJP_OU5j5zQ0oUBOrMbnKQsfLU9qBCsVIGxS6poUn1HuUNsM5aMXWMgOL2i0OXNXfOlK4_Aj4gTiFLv21AiFKbuC6MQ-vBORnYFfYnVtv088MqrxDjrzyGJrcoz_HqSL3WnOcAOxIRHVI/s1600/burial+4.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJP_OU5j5zQ0oUBOrMbnKQsfLU9qBCsVIGxS6poUn1HuUNsM5aMXWMgOL2i0OXNXfOlK4_Aj4gTiFLv21AiFKbuC6MQ-vBORnYFfYnVtv088MqrxDjrzyGJrcoz_HqSL3WnOcAOxIRHVI/s1600/burial+4.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Alie</td></tr>
</tbody></table>
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In order to understand the process more thoroughly Trevor
recommended that Grace (one of the other KSLP volunteer doctors) and I should
join the Burial Team to follow what happens when a corpse is collected from our
Isolation Unit. So on Thursday, we
met Alie, a warm-hearted friendly Sierra Leonean who has worked for the Burial
Team since the very beginning of the epidemic. He must have worked through very
tough times in the last few months but he was amazingly approachable, calm and
patient whilst on the job.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijHcep27cU7iXF-1Tuf6aGXkGtywNGnpVDCPz-7HFZYCjQAqBVWem7SWT_Ousz1ujDJQPzwKpKRg50BsVFjvyBXIzItqKmLv2YR7G2oA-0n9-ewmAb7x3MKW1SgCu2FpYEwjzEFhxFvO0/s1600/burial+2.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijHcep27cU7iXF-1Tuf6aGXkGtywNGnpVDCPz-7HFZYCjQAqBVWem7SWT_Ousz1ujDJQPzwKpKRg50BsVFjvyBXIzItqKmLv2YR7G2oA-0n9-ewmAb7x3MKW1SgCu2FpYEwjzEFhxFvO0/s1600/burial+2.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The burial team arrives at Connaught Hospital</td></tr>
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When someone dies in our unit the first thing to do is to
inform the family. Over time I have learnt it is better to tell the male
relatives first, preferably the eldest or head of the family if they are
available. The men will then either tell the women themselves or ask you to
break the news but at least they are ready to console the women as emotional
outbursts of crying and wailing are likely to ensue. This is really hard, the
wailing can often be heard from across the other side of the hospital grounds
and it haunts you wherever you go. </div>
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If a blood sample has not already been taken
before the person died then an oral swab sample is taken to test for Ebola.
Unfortunately these swabs are not 100% reliable, for example due to inadequate
sampling or failure due to chlorine contamination. It is at this stage that a
difficult dilemma often arises… relatives often want to wait for the result of
the blood test and/or swab before the person is buried, so that if negative
they can give them a ‘normal’ funeral. However, during my time with the burial
team, I came realise that there is no such thing as a ‘normal’ burial any
longer in Sierra Leone.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwj1BGfWkuC5f4udqpw4ygBUhG4t9aeXiW_9k-0gHzip3TPQrPaevyGg8tZQiJlH-3Y4_tFhMGEeuKCJw53JslXPQQxJFKPcUxgdME8iJ96HTA6MsJ_f-dGpJUM4lF4kDW_SE_xYq87EY/s1600/burial+3).jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwj1BGfWkuC5f4udqpw4ygBUhG4t9aeXiW_9k-0gHzip3TPQrPaevyGg8tZQiJlH-3Y4_tFhMGEeuKCJw53JslXPQQxJFKPcUxgdME8iJ96HTA6MsJ_f-dGpJUM4lF4kDW_SE_xYq87EY/s1600/burial+3).jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Burial Team get into PPE to collect the body from the Isolation Unit</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAG8SJSbs5e_Tdsu0bra0xtl8HOeywcmTz-1-xekz3faJEXPYVsEK2DTPHy0lZ63pMsiYTfHMnhi5I81gW6L04bOMjUFzsQtTKJgV5IGddkHp65qHd5lJMGelVqm6a9PdehT6F8ZA4RoU/s1600/burial+8.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAG8SJSbs5e_Tdsu0bra0xtl8HOeywcmTz-1-xekz3faJEXPYVsEK2DTPHy0lZ63pMsiYTfHMnhi5I81gW6L04bOMjUFzsQtTKJgV5IGddkHp65qHd5lJMGelVqm6a9PdehT6F8ZA4RoU/s1600/burial+8.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Burial team</td></tr>
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The corpse(s) get collected from the Isolation Unit by the
burial team, who arrive in two vehicles; one van with stocks of PPE and
chlorine and 4 or 5 men crammed in the back and one open-air truck with some
tarpaulin sheeting to cover the body bags. The burial team gets dressed into
PPE and collects the corpse in a white body bag from the mortuary inside the
unit. They then decontaminate by the vehicle using a method that seemed very
rushed and flawed to me and yet it is a process they are familiar with having done this day in day out for months.</div>
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Grace and I followed this open-air truck around the corner to
the Connaught Hospital Mortuary where the burial team were going to find out if
there were any other bodies to be buried. The Mortuary, just next door to our
KSLP office, is for patients who die on the general wards or for the community
in general, e.g. accidental deaths. Inside the Mortuary every corpse has an
oral swab sent for Ebola and is then transferred to a body bag for ‘safe’ burial.
This means that the earlier dilemma of waiting for a result in the Isolation
Unit doesn’t change things greatly for families, although it may give them an
extra day or two to organise a coffin since body bags are allowed to be buried
inside coffins. <o:p></o:p></div>
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Grace and I were welcomed inside the Mortuary and given seats
in the director’s office since we were there to observe the burial process. We
spent the best part of a very uncomfortable hour observing the manager explain
the burial process to the bereaved parents of a child who had been killed in a
road traffic accident that morning and then to the family of a patient who died
on the wards. The manager alluded to a small, but nevertheless very significant,
caveat to the safe burial procedure when he suggested corpses could be released
to relatives for, presumably, normal non-safe burials if the swab tests are
negative and they get a certificate from a doctor. We were shown the required
certificate: a flimsy piece of paper filled in by hand that could quite easily
be forged. This flaw in the system is something that will be clamped down on
next week as a new media campaign is starting to emphasise the need for 100%
safe burials in Sierra Leone. </div>
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(In fact, a couple of days later whilst another
Kings volunteer, Dominic, was visiting the cemetery he witnessed a fake burial
team turn up at Kingtom. They were wearing dubious PPE that they kept taking on
and off. The body was wrapped in a sheet (not a body bag) and when questioned
they said, “We are the Connaught burial team” which was an obvious lie. The
police where called and arrested them on the spot whilst the driver did a runner!
We have no idea who they were but the whole scene sounded very bizarre; why
turn up at the official cemetery and do a bad job of pretending to be official?
More worryingly, despite all the media campaigns and the devastating epidemic
for 8 months, people are still intent on bending the regulations.)<o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;">Following the burial team (Toyota) to the cemetery</td></tr>
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Anyway eventually, thankfully, Grace and I excused ourselves
from this manager’s cramped office which reeked of formaldehyde and waited
outside for the burial team to move one more body from the mortuary into the
back of the van. This was someone who had died on the normal wards but for all
purposes was treated exactly the same way: swab, body bag, full PPE… so “safe
burial”. Then we followed the van through the streets of Freetown to Kingtom
Cemetery, about a mile away. Little did people know that there were two corpses
under the tarpaulin and a bag of contaminated PPE on top as this vehicle crawled
its way through the crowded streets of Kroobay. <o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;">Creating more space; excavating the rubbish dump</td></tr>
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Kingtom Cemetery is a wide-open area of graves much like any
other cemetery. However, on one edge, the cemetery is a daily hive of activity,
as it now has to expand rapidly to accommodate all of Freetown’s deaths. It was
here that we met Trevor and he kindly showed us around. I felt quite unsettled,
as if I were an ‘Ebola tourist’ but Trevor reassured us that it was 100% fine
to observe and even take photographs. The cemetery’s perimeter fence is covered
in black plastic sheeting to block the view of the rubbish dump behind, giving
at least a little visual dignity to the fact that the extra space required has
had to come from somewhere. Fifty metres from where the current graves are
being dug and filled there’s a big tractor tearing through the years-old layers
of a landfill site making space for more. But Trevor tells us they are running
out of space. There’s a new site at Waterloo, half an hour drive to the East, which
will take over when Kingtom has reached capacity. <o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXrKFvPFLpNYhSArz70gWGkeVNAFT9D3gQPn4DKhGDaHJFk3bkAKgG5OHd4XDI9rFTyWvraEnTHxnaQKcLTMV6Gu1J7xf5IxIDSCten8W6VDF_YfLxJYeLsvacZPWEY7X0omcpanhB2NA/s1600/burial+17.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXrKFvPFLpNYhSArz70gWGkeVNAFT9D3gQPn4DKhGDaHJFk3bkAKgG5OHd4XDI9rFTyWvraEnTHxnaQKcLTMV6Gu1J7xf5IxIDSCten8W6VDF_YfLxJYeLsvacZPWEY7X0omcpanhB2NA/s1600/burial+17.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Limited space available</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">A safe burial</td></tr>
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I suppose it’s not very often you consider the daily mortality
rate of a city. Certainly in the half an hour that I was there, I was amazed to
see a number of burial teams bring in at least five bodies and bury them in the
same amount of time. There are various practices that have developed over the
course of the epidemic to allow families to say goodbye as best they can. They
are allowed a maximum of ten relatives to attend the graveside, where they
watch the teams in full PPE bring the body bag from the van to the grave.
Muslims can be buried with a white cloth, and Christians can be buried in a
coffin but they are buried alongside each other, whilst an Imam or a Priest
guides the relatives through prayers from a safe distance. </div>
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Once the body is
placed at the bottom of the grave, the burial team decontaminates throwing
their used PPE in the grave and then, quick as anything, the gravediggers fill
the grave with soil. It was a sadly unemotional procedure to watch. The
relatives helplessly stand by and watch, hopefully with some indication of
which body bag belongs to their relative as it is carried to its grave. </div>
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<tr><td class="tr-caption" style="text-align: center;">Trevor and Grace walk past recent burials</td></tr>
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Concern
Worldwide will be providing gravestones for each grave, but until those are in
place they are currently being marked with a name on a wooden stick and a
number. There’s also a small area with white fencing to one side which contains
a number of graves from the beginning of the epidemic when there were just too
many corpses and too little infrastructure to organise one body per grave.
There are plans to make a plaque to indicate the names of all those buried in
that area.</div>
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I came away feeling cold and deeply saddened by this
epidemic and its consequences for all. I cannot imagine what it must feel like
to be told one morning, “<i>your
brother/father/mother/daughter has died, possibly of Ebola (but we won’t know
for a few days), and you have to follow this burial team, who will bury the
body like every other body in a white heavy duty plastic bag in a newly dug
grave on an ex-rubbish dump.</i>” The people are Sierra Leone are truly
resilient; they have seen more than their fair share of suffering. As if to
cruelly remind everyone of this, the raised ground where the relatives stand to
watch the safe burials is, itself, a mass burial site from the civil war.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMw3hHrPjiWUbnRO9d4UrUw-TMZwnjiQ0SibI0MNfqm-cjfBTIgRVvMO59cgbFMib_FqszbMSIt0ZN0EuBWSLk4yN9-rRzamhaGzpIYSL37HuXPZeTdD8E9GssebWR2Ah4ZPhvwUz-Sgc/s1600/burial+9.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMw3hHrPjiWUbnRO9d4UrUw-TMZwnjiQ0SibI0MNfqm-cjfBTIgRVvMO59cgbFMib_FqszbMSIt0ZN0EuBWSLk4yN9-rRzamhaGzpIYSL37HuXPZeTdD8E9GssebWR2Ah4ZPhvwUz-Sgc/s1600/burial+9.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Relatives (wearing blue overshoes) standing on war grave site watching the burials below</td></tr>
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Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-17668517105407200442015-02-23T04:13:00.000-08:002015-02-23T04:13:21.579-08:00The silly things we sign up to...<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNuqELIWx5oatsq-PJu_7jOddoaVJwRE1x6cDI7i66QmKY7nt9Dz5dS5hI5b5iao6F1ihajTL7aMqEO5X1OzV7MfwLKMYJzVvjqGWoB80wmALnEthGhEafGCMMTr94qUnHEAadB6Ng3hc/s1600/broken+down.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNuqELIWx5oatsq-PJu_7jOddoaVJwRE1x6cDI7i66QmKY7nt9Dz5dS5hI5b5iao6F1ihajTL7aMqEO5X1OzV7MfwLKMYJzVvjqGWoB80wmALnEthGhEafGCMMTr94qUnHEAadB6Ng3hc/s1600/broken+down.jpg" height="240" style="cursor: move;" width="320" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: x-small;">Fire in the engine?</span></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Times, 'Times New Roman', serif;"><span style="font-size: x-small;">Luckily we broke down next to this fruit & veg stall</span></span><span style="font-family: Times, Times New Roman, serif; font-size: small;"><br /> </span></td></tr>
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<span style="font-family: Times, 'Times New Roman', serif; line-height: 19.2000007629395px;">I really apologise for the delay in blogging, in all honesty I’ve found it quite unsettling coming back to Freetown after a pretty intense (but lovely) few days at home. Following my interview, I saw a number of close friends and my brothers in London and my parents and family friends at my mum’s church. I needn’t have worried about stigma. I was really quite overwhelmed with the overall warm reception I received everywhere. It came to the point where I’d never had so many hugs in one day! So I’d like to say a big ‘thank you’ to those of you who I met while I was home.</span><span style="font-family: Times, 'Times New Roman', serif;"> </span></div>
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<span style="font-family: Times, Times New Roman, serif;">Settling back into Freetown h</span><span style="font-family: inherit;">as been tricky for a number of reasons. It’s definitely a lot hotter than when I left; no patch of scrubs manages to stay dry even if you’ve been in the unit for half an hour. It’s hot at night too so I’m not sleeping very well. It’s taken me a while to get back into the swing of things and catch-up with emails and meetings I missed etc.</span></div>
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<span style="font-family: inherit;">Yet in all honesty the main reason for the delay in blogging is because I did something pretty silly when I was at home and I’ve been debating about whether or not to go ‘public’ about it. I signed up to run the London Marathon. Oh yes, indeed possibly one of the silliest decisions I’ve made in quite a while. With 11 and half weeks to go until the big race on April 26th I thought it would be a really good idea to start marathon training in a chaotic hot dusty pot-holed African city, alongside working in an ebola unit and tons of other commitments. Can you sense my sarcasm?! Aaaaah. My only saving grace is that I’ll be raising money for Kings Sierra Leone Partnership and what better motivation to train hard than working for this fantastic charity and knowing how much the funds raised will benefit the health system in Freetown. I know many of you have been keenly following my blog, thank you so much for your support, if you feel able to contribute to my ridiculous marathon appeal then please visit my fundraising site: </span><a href="http://uk.virginmoneygiving.com/canclairerunamarathon" style="font-family: inherit;">http://uk.virginmoneygiving.com/canclairerunamarathon</a><span style="font-family: inherit;"> I will try to keep you updated of my training progress. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdShCCMZSv64lys95TKoce3qU2OFr4NJh1z9HuhfEW73wdXKwLnRznJllDrUmL2Ymj0ZiIMqTBKSIrPpLdSEndAlEwt-YUnClKFeULN-LJO2V1kwRm4ORImpfdUn237RFChZJtWvKdIs/s1600/football+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdShCCMZSv64lys95TKoce3qU2OFr4NJh1z9HuhfEW73wdXKwLnRznJllDrUmL2Ymj0ZiIMqTBKSIrPpLdSEndAlEwt-YUnClKFeULN-LJO2V1kwRm4ORImpfdUn237RFChZJtWvKdIs/s1600/football+2.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">KSLP vs Isolation Staff Football match</td></tr>
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<span style="font-family: inherit;"><br /><br />Back to the point of my blog and probably what you are more interested to hear about… <br /><br />Just before leaving Freetown at the end of January, Connaught Hospital Ebola holding unit was enjoying a relative quiet time. (All doctors will know that you should never say the ‘q’ word as it just jinxes things for later). There were nearly three weeks in a row when the unit did not have a single positive patient identified. There was general optimism in the team and things seemed to be improving all over the country with the daily case number consistently in single figures for the first time in months. The topic of discussion had changed towards how to deal with the low numbers of cases (and high proportions of patients testing negative in holding units) and keep vigilance high to prevent lapses in the screening process and so exposing healthcare workers in the main hospital to potential Ebola suspects. So it was with some frustration that in the first week of my return, I found the holding unit full and a few positive cases identified. We’re not talking big numbers but 1 or 2 positive cases every few days. As I’ve said a few times in this blog, it’s difficult to know what’s happening elsewhere in the city. There are so many different holding units now (which is fab) it just means the burden of the epidemic is spread and although Connaught hospital are only seeing occasional cases, if this replicated across 10 different sites then we still have a significant epidemic. In fact, the national data has shown a fluctuating daily case rate of between 2-12 new infections in Freetown over the last month. Dr Tom (the original ID consultant who trained me) has written an insightful <a href="http://blogs.plos.org/speakingofmedicine/2015/01/27/will-ebola-epidemic-end/">blog entry</a> about how the ‘last mile could be the longest’ in winning this battle and I very much agree with him. We are very far away from having 42 days (two incubation periods) of no cases, which is the current definition of end of the outbreak. Cases are still spread across different areas of Freetown, different districts of Sierra Leone and also the neighbouring countries of Liberia and Guinea… the whole region is so interconnected that each village, town or city really can’t afford to become complacent until all three countries are in the clear. <br /><br />So it’s going to be a long time yet until we are ready to stop screening all patients that attend the hospital. This means that everyday sick patients who meet the case definition are getting non-specific and often inadequate care in an Ebola holding unit rather than seeing the ‘normal’ doctors in the Accident & Emergency departments. All this in order to protect healthcare workers and trace every last case of Ebola but at what cost to individual’s health? For example, a lady who is currently under investigation for possible Type 2 Diabetes at another health centre, attended our hospital feeling unwell, met our case definition and was admitted to the unit. Over the next two days she deteriorated and sadly died before her Ebola blood result was available. Simple investigations are put on hold due to the risk of Ebola, for example a glucose meter, which would have made the difference in giving this patient some insulin and preventing her likely diabetic coma leading to death. The family also have to come to terms with the fact she will have a ‘safe’ burial as an Ebola suspect – although this, as I discovered yesterday on a visit to the Kingtom Cemetery, is very complicated process and topic for a blog entry of its own.<br /><br />We had a patient in our unit this week with tetanus. He was isolated for Ebola as the overlap of symptoms can mimic almost anything and yet as time progressed and his clinical condition developed it became more obvious that he had tetanus; recurrent tonic seizures with a classic lock-jaw, arched back and neck extension. He even had a puncture wound on his right foot where the often-deadly spore entered his body. I remember looking after a couple of patients with tetanus during my elective in an Infectious Diseases Unit in a tertiary referral hospital in Senegal. That was in the intensive care where they had oxygen, strong painkillers, and close observation for quick response to seizures. There are many distressing aspects about tetanus, patients remain conscious throughout their muscle contractions and experience a great deal of pain. Within the unit, we were able to initiate antibiotics and whenever a healthcare worker witnessed a seizure, we could administer diazepam and monitor him for respiratory depression. However, there are times when no one is inside the unit and so our care was suboptimal. Once the neurotoxin takes hold, “if patients can be supported through one or two weeks of muscle spasm and other complications, the chances of complete recovery greatly increase” <i>(Current recommendations for treatment of tetanus during humanitarian emergencies, WHO Technical Note, January 2010)</i>. Also, the KSLP pharmacist, Suzanne, spent an afternoon trying to procure tetanus immunoglobulin from any pharmacy or hospital (including the private ones) in Freetown but nobody stocked it. Most frustrating of all is the infection is completely preventable with routine childhood vaccinations. The man had a negative Ebola test and has been referred to the hospital for ongoing support.<br /><br />I mentioned in an earlier blog entry, non-Ebola healthcare, about trying to arrange a system for our negative discharges. This is very much work in progress but some successes have been achieved in the last few weeks. Connaught Hospital, with agreement from the Ministry, now waivers the 15,000 Leone registration fee for all patients who have come through the Ebola holding unit and tested negative and also Ebola survivors from treatment units. There’s now a referral method for reserving a bed in observation unit, even from other holding units across the city. This was essential because on countless occasions ambulances were coming to drop off patients for ongoing medical care when there were no beds available or without informing the patient’s relatives. It’s by setting up systems like this that I think Kings’ can have a real positive and sustainable impact on the functioning and efficiency of the health service. </span></div>
</div>
</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com1tag:blogger.com,1999:blog-3254486670151822403.post-38511637328975336622015-01-25T17:29:00.001-08:002015-01-26T03:27:39.372-08:00How (not) to communicate in an ebola crisis<div class="MsoNormal" style="margin-top: 0cm;">
16<sup>th</sup> Jan: A few days ago,
I received confirmation of my interview in London on the 28<sup>th</sup>
January for Core Medical Training – the next step in my training that will
re-start in August. So I’ll be heading home a week on Sunday for 10 days for a
break and to coincide with this interview. </div>
<div class="MsoNormal" style="margin-top: 0cm;">
On my one (half) day off last week, I
started to think about interview preparation and looked to a list of sample
questions: </div>
<ul style="margin-top: 0cm;" type="disc">
<li><span style="text-indent: -18pt;">Tell me about a time you’ve had to show
resilience to achieve a goal.</span></li>
<li class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-list: l0 level1 lfo1; mso-pagination: widow-orphan; tab-stops: list 36.0pt; text-autospace: ideograph-numeric ideograph-other;">Please describe a time
when you were unsure whether what you were being told represented the
patient’s true thoughts or feelings. How did you recognise this? What did
you do about it?</li>
<li class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-list: l0 level1 lfo1; mso-pagination: widow-orphan; tab-stops: list 36.0pt; text-autospace: ideograph-numeric ideograph-other;"><span style="text-indent: -18pt;">All Doctors need strong communication skills.
Can you give me an example of when you have used your communication skills in a
difficult situation?</span></li>
</ul>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
Ha!
How am I ever going to talk about anything other than my experience at
Connaught Hospital? </div>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<br />
Communication
in an ebola context – I could write a book about this! Just trying to take an
accurate history from a suspect patient in the screening tent has been one of
the hardest things I’ve done since leaving medical school. Firstly and most
obviously there is a language barrier. Krio is a really cool language. It’s
relatively easy to understand maybe 70% of it is actually English in a ‘slang,
kind of sloppy accent’ with the odd ‘nah’ and ‘de’ thrown in between words… “Ah
da go nah beach” for example. I’m getting quite good at asking a history in
Krio, “you de bodi wam?”, “you de vomit?”, and my favourite… “you de toilet
fast fast?” But even having mastered the lingo, it’s rare that you get a straight
answer. It feels like there are about a hundred and one ways to ask if someone
has a fever. They will often completely deny it, “no bodi not de warm, no, I
not get no fever… but I get feel fo malaria and I de sweat beaucoup” and the
person is obviously sitting there in a thick coat, dripping in sweat and shivering. You check
their temperature and it’s 39 deg C. </div>
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<br /></div>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
Communication
between colleagues is also tricky mainly because whilst wearing PPE your
hearing is all muffled by the suit, your mouth’s covered by a mask and there’s
nearly always a background din of arguments, distressed relatives or ambulance
sirens nearby. It’s so essential that the team is well organised though and
communicating effectively. Especially if it’s a busy morning in the unit with
multiple negative patients to discharge and new suspects to admit, ensuring
everyone gets the correct name band, bed number and making sure their paperwork
all matches up correctly is essential. It also doesn’t help that there are only
about 6 different surnames in Sierra Leone; so at times there can be many
Kamaras, Sesays, Koromas, or Contehs on the unit along with multiple Fatmatas,
Mohammeds and Ibrahims etc. You can see how easily problems arise!</div>
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<br /></div>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
Good
communication skills is something that the western-trained doctors and nurses
have had drilled into them since day one of their training. It would be easy to
blame the ineffectiveness of communication to a simple difference in
culture here but I do believe it is something that can be taught and practised
and improved upon. The importance of this was no more apparent to me than on
Monday when I was called by the doctor working in out-patient department to
speak to a relative of someone who had just died. Assuming, incorrectly it
turns out, that the doctor, who had assessed the patient when she was alive and
witnessed her death in his small office, had told the relative I introduced
myself to the husband and added “I’m sorry for your loss”. However his blank
bewildered stare made me realise suddenly that no-one had actually told him.
So, embarrassingly, I tried to back-track very quickly, took a brief history
and broke the bad news (again) hoping he wouldn’t remember the first thing I
said. Oh dear, what an example of how not to communicate - maybe not one I
should bring up at interview!<span style="mso-spacerun: yes;">
</span>Later, I talked directly to the doctor and asked him why he hadn’t told
the husband. Looking uncomfortable, he made an awkward remark about how he
prefers to avoid talking to relatives about death directly. “It often just
makes them too upset, sometimes they can even get angry and aggressive and I
don’t like it when the situation gets difficult like that”. This just made me
feel unbelievably lucky for the medical training I received and the quality of
professional care we have in the UK. This doctor didn’t know any different,
he’d never been taught how to effectively talk to patient to elicit what’s
going on, how to actively listen to someone’s ideas, concerns or expectations,
or have compassion or empathy in informing a man that their loved one has died.
</div>
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<br /></div>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
The
NHS feels like a galaxy away. I know there are shocking news headlines of busy
A&Es and unsociable work hour disputes in the UK right now.<span style="mso-spacerun: yes;"> </span>A few weeks ago I would be right in
there campaigning for a more just system as well, and of course, I still do
support the negotiations for fair junior doctor contracts… and yet here, the
debate scales into insignificance. Similar issues crop up, ofcourse, but in
Sierra Leone it’s healthcare workers campaigning to get paid in the first
place. Since the ebola response scaled up a few months ago, there are some
nurses and cleaners in our unit that have still not been paid a penny for the
dangerous job they have opted to take on. All ebola healthcare workers should
get paid a ‘hazard pay’, which is a monthly financial incentive to work with high-risk
ebola patients. A recurrent problem encountered in some of the other hospitals
that KSLP supports (and many others, I’m sure) is the list of ‘hazard pay’
ebola staff seems suspiciously large compared to the number of people actually
working in the unit.<span style="mso-spacerun: yes;"> </span>There are
numerous other examples of corruption in the system here, but I’m getting away
from the point…</div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
25<sup>th</sup>
Jan: I never managed to post the above blog – got side-tracked/busy with IPC
spreadsheets – oh how my Kings colleagues will tell you, <i style="mso-bidi-font-style: normal;">“I do love a good spreadsheet!”</i> <span style="mso-spacerun: yes;"> </span>I’m currently sat in Casablanca airport on my way home. What
will await me? cold weather – it was minus 9 in Amersham a few days ago;
culture shock – just the journey home on the tube will feel like a jump in the
deep end of technology, functional transport systems and busy, unfriendly
people; a welcoming, comforting cup of tea with housemates – definitely. </div>
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<br /></div>
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<div class="MsoNormal" style="margin-top: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
How
about stigma – well maybe? Since I’ve been in Sierra Leone, I’ve heard of
countless examples of returning ebola workers facing concerns of friends and
family not wanting to see them for fear of contracting ebola. There’s a common
theme running through most examples, it’s always in reference to children. I
was talking to one Save the Children medic on my flight just now who says he
cannot go home to his wife and kids for the next 21 days because his children’s
school will not allow them to attend if he sees them for fear of spreading
ebola. Similarly, following very honest discussions with my brother, it was
also decided that it was probably best I didn’t attend my nephew’s birthday
party on Thursday, not because of the risk to his family but the concerns of
the other kids’ parents that will be there too. I completely understand where
this worry originates. I think the vulnerability of precious, innocent children
and our inability to quantify risk appropriately as human beings leads to an
emotive sense of overprotection. If the image of a sick, weak and confused patient vomiting blood doesn’t warp
one’s sense of risk then I’m not sure what will. <span style="mso-spacerun: yes;"> </span>Over the next 10 days I’m just going to have to remind myself
of how I felt back at the end of November when I impulsively washed my hands
after meeting a co-worker from Kings. Sometimes <a href="http://claireferraro.blogspot.co.uk/2014/12/irrational-fears.html">fears are irrational </a>and
there’s nothing we can about that. Let’s just hope I avoid getting the 'flu (and a fever that gets confused for ebola) so that I can actually
attend my interview on Thursday!</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-64738166791042426762015-01-19T12:19:00.000-08:002015-01-26T03:16:41.762-08:00Non-ebola health services<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9ahnjxzHuY9IobbbRm3qVmeQQQ_SP5aZDYVKIRk2FUhiWtLIds17nR77DZZCvB5TmtB039QhfJfs_CN2_ghyo3eCx04qyfeprE2O2mHJ-Dsi7qAqwxbE_F9-ShMBgRTZvvhyphenhyphenv-yMf0pE/s1600/Connaught+ambulance.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9ahnjxzHuY9IobbbRm3qVmeQQQ_SP5aZDYVKIRk2FUhiWtLIds17nR77DZZCvB5TmtB039QhfJfs_CN2_ghyo3eCx04qyfeprE2O2mHJ-Dsi7qAqwxbE_F9-ShMBgRTZvvhyphenhyphenv-yMf0pE/s1600/Connaught+ambulance.jpg" height="240" width="320" /></a></div>
<div class="MsoNormal">
Our small (piece of the pie) holding unit has been half empty most of the week. Of those isolated patients only a handful have been confirmed positive. Obviously if this is a trend that is reflected across the
district/country then it is really encouraging. However, what it has done is
expose the vast shortcomings of the general non-ebola healthcare system that is
left behind, neglected in the past few months but also chronically
under-resourced for years.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some of the suspected patients who test negative are sent
home but many require ongoing medical care. Obviously they arrived unwell and
it’s understandable that our generic one-size-fits-all 24 hours of antibiotics
and anti-malarials hasn’t cured them. So we often refer patients to the
observation department (which is the equivalent of a short-stay acute medical
ward) from where they can be admitted to the wards. Registration to see a
doctor costs 15,000 Leone (£2) and admission costs 30,000. Patients, or
relatives, have to pay for all investigations, blood tests, medicines, even
equipment – such as IV giving sets, canulas, catheters and catheter bags (the
latter two cost 16,000 Leone (£2.15), surprisingly cheap - I thought!). This
payment system was set up from structural adjustment programmes by the World
Bank in the 1980’s. A relative or caregiver has to stay with the patient at all
times to help with general care of the patient – bathing them, taking them to the
toilet, providing food, whilst the nurses do drug rounds, take observations,
change dressings etc. In many ways this system works quite well because
individuals are often very well supported by family members. It’s
only when homeless or ‘destitute’ patients are unwell and need admission that
the true limits of such a privatised health service are revealed. There is certainly
no social welfare system here. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are a number of reasons why our negative patients are
not particularly welcomed on the wards;<span style="font-family: Onyx; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="text-indent: -18pt;">Stigma – suspicion that being inside the unit has
caused cross-contamination and/or possibly a general distrust in the lab
results</span></li>
<li><span style="text-indent: -18pt;">Jumping the queue, every day there are lots of
patients that need to be admitted from A&E through Observation Ward, but
our negative discharges get priority so that they free up isolation beds in the
holding unit. There’s no A&E overnight either so there are often queues of
patients in the morning waiting to be screened and see a doctor. (I actually
think this is a good sign as it shows that people’s faith in the system is
improving as they recognise that non-ebola healthcare is getting back up and
running compared to a few months ago.)</span></li>
<li><span style="font-family: Onyx; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">No caregiver or relative – we always try to
contact the relatives when our patients are discharged but sometimes it proves
so difficult to get in touch with them. Incorrect contact details on the form,
mobile phone network issues, etc. meaning there’s often quite a delay in them
arriving to care for their sick relatives</span></li>
<li><span style="font-family: Onyx; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">Financial - relatives not wanting to pay or not
being able to afford to pay registration or admission fees.</span></li>
</ul>
<br />
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<o:p></o:p></div>
<div class="MsoNormal">
Also, as a consequence of quarantine homes, community
surveillance and general awareness unwell individuals are being round up and
tested for ebola much sooner than they probably would present to hospital before
the epidemic. When ebola is ruled out there is an assumption that they should
see the doctor, they are in a hospital after all, resulting in an overwhelmed
and struggling general non-ebola medical system. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYMzHlkgAFVaOfiVOb9dGGx_hUgv0t8N3SCgVHbv9Yx5xec3Cs6yb7PuEKcGpWFK9AebFle0g8Yb3fhkAHbuaV8hXc7fL0LePaeZg0B14BLCOnq5FgWxGEHgNopdMQ5Qot7vbNH9o4GuE/s1600/Front+of+hospital.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYMzHlkgAFVaOfiVOb9dGGx_hUgv0t8N3SCgVHbv9Yx5xec3Cs6yb7PuEKcGpWFK9AebFle0g8Yb3fhkAHbuaV8hXc7fL0LePaeZg0B14BLCOnq5FgWxGEHgNopdMQ5Qot7vbNH9o4GuE/s1600/Front+of+hospital.jpg" height="300" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The front of the hospital: screening on the left, holding tent for<br />
suspect cases on the right</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
KSLP are very much involved with trying to get the health
system back up and running. One of my roles over the last few weeks has been to
do the ground-work for a large Infection Prevention & Control (IPC) United
States funded 1-year programme in four different hospitals, including Connaught Hospital, that KSLP will be
supporting. The grant will support 18 different
government hospitals in total and includes setting up a Patient Safety
Committee in each hospital, training all healthcare workers in IPC and
infrastructure improvements in Water, Sanitation & Hygiene (WASH). It’s a
very necessary programme as the concepts of hand washing, infection prevention,
safe sharps practices, appropriate antibiotic therapy etc are all quite novel
here but it will be good to build on the initial understanding that ebola has
generated. Hopefully, it will help hospitals stay open and healthcare workers
stay safe as ebola ebbs away (but flares up occasionally) over the coming
months.<span style="mso-spacerun: yes;"> </span>Personally, I’ve been
learning all sorts of new skills – how to scale up costs, the interaction and
co-ordination of large organisations all wanting to do the same thing, engaging
local leaders of hospitals in programme design and implementation and even the
difference between a septic tank and a soak away!<br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKUdPOhnjbbV-P9vnfhbxZniAU7YeNXzP516pi7lqBjwY-iMEsvQS2iP6Tri4yODF_Oo0tBPEoYW0VnkML_UhiKCACghBMU7O5xn5Qw_T42rlbGFF5vZqr2JqbLPjUgVUjs40OA4cGIVU/s1600/Kroo+Bay.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKUdPOhnjbbV-P9vnfhbxZniAU7YeNXzP516pi7lqBjwY-iMEsvQS2iP6Tri4yODF_Oo0tBPEoYW0VnkML_UhiKCACghBMU7O5xn5Qw_T42rlbGFF5vZqr2JqbLPjUgVUjs40OA4cGIVU/s1600/Kroo+Bay.jpg" height="400" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Brendan & Nat admiring the view of Kroo Bay from the hospital waste management site</td></tr>
</tbody></table>
<div class="MsoNormal">
It’s also been quite satisfying to get my medical brain back
in action in the last week or so whilst doing my clinical duties. (I do
apologise to my non-medic blog readers for this paragraph…) We have had a
number of patients in our screening tent that meet the case definition (fever
plus 2 other symptoms) but quite obviously have other diagnoses than ebola. The
only difficulty is we have to isolate them before anyone on the general wards
would go near them for fear of healthcare worker infections – a decision that
is entirely appropriate but frustrating as it limits our ability to give good quality
care. Last week I trained one of our new volunteers, Brendan, who is an
infectious diseases consultant in Wales in how our unit works and how to wear
PPE. (It doesn’t feel that long ago since Dr Tom was training me!) It has been
great to be on duty with him because he’s helping me spot-diagnose all the
other non-ebola medical problems. For example, a thin, malnourished older woman
with extensive cervical lymphadenopathy and parotitis (HIV/AIDS?), progressive
peripheral neuropathy and neck pain in a teenager (Spinal TB?), a young woman
with a stiff neck, altered personality, left-sided limb weakness, and left-sided
hemianopia over a few months (HIV – Progressive Multifocal Leucoencephalopathy?).
All these patients were negative for ebola but unfortunately I have not managed
to follow them up to find out confirmation of the diagnosis – assuming they had
the money to pay for investigations.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A particular case that has resonated with me this week is a
little boy who had been kicked in the left side of his abdomen when playing
with some friends at the weekend. His parents brought him in saying that he’s
complaining of abdominal pain, loss of appetite, weakness and possibly some
fevers over the last two days since the scuffle with his mates.<span style="mso-spacerun: yes;"> </span>He was doubled over in pain, breathing
fast, with a grossly swollen firm abdomen. I immediately wondered if this boy
had ruptured his spleen. He definitely didn’t look like he had ebola but all we
could do was isolate him (he officially met the case-definition) and give him
conservative management until his test came back negative. We spoke to the
surgeon on-call (hurray - even the surgeons have come back to work recently!)
and he confirmed our suspicions that they would not operate unless he had a
negative ebola test. So we admitted the little boy, away from his family, into
his own room (so as to minimise cross-contamination). We gave him fluids, IV
antibiotics and painkillers. I’ve never seen an adult, let alone a child, cope
with such obvious pain with incredible resilience; he didn’t even seem too fazed
to see me in PPE. The next day, his test unsurprisingly came back negative and
we were able to transfer him to the wards. In the end he got transferred to a
different hospital for a possible splenectomy (removal of spleen) so again, I
don’t actually know anything of his progress.</div>
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiINLrX6vEHV528c8DQ8jp8NQT3Fop563r5jquLYlxCORRgqnh4_taly2kvvxW7gTXQIE1Jvg4gOC0fVs0OokrqDG70fIEfhXSKotGIde029lQ5oSpN5kOEFHT9HT9BRjmmXIfG2JU7gn4/s1600/sweaty+me!.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiINLrX6vEHV528c8DQ8jp8NQT3Fop563r5jquLYlxCORRgqnh4_taly2kvvxW7gTXQIE1Jvg4gOC0fVs0OokrqDG70fIEfhXSKotGIde029lQ5oSpN5kOEFHT9HT9BRjmmXIfG2JU7gn4/s1600/sweaty+me!.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A sweaty post-PPE pic!</td></tr>
</tbody></table>
<o:p></o:p><br />
<div class="MsoNormal">
Just a quick mention of other non-ebola health problems
before I finish this mammoth blog entry! There was a general announcement via
various NGOs/hospitals this week to look out for cases of measles as the
children’s hospital had seen a couple of suspected cases. With childhood
immunisation rates down by 40-60% in some peripheral health units over the last
few months, the population has lost its critical herd immunity and are setting
themselves up for significant outbreaks. Not something we want to complicate
the post-ebola transition particularly.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The other obvious critical shortcoming of the non-ebola
health care in the last few months is the continuity of HIV/TB services. As most
hospitals were pretty much shut for the entire months of September to December,
and some still are closed, many HIV and TB patients were unable to attend their
routine out-patient appointments. Many have presumably stopped their
medications leading to the risk of developing resistant strains. UNAIDS
estimates that 1.6% of Sierra Leone is living with HIV in 2013 – although it’s
not clear from the UN report I’ve just read how this is calculated. HIV
patients are obviously more over-represented in hospital settings than the general
population but I have definitely seen signs of disseminated AIDS in many
patients. I would love to try and quantify the difference in service provision before,
during and after ebola though I
suspect that may be rather difficult!</div>
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<o:p></o:p></div>
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Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com2tag:blogger.com,1999:blog-3254486670151822403.post-9067967308199450422015-01-11T07:21:00.001-08:002015-01-26T03:17:15.844-08:00Ebola Myths<div class="MsoNormal">
I thought I would share a few myths about ebola that I’ve heard
about since being here… thanks to Ibby (Fixer), William, Patricia (nurses),
housemate Katie and night nurse Tamba for helping me compile this little list:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
1) Initially nobody thought that ebola was real. Everyone
thought the government was making it up so that they could invite more NGOs, agencies
and funding into the country and make hefty profits for themselves.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 3.3pt;">
2) Quote: <i style="mso-bidi-font-style: normal;">“A witch-craft was flying over the provinces and crashed into Port Loko
(a large town) causing a lot of deaths all of a sudden.”</i> I don’t even know
what to make of this - is it a bird? is it a UFO? No, it's a witch-craft! In
fact, of course, these deaths were actually due to ebola but the local people’s
strong traditional beliefs were the only thing that could explain such a
catastrophe. Lots of people in West Africa seek traditional healers <i>(‘herbalists’</i>) before attending
formalised medical care. One thing the local nurses here pointed out is that this means literally hundreds
of the traditional healers have died from ebola during this epidemic. Practices and knowledge are passed down by elder generations
within families so this loss will surely impact the availability of traditional
healers in the future, especially in the provinces. Although the nurses seem to
think that this will not diminish people beliefs. Currently we are seeing a
hotspot of cases in Waterloo, a suburb of Freetown, where there is a strong
dependency on traditional healers.</div>
<div class="MsoNormal" style="margin-left: 3.3pt;">
<br /></div>
<div class="MsoNormal">
3) All the patients that were taken to the hospitals were found
to be ‘positive’, in contrast to those who were sick and died at home.<span style="mso-spacerun: yes;"> </span>So began the association with white
doctors working in facilities and confirming ebola cases which was
mis-understood as white doctors giving people (i.e. injecting) ebola.
This spread a deep mistrust amongst the community and increased the fear of attending hospitals.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQO7fC86vKeVW5Lt6di1KS_wOIJXvHdq64huqmO8j9L-oJqgueuq9eh7ECXrzMadure9gqSYVNwgUEdhjkQxzrM4pr2UviWUHraSnib1DoEjFQWORmc156AlCYPmj_sYMTM9NU4HkbQ/s1600/photo+(29).jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPgQO7fC86vKeVW5Lt6di1KS_wOIJXvHdq64huqmO8j9L-oJqgueuq9eh7ECXrzMadure9gqSYVNwgUEdhjkQxzrM4pr2UviWUHraSnib1DoEjFQWORmc156AlCYPmj_sYMTM9NU4HkbQ/s1600/photo+(29).jpg" height="400" width="300" /></a>4) In August, a well renowned pastor from Nigeria had a vision
that if all people bathed in hot water and salt before daybreak they would be
protected from catching ebola forever. Apparently, it was attributed to a quote
from the bible about being cleansed of sin by washing in salt water. The message
was spread quickly across the country; bellowed out from all the radio stations,
repeated at church services, loud-speakers, whatsapp messages – you name it…
resulting in the whole country wanting to get their hands on some salt. Will
told me that in Kenema people turned up at the treatment centres with huge kilo
packets of salt to ‘cure’ the patients. In fact, just last weekend, I came
across remnants of this rumour myself. Amar (a Kings colleague) and I were at
the beach for the day and we took a boat trip up river to a small waterfall
with a man called ‘Heavy D’. He proudly told us that there was no ebola in his
village <i style="mso-bidi-font-style: normal;">“because we live by the sea”.</i>
Obviously I questioned him on this, trying to warn him that was not the reason
and he still needed to take precautions if anyone became sick, when Amar
pitched in to explain his thinking was related to the salt-water message from
August. I find it so worrying how inaccurate information can cause such
long-lasting false beliefs. It reminded me of the crazy rumour in Zimbabwe and
South of Africa that <i style="mso-bidi-font-style: normal;">“having sex with a
virgin cures AIDS”.</i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
5) A (almost) funny and verging on ridiculous rumour I heard
yesterday was about how Medecin sans Frontieres are screening for ebola at their isolation units. Just
as background, our screening process involves asking every patient that attends
the hospital whether they have a fever, or history of fever, in the last 3
weeks – if yes: they are asked a whole list of symptoms (vomiting, diarrhoea,
weakness, abdo pain etc), if no: they are asked if they have any contact
history with sick people, dead bodies, burials etc. In contrast, night nurse
Tamba told me his friend works for MSF in Freetown and their
screening process is completely different. According to Tamba’s friend, they
give a suspect patient a peanut and wait 5 minutes. If he vomits then he probably has
ebola and is isolated. If he doesn’t vomit he’s probably fine and allowed home!
I tried exposing the absurdity of this screening process to Tamba,<i style="mso-bidi-font-style: normal;">“do all patients with ebola vomit?”</i> No!
Even so, he still believed his friend and not me.<br />
<br />
And so the rumours continue…</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com1tag:blogger.com,1999:blog-3254486670151822403.post-31104743755486711232015-01-07T02:33:00.001-08:002015-01-07T02:33:15.379-08:00End of the middle?<div class="MsoNormal">
Sorry for the delay in posting my next blog. I’ve been
getting wrapped up in all sort of things but actually mostly non-ebola work and
starting to think about the post-ebola transition... I'm not sure I've got the balance of writing blog entries vs working in the unit quite right yet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So I stand corrected… maybe ‘The Surge’ is making a difference.
In the last couple of weeks there has definitely been an increase in the number
of holding beds (in isolation units where ebola suspects are taken) available.
Many of the beds are being filled with suspects rounded up by the community
teams who are going door to door looking for sick people in confirmed ebola
hotspots of the city. There were some initial suspicions that the community
teams were just isolating the elderly, the infirm and the homeless but if this
was the case then the proportion of suspects testing negative would have
increased and that, as far as I am aware, hasn’t occurred. In fact, in eastern
parts of the city, which is generally more crowded and poorer and consequentially
more ebola-ridden, the proportion of suspects testing positive is about 50% -
higher than in most areas. These diseases are always the same – <a href="http://www.lrb.co.uk/v36/n20/paul-farmer/diary">Paul Farmer</a> wrote a compelling diary entry back in October about structural violence and
health inequality relating to ebola.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Even the scale-up in laboratory testing is filtering down to
real improvements on the ground.<span style="mso-spacerun: yes;">
</span>We now have three collection times for blood tests in a day from
Connaught’s Isolation Unit: 8:30am, 12:30pm and 4:30pm. Yesterday, we had
patients admitted in the morning whose bloods were sent by 12:30pm and
amazingly the results were back by 7pm. This meant we were able to discharge
four negative patients home in the evening without them having to stay any longer
in our unit, minimising their exposure to possible positive patients. <span style="mso-spacerun: yes;"> </span>It also meant we could isolate the two
remaining suspects in the holding tent rather than sending them home to the
community. What a win-win situation <span style="font-family: Wingdings; mso-ascii-font-family: Arial; mso-char-type: symbol; mso-hansi-font-family: Arial; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">J</span></span> </div>
<div class="MsoNormal">
So it looks like things are starting to turn around; maybe
this is the beginning of the end or more likely the end of the middle. What
happens next in looking to the post ebola phase of health system strengthening
will be the subject of another blog entry. It certainly was and continues to be
the focus of the Kings Sierra Leone Partnership to make long-term positive
impact on the structure and quality of the health system and I’m excited to get
involved in a few projects that have a longer outlook and non-ebola focus. </div>
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<br /></div>
<div class="MsoNormal">
A little disclaimer – it’s very hard to get accurate
information about how the epidemic is progressing here. I suppose I am at an
advantage about not having the media cloud my perspective but the above
assessment is simply based upon discussions with colleagues and a general
feeling within the team rather than facts and figures that I have personally
have opportunity to see.</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-5128994802418778502014-12-28T11:13:00.001-08:002014-12-29T00:29:04.173-08:00An Alternative Christmas<div class="MsoNormal">
At about 4pm on Christmas Eve wherever you are in the world
it seems there is always some element of desperation to leave work on
time/early, the last-minute dash to the shops and frustrating traffic jams. For
a few of us at Connaught this process was interrupted by a phone-call from the
group that had already made it to the beach the day before warning us that we
may have difficulties. There were soldiers on the beach warning them that there
would be military personnel on the beach to enforce no swimming or use of the
beach on Christmas Day and that there would be absolutely no travel allowed out
of Freetown on Christmas Day. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Since I was fortunate enough to be in the group due to be
leaving on Christmas Eve and returning on Boxing day we chose to risk it and
set off for the beach in the afternoon via the supermarket for that all
important ‘dash’. We were stopped at a number of check-points along the new
Chinese-built super highway to Burreh Beach but had no trouble passing through
them as we were ushered along with chirpy “Compliments of the Season”, the Sileonian
equivalent of “Happy Christmas”. </div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsLXsKpjISBBk4WkEHO7wCa3v7ax1O2RoNWWo7bBg-qAaL4XRPooSNimwqRNUuL8G9-LpiDfrFeGHO36CajLY4wWKt-68sjkOQ37V7ET51gzDHhMUPfHtyQWTrlWQY3KPruHWnr6RWydY/s1600/beach+burrey.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsLXsKpjISBBk4WkEHO7wCa3v7ax1O2RoNWWo7bBg-qAaL4XRPooSNimwqRNUuL8G9-LpiDfrFeGHO36CajLY4wWKt-68sjkOQ37V7ET51gzDHhMUPfHtyQWTrlWQY3KPruHWnr6RWydY/s1600/beach+burrey.jpg" height="300" width="400" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And oh my goodness was it worth the ‘risk’. A beautiful white-sandy
picture-perfect expansive beach. We were staying in little huts (well actually I
was camping, why not make it an even more alternative Christmas?!) right on the
beach, nestled in amongst the bustle of Burreh village and next door to the Sierra
Leone’s first <a href="http://magicseaweed.com/news/sierra-leones-first-surf-club/4806/">surf club</a>. Unfortunately, the swell was less than 1 foot high so no actual surfing took
place! Instead, Christmas Day for me entailed a 3 or 4 mile run barefoot along
the beach, followed by a dip in the bath-like clear warm sea, omelette and
coffee for breakfast and then present opening courtesy of guess who? My
wonderful Mum for a little pack of goodies including yet more Christmas yummy-things
for my colleagues, she’s getting quite a reputation! There was not a hint of
military presence on the beach all day and another car load of volunteers
arrived in the afternoon having worked the morning shift in the unit – they had
no troubles getting through the road blocks either.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYae_P7-AbRAvXrBG5W2HZBlmjcd7plzJCGqp6wmlLMr-u_romF6C4IIBPWNJyV80YfgcsfEK-oJ9PDC6MuDYGLlxUHrBLbayIaupB4fYjBNS9r3Aa3ALoIgi5SnQp8O0ZPI71kncl2Gs/s1600/opening+presents.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYae_P7-AbRAvXrBG5W2HZBlmjcd7plzJCGqp6wmlLMr-u_romF6C4IIBPWNJyV80YfgcsfEK-oJ9PDC6MuDYGLlxUHrBLbayIaupB4fYjBNS9r3Aa3ALoIgi5SnQp8O0ZPI71kncl2Gs/s1600/opening+presents.jpg" height="300" width="400" /></a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin: 0cm;">
After being here nearly two
weeks without a day off (completely self-inflicted as I went on a
general medical ward round with Dr Terry on my day off!) I was more than ready
for this break. It certainly felt like we were a world away from the stresses of
the ebola epidemic and daily challenges at the hospital. And yet, I was also very
aware that we were the privileged few that could leave all that behind and
comfortably turn our backs on the situation for a day or two. Even taking the
risk of meeting resistance at the road blocks or the potential of defying the
police presence by going to the beach sat uncomfortably with a few of us. We
felt like we were taking the luxury to celebrate Christmas when others had no
opportunity to do this. As a dear friend of mine wrote to me in an email this week... "isn't the world a strange place, where you can have such beauty and enjoyment in close proximity to such suffering." Too true.<br />
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg98eKDSFGmxQZx1Jzaak6frsqP-NvWgQ0d7E0LJVAlqNfHjOOi-wyWCkNby9NMhyYYryqqdKJIubPLgEjUboWSwbvm1kvFfU8Ib3gjkxTyGmm28bYt_khZhyphenhyphenIx6flSBRyo_oTn6CJIJA8/s1600/palm+trees+beach.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg98eKDSFGmxQZx1Jzaak6frsqP-NvWgQ0d7E0LJVAlqNfHjOOi-wyWCkNby9NMhyYYryqqdKJIubPLgEjUboWSwbvm1kvFfU8Ib3gjkxTyGmm28bYt_khZhyphenhyphenIx6flSBRyo_oTn6CJIJA8/s1600/palm+trees+beach.jpg" height="400" width="300" /></a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div class="MsoNormal">
On the way back in the evening of Boxing Day, feeling
refreshed and happily sleepy from maybe a little too much sun and fresh air, the polluted stench of Freetown hits you a hundred times worse than you’re expecting. Overwhelming
rancid fumes of exhausts mixed with burning plastic, as my housemate Katie puts
it, simply ‘the smell of poverty’. <span style="mso-spacerun: yes;"> </span>At a roadblock just entering the outskirts of Freetown we all
had our temperature taken by some guy in a grubby t-shirt who definitely didn’t
know what he was doing. They use these infra-red thermometers which are a bit
like a plastic gun, that you hold at your temple at a distance of 5-6cm to get
an accurate reading. This guy half-heartedly leaned across the driver to point
it vaguely at Pete who was sat in the passenger seat at a distance of maybe
50cm and told him his temperature was 30 deg C. He then directed it towards me,
a bit closer, and told me my temp was 34 deg C. He obviously had no idea what
he was doing and certainly didn’t know the range of a normal temperature.
Frustrated, I started to teach him how to use this thermometer, but he shrugged
his shoulders and claimed ‘but it’s quicker like this’. Oh dear, where to
start?!</div>
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If you haven't already seen it, tune in to Channel 4od to watch friend and colleague, Will Pooley's <a href="http://www.channel4.com/programmes/alternative-christmas-message">Alternative Christmas Message</a> for a few scenes from Connaught Hospital. </div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-76365233702203879302014-12-24T07:11:00.000-08:002014-12-24T07:11:27.259-08:00Christmas is cancelled… or is it? <div class="MsoNormal">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqKajoef-jT8UYKJ1fafxt1DOvv2Eg6CLf0LYsAcO4ENJ4qS8Nv5R5mVE3ZWSBNsg0ej5jHG5FpjMFzndlVG4ftE04eGHzAMbXqc1OV9eaIQXLJ3p-G_78PcyUbVXv1VJgIdIiug8SQdo/s1600/photo+(8).jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqKajoef-jT8UYKJ1fafxt1DOvv2Eg6CLf0LYsAcO4ENJ4qS8Nv5R5mVE3ZWSBNsg0ej5jHG5FpjMFzndlVG4ftE04eGHzAMbXqc1OV9eaIQXLJ3p-G_78PcyUbVXv1VJgIdIiug8SQdo/s1600/photo+(8).jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Inflatable santas</td></tr>
</tbody></table>
Last week the Sierra Leone government announced plans for “The
Surge”, an ominously named attempt to curb the spread of ebola before
Christmas. It’s a promise to scale-up community teams searching for unwell
patients, holding centre beds, laboratory services, ambulances, treatment centre
beds and burial teams. So basically what everyone has been trying to do for the
last however many months. It came into action on Wednesday 17<sup>th</sup> Dec,
overnight. Yesterday, a local radio station interviewed me to give my
assessment of whether it had made any difference. Firstly, it has to be said, that I am working in only one ebola holding units of many, a
very small piece in a big jigsaw - I think there are 11 in the Western Area
(Freetown and surroundings), so whatever I see first hand cannot be
extrapolated to the whole area but to me it hasn’t made an obvious difference.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiewRRXSNgfAzMUmFsT-9bTzM8g8hMLPdR4aSjs4CPvbEpWAoTAbMKR73assmMii2hwksLN_AkH3EUVxNURe9Nte8rVU0wI2LO4uOSN7fgM3IRtTbr3qBtpQCfa9sOp-SF0YQfSInOffqY/s1600/eclairs.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiewRRXSNgfAzMUmFsT-9bTzM8g8hMLPdR4aSjs4CPvbEpWAoTAbMKR73assmMii2hwksLN_AkH3EUVxNURe9Nte8rVU0wI2LO4uOSN7fgM3IRtTbr3qBtpQCfa9sOp-SF0YQfSInOffqY/s1600/eclairs.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The chocolate eclairs disappeared in a day at the office!</td></tr>
</tbody></table>
Local staff members tell me that Christmas is simply the best time
of year in Sierra Leone. It’s not too hot and it’s usually one long party
month, music blaring with parties in clubs and on the beach in the lead up to
Christmas. You wouldn’t have guessed it from the Freetown I’ve come to know.
I’ve seen the occasional inflatable santa and Christmas decorations, but since
The Surge started on Wednesday I’ve noticed an even greater change in the atmosphere. The streets are empty and the place is relatively quiet. The government has ordered, in addition to the scale-up of resources, all
shops, restaurants, football cinemas and bars to close at 6pm on weekdays and
12pm on weekends. And yet, people don’t generally catch ebola from restaurants
or shops they catch it looking after their sick relatives at home. So in my
opinion this aspect of The Surge is only damaging the weakened economy even
further and it seems like an exercise to show that the police and army can
still exert their power.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhitSbgrzkO__Whk-wq_nEcMQaf-dXza6sPdXB6ehH4EzSabrTlT2-0pKDT6b-hLweAxO3z8FY01afElk7qgE_lh_a7vYlT8zrbwhTB6Xk7VvxS1lrZ57SZohQ7J6YRnb1nNgp4yqtwHUw/s1600/photo+(9).jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhitSbgrzkO__Whk-wq_nEcMQaf-dXza6sPdXB6ehH4EzSabrTlT2-0pKDT6b-hLweAxO3z8FY01afElk7qgE_lh_a7vYlT8zrbwhTB6Xk7VvxS1lrZ57SZohQ7J6YRnb1nNgp4yqtwHUw/s1600/photo+(9).jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Christmas Cake was a big hit too!</td></tr>
</tbody></table>
On a personal level, it’s certainly making life
difficult for us volunteers because after a long day in the unit we value our
downtime, usually eating in restaurants or having a couple of beers together in the evenings.
We’ve had some recent serious discussions about stocking up on food supplies
for our houses so we don’t go hungry! As for Christmas - for us volunteers is very
much NOT cancelled. The admin staff here have done a fantastic job of making
sure that we all get a couple of days break over the Christmas period whilst
ensuring enough staff remain on duty in the unit. So at various different times
this week we’re all heading off to the beach for a couple of nights of well
deserved ‘downtime’, fun and festivities on an idyllic white sandy beach,
swimming in the sea, with newly formed friends. Not a bad way to spend my first
Christmas ever away from home… <span style="mso-spacerun: yes;"> </span></div>
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Happy Christmas one and all.</div>
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Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com1tag:blogger.com,1999:blog-3254486670151822403.post-89593248925262493742014-12-19T07:03:00.002-08:002014-12-22T12:58:11.586-08:00The Isolation Unit at Connaught Hospital<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Times, 'Times New Roman', serif;">I’m not quite sure where to start… time passes in strange
ways here, I arrived less than a week ago and yet it feels like I’ve seen so
much, met many amazing people and beginning, ‘slow slow’, to get my head around
the current situation.</span><span style="mso-spacerun: yes;"> </span><span style="font-family: Times, 'Times New Roman', serif;">I also
should warn you that this blog makes for fairly upsetting reading. I promise to
try and focus on less gruesome topics in future blogs but I thought it was
quite important to set the scene initially.</span><br />
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<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Times, Times New Roman, serif;">So I’ve started working in the Isolation Unit at Connaught
Hospital. I had 3 days of thorough one-on-one training about PPE and the how
the unit runs from Tom, an HIV Consultant from South Africa, who has been here
for about a month. We talked through the PPE training together in a classroom,
then practiced putting it on and off in the correct 22 steps and order. On
Friday, I walked through the unit for the first time for an induction. Eyes
wide open, blinking through the foggy visa of my mask, hands clasped firmly at
my waist in a surgical pose, not touching anything but just allowing it to sink
in. I then continued to shadow and work with Tom for another couple of shifts
until now it feels like I’ve always known how to wear PPE. <span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<span style="font-family: Times, Times New Roman, serif; mso-spacerun: yes;"></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWDIAJB49JHxHOyWsVuOs3-ib4V53FwHX5ZJXU8WJhlLtQbEoRq0HfUTzgIwEWfePWLdNsbyBjUB6CDargKLNlR2LlP4NYCB3zd_HJFc3h1XOw9UCYB35nB-yXxIluCnx2A3oYgOkfA9w/s1600/PPE+1.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Times, Times New Roman, serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWDIAJB49JHxHOyWsVuOs3-ib4V53FwHX5ZJXU8WJhlLtQbEoRq0HfUTzgIwEWfePWLdNsbyBjUB6CDargKLNlR2LlP4NYCB3zd_HJFc3h1XOw9UCYB35nB-yXxIluCnx2A3oYgOkfA9w/s1600/PPE+1.jpg" height="400" width="300" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Times, Times New Roman, serif; font-size: small;">Getting into PPE</span></td></tr>
</tbody></table>
<span style="font-family: Times, Times New Roman, serif;">We have 16 beds and 2 cots in our unit. All patients coming to the hospital are screened outside the front entrance with a questionnaire. If there are any suspicions that they have symptoms of ebola (fever and 2 other symptoms) they are then isolated in a tent outside the hospital gates. Once there is a bed available in the unit, our role as doctors is to take a patient from the tent into the unit to have their blood test taken to confirm ebola or not. We try to take the sickest patient first; Tom tells me an easy way to triage is to do a very crude visual check; the sickest (and therefore most infectious) are first to get in the unit are those usually lying on the floor, then those sat on the benches and finally the least unwell are standing. The first day I arrived there were about 10 patients in the tent, some had been there for more than one day. The alternative is to send patients home with a self-isolation pack and tell them to come back tomorrow – a less than ideal situation given the risks of onward transmission. And yet, this screening tent is the reason why Connaught Hospital has remained open for non-ebola medical care compared to most (if not all) other hospitals. Without a screening process, the patients all sat together in the A&E waiting area and the staff would have no idea until it’s potentially too late whether someone is a suspect ebola patient or not. This is the way healthcare workers get sick and fear spreads causing doctors and nurses to quit - something I can completely understand. As it is, at the moment, the rest of the hospital (300 beds) has only one doctor (Dr Terry, a recently retired medic from London). All the junior doctors are currently on strike and the other few senior doctors have all died of ebola in the last few months – their faces in posters haunt the corridors; a continual reminder of the consequences of this devastating epidemic in a country that only had about 350 doctors at the beginning of the year.</span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5KuW1YZ-edAl1Uu3mmpdCH6b7t2UaGHfix6rb_zxViE7NEWJLMDQoZ9VRm0BXf9z0AxktivFM988tpfCgOMIozGc5WRFxGSLYjXxmkqZVBlHH28XvBnMM9-PtWtI2uejiB837VMjzdfo/s1600/PPE+2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Times, Times New Roman, serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5KuW1YZ-edAl1Uu3mmpdCH6b7t2UaGHfix6rb_zxViE7NEWJLMDQoZ9VRm0BXf9z0AxktivFM988tpfCgOMIozGc5WRFxGSLYjXxmkqZVBlHH28XvBnMM9-PtWtI2uejiB837VMjzdfo/s1600/PPE+2.jpg" height="400" width="300" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Times, Times New Roman, serif; font-size: small;">In full PPE - I'm smiling I promise, you just can't tell!</span></td></tr>
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<span style="font-family: Times, Times New Roman, serif;">Back to the Unit… once inside, a suspected ebola patient
gets antibiotics, anti-malarials, water, oral rehydration solution and a blood
test for ebola. They also get food twice a day from the hospital canteen. We
are trialling IV fluid lines in the more stable patients with full auditing of
any problems (there had been some previously) as rehydration is the most
important intervention available. The blood tests take 1 – 2 days to come back
so our 16 patients are told to stay in the beds, pee in one bucket next to
their bed, poo in the other, and wait. There is plastic sheeting hanging
between beds to prevent cross contamination. There’s a stench of chlorine (even
through the mask) from the buckets in every room where we wash our hands
between patients as we do all we can to try to prevent those negative patients
becoming positive during their stay in the unit. When the test results are
available, we give the negative patients a shower, a set of new clothes, a
certificate and a bit of money for transport home. The positive patients get
taken in an ambulance to a treatment centre – often Kerrytown, which is about an
hour and half drive away. </span></div>
<div class="MsoNormal">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Times, Times New Roman, serif;">There’s a fantastic team of local nurses and cleaners who we
work alongside. They are often in full spirits and have been really friendly
and welcoming to me. Inside the unit we all work together, helping patients to drink,
giving medicines, washing down the beds, clearing up diarrhoea, vomit and blood
and putting deceased patients in body bags and into the mortuary. It’s
gruelling, hot work and exhausting in full PPE. In the decontamination room, we
take off our PPE in the specific way required including the ‘shrug and wiggle’ move
to get the suit off.<span style="mso-spacerun: yes;"> </span>Lastly, we
all compare sweat patches! Luckily this last week has not been so hot as the Harmattan
has started (a West African dry wind that lasts for a few weeks).</span></div>
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<span style="font-family: Times, Times New Roman, serif;">My first shift proper, on Saturday, felt like a bit of a
jump in the deep end, but actually I’ve come to realise it was probably fairly
representative of an average day in the unit. Arriving at the main entrance of
the hospital, I noticed an elderly woman slumped in a wheelchair that not many
people were taking notice of, people just walking past her on the way to
A&E and other parts of the hospital. Her relatives were sitting on the
bench waiting for her to be seen at A&E themselves. I had no idea how long
they had been there. However, it was quite obvious to me that she had died. I
don’t know how long ago – whether she’d arrived at the hospital alive or even
had been transferred to the wheelchair already dead. A nurse walked by in
gloves & apron and, as I had no protective clothing on myself, she confirmed
the absence of pulse but she didn’t want to tell the relatives. So I broke the
bad news to the daughter, slowly, giving a warning shot, careful to use those
good communication skills that had been drummed into us at medical school, even
though we were stood there in front of her dead mother. She was upset but did
not seem too surprised. Informing Tom of the situation, it was only then that I
realised all sudden deaths had to be treated as ebola suspects. This woman’s
daughter had told me she had a history of high blood pressure so I had just
assumed she’d had a stroke, maybe she had, but the nature of the ebola epidemic
is that you can never be too cautious. So all sudden deaths have to be dealt
with full protection. <span style="mso-spacerun: yes;"> </span>That had not
occurred to me at all. Within, a few minutes, in full PPE we wheeled her into
the mortuary, took an oral swab for ebola, covered her in chlorine and put her
in a body bag with a nametag for an unmarked, unceremonious burial. There was simply
no time for the family to grieve. <span style="mso-spacerun: yes;"> </span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7yKBIZPz2Uwzm8Ccb2p76FxAnPzaaf-fGpspyx6I4HC_Ba4Ki8c7pWsiC2mUI0XPm0vcdzfp0w_pbPsgxPjHu-fzh1U84-VG-Mrs0BCEnVJkyF9oB6gR-cQIAINTac7cGi4bkF4s9tc/s1600/blue+house.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Times, Times New Roman, serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm7yKBIZPz2Uwzm8Ccb2p76FxAnPzaaf-fGpspyx6I4HC_Ba4Ki8c7pWsiC2mUI0XPm0vcdzfp0w_pbPsgxPjHu-fzh1U84-VG-Mrs0BCEnVJkyF9oB6gR-cQIAINTac7cGi4bkF4s9tc/s1600/blue+house.jpg" height="400" width="300" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Times, Times New Roman, serif; font-size: small;">A pretty blue wooden house we pass on our </span><br />
<span style="font-family: Times, Times New Roman, serif; font-size: small;">way to the hospital each morning.</span></td></tr>
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<span style="font-family: Times, Times New Roman, serif;">We then went to one of the open wards, where the nurses were
concerned a patient had ebola and wanted him taken to the unit. Walking into
the ward in full PPE, you could see the fear and silence descend amongst the
other patients and their relatives (a surgical ward - patients with awful third
degree burns, broken legs, head injuries etc). We transferred him to the unit
and placed him in the only free bed, next to a young boy who lay curled up at
one end of the bed facing the wall - the boy was the same age as my eldest
nephew. Sadly, the man we had transferred died a few hours later before he had
his ebola blood test taken so we took swabs instead. Again we put him in a body
bag and transferred him to the mortuary. All the while I was thinking that poor
little boy is witnessing such horrible scenes, how can he comprehend it all? He
must have been so scared.<span style="line-height: 150%;"> </span>In the isolation unit the scene can vary drastically day to
day. The sickest patients nearly always end up lying on the floor, confused and
too weak to move. They are also sometimes found lying in pools of diarrhoea and/or
blood just next to comparatively well patients sitting quietly on their bed
looking fearful. On Saturday, one agitated
patient, muttering to herself, had actually pulled herself towards another
patient, holding onto his bed linen. It’s difficult to give any sort of
reassurance through the barriers of the PPE and the patients unhelpfully just
have to wait and sit it out.</span></div>
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<span style="font-family: Times, Times New Roman, serif;">The busiest time of day is when results are available and
there’s a mass change over of patients in the unit. Yesterday the little boy,
who had been curled up facing the wall, was discharged because he had tested
negative. He was given new clothes, some jeans that were far to big for him, a
yellow t-shirt and new flip-flops. He left the unit via the clean entrance
where I was ready to greet him with a certificate and 10,000 Le (£1.30) to get
the bus home. He was quiet and I’m not sure if he really understood the
situation. With my arm around his shoulders, I gave him a big squeeze – the first
human contact he’d had in 3 days, I tried to make him smile and reassure him
that everything would be ok. We contacted his family and they came to pick him
up an hour or so later. I was worried that this would be the first time I would
witness first-hand stigma from his family, but thankfully I was pleasantly
surprised. <span style="mso-spacerun: yes;"> </span>His mother and
grandmother arrived, all smiles, gave him a big hug and took him away. We are
all thankful for those moments of happiness which so important to hold onto in
such terribly difficult times.</span></div>
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Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com1tag:blogger.com,1999:blog-3254486670151822403.post-41298260111888502082014-12-12T09:36:00.001-08:002014-12-12T09:36:58.391-08:00A big thank you<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">I just want to say an enormous thank
you to everyone who has sent me their well wishes, either directly, on facebook
or via my mum! (I know she's been telling lots of people!)</span><span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br />
<br />
<span style="background: white;">Here's a little collection of cards I'm taking
with me :)<o:p></o:p></span></span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheVqZ_0j552iUWuBMEsT1lUmcnXRb86vuH4mdsnwv6L2fEokodo4NHZF0J6zdY7SMNS7z8St9kLJXu3VPHVn7K-FvhWZPWPcrRRxPw0fRDcL-aOE0OWFtQYpG9wIwy88nlPAdCtB1OIOI/s1600/photo+(3).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheVqZ_0j552iUWuBMEsT1lUmcnXRb86vuH4mdsnwv6L2fEokodo4NHZF0J6zdY7SMNS7z8St9kLJXu3VPHVn7K-FvhWZPWPcrRRxPw0fRDcL-aOE0OWFtQYpG9wIwy88nlPAdCtB1OIOI/s1600/photo+(3).JPG" height="300" width="400" /></a></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br />
<br />
<span style="background: white;">It has meant a tremendous amount to me to know that
so many people are supporting me, praying for me and generally keeping me in
their thoughts. I'll try update this blog as much as I can - if there's
anything you particularly want to hear about please let me know. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
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<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">I'd also love to continue to hear
from friends and family while I'm out there so please email me and keep in
touch… a few routine day-to-day tales of ‘normal life’, especially over
Christmas would be fab. </span><span style="font-family: Times; font-size: 10.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-39004777616410556602014-12-12T08:43:00.000-08:002014-12-12T08:43:11.741-08:00What to pack?<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="color: #222222;"><span style="background-color: white; font-size: 17px;"><i>I've arrived safely, settling in and everything's fine so far! This is a blog that I wrote the day before yesterday that I can upload with the wifi at the office :) ... more updates to come soon.</i></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">So I'm sat in my living room and the
day of departure is finally here. In front of me are piles of clothing, a
few pairs of shoes, 20-something pairs of socks (they recommend bringing plenty
as you sweat through 2 or 3 in every 6 hour shift wearing PPE), a lantern, a UV water filter, my bikini, and various other things that I hope will be useful.
I'm also taking a suitcase full of important equipment for the charity e.g. thermometers,
printer toner, a couple of laptops. Finally, my parents are on their way to my
house to bring me a 3rd suitcase which is stocked with yummy Christmas
treats for the staff at Connaught Hospital!</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br />
<span style="background: white;">(My mum has a sneaky habit of winning raffles
and other such prizes. Sure enough, at the Missenden Christmas Fete last
Saturday... mum not only won the main prize of a luxury Marks&Spencer's
Christmas hamper and a 4.5kg fully iced Christmas cake but also the 'guess the
number of sweets in the jar' (521 chocolate eclairs!). Combine that with the 4
packets of mince pies that Kings SLP sneaked into their suitcase, and the
volunteers at Connaught might begin to feel a bit spoilt.)</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><span style="background: white;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS9okQw01vv1eljrngnlG7RHIqrth0qWJlONbceUNVmqdks1y8fVNXbGkPqdJrA4x7PINrrU7guME336hte5mh_OlquQHSBx4aKDaSUmTzt-g77QZHUE0jqknwrBwQGfrg4Fefxh_Us3g/s1600/xmas+goodies.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS9okQw01vv1eljrngnlG7RHIqrth0qWJlONbceUNVmqdks1y8fVNXbGkPqdJrA4x7PINrrU7guME336hte5mh_OlquQHSBx4aKDaSUmTzt-g77QZHUE0jqknwrBwQGfrg4Fefxh_Us3g/s1600/xmas+goodies.jpg" height="240" width="320" /></a></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br />
<br />
<span style="background: white;">So having had 6 weeks since my interview to
prepare and get my head in gear, how do I feel?The main emotion, at
the moment, is definitely excitement. That might come as a surprise and obviously there is
a healthy amount of fear and anxiety mixed in there too. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">In fact, I had a real nervous period
a few weeks ago. Initially, it was fear of contacting ebola via a needle stick,
slipping in my PPE or even an unknown exposure in a public space. I even had an
unnerving dream I was inside the Royal Free Hospital my parents encouragingly waving
back at me through the plastic sheeting. But actually fears of
contracting ebola have been somewhat alleviated by the few returning volunteers
I’ve spoken to and general communications with Kings who know their protocols
are tried and tested and are safe. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; text-autospace: ideograph-numeric ideograph-other;">
<span style="background: white; color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">A but of an ‘eek’ moment was when I found out
the accommodation facilities were fairly basic; external water supply,
generator electricity for the lights and fridge only, meaning there would be no
getting home from a tough day at work, having a normal shower and settling down to a good DVD, and
certainly no wifi. This made me doubt my ability to mentally cope outside
of work. Once again, however, having spoken to a few returning volunteers, they report conditions are not too tough. They reassured me that the team of volunteers is so friendly
everyone makes sure there is sufficient ‘down time’. Hopefully I'll be able to send an update in a few
days... So ultimately now all those fears have been
replaced with excitement and eagerness to get out there.</span><span style="color: #222222; font-size: 13.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><br />
<br />
<span style="background: white;">However, if you've been watching the same news
programmes and media sources as me then you'd be forgiven in thinking ebola is
no longer much of a problem. It's certainly not half as prominent a news story
as a month ago. I’m beginning to kick myself that I hadn't gone earlier and worried
that there wouldn't be much for me to do when I arrived. And yet my daily
HealthMap ebola email last night told me otherwise, it's 3 main alerts related
to Sierra Leone: 1) More ebola cases recorded in SL than Liberia... 2) Junior
doctors in ebola-plagued SL stage strike... 3) Ebola still spreading fast in
western SL. So the demand for help on the ground is still very acute and it's
with slightly anxious anticipation but lots of excitement that I pack my bags,
hoping I've also packed my courage!</span></span></div>
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Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-26220396632527712732014-12-08T01:37:00.000-08:002014-12-08T01:37:19.740-08:00Irrational fears?<div class="MsoNormal">
I’ve had quite a few conversations with people about what
happens when I get back. My housemate cautiously asked me the other day,
“Claire, will you, um, be staying here when you’re back?” gulp, an uneasy look
in his eye. I can completely understand that there is a fear that returning
healthcare workers (or members of the public, for that matter) bring back ebola
to the UK. The issue of enforced quarantine certainly reached the <a href="http://www.reuters.com/article/2014/11/03/us-health-ebola-usa-poll-idUSKBN0IN28820141103">media headlines</a>
in the US in a big way. I don’t think it has been very well explained in media
that unless someone starts showing symptoms they are not infectious and they
pose no risk to others. So I took the time to explain to my housemate that he
will be perfectly safe to live with me, share the same cutlery, sit on the same
loo etc when I get back as long as I am well (i.e. no fever, muscle aches,
diarrhoea or anything else). And trust me if I have any doubt that I am
developing any symptom whatsoever I will lock myself in my room and call 999
requesting a PPE-pick-up (personal protective equipment) ASAP.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Armed with this knowledge and understanding of the virus’ transmissibility
my first ‘hands-on’ (excuse the pun!) irrational fear of contracting ebola took
me completely by surprise. It was last week when I went to the Alma Mata talk
at the Royal College of Physicians. I met one of the returning KSLP volunteers
after the talk. He had just got back from Freetown a few days before and
without any thought I held out my right hand to greet him. He made some
reference to no-one shaking hands in Sierra Leone but he would allow me to
decide whether to shake his or not now he was back in the UK. (I already noted
that he had said earlier in the talk that he didn’t have a fever and I’m sure
he wouldn’t have been there if he did!) I grasped his hand in mine and gave it
the firmest shake I’m capable of, I think my left hand might have joined in as
well just for good measure.<span style="mso-spacerun: yes;"> </span>Almost
immediately, I realised I had the picture of <a href="https://www.google.co.uk/search?q=obama+ebola+survivor+photo&es_sm=91&tbm=isch&imgil=A0wVn0o2-8emIM%253A%253BA-XBopNglgfGIM%253Bhttp%25253A%25252F%25252Fwww.koreatimesus.com%25252Fcured-of-ebola-nina-pham-gets-a-hug-from-obama%25252F&source=iu&pf=m&fir=A0wVn0o2-8emIM%253A%252CA-XBopNglgfGIM%252C_&usg=__y32qowOMgJQpziuEAS_49EaUSRw%3D&biw=1199&bih=706&ved=0CDYQyjc&ei=5XCFVOOVEcnoUtDag-gP#facrc=_&imgdii=_&imgrc=ilyFwZtanpILVM%253A%3B0TOa2LpAP8zPZM%3Bhttp%253A%252F%252Fthenypost.files.wordpress.com%252F2014%252F10%252Fusa_obama_ebola-1.jpg%3Bhttp%253A%252F%252Fnypost.com%252F2014%252F10%252F24%252Fdallas-nurse-free-of-ebola%252F%3B2000%3B1334">Barak Obama</a> demonstrating how one
should approach a survivor of ebola in my mind and not someone who may be
incubating it! All of a sudden I became distracted, he was talking to me but I
wasn’t really listening, all I wanted to do was wash my hands! I knew I was
being irrational but a moment later I made some excuse to run to the bathroom
and scrubbed my hands a few times until they were clean, then a bit more! I was
so annoyed with myself for letting my irrational fear overcome sense and
science. </div>
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<br /></div>
<div class="MsoNormal">
This experience made me really aware that it doesn’t really
matter how many times I say to my housemate or anyone else that they will be
safe. There’s always that human instinct of distrust and fear and I suppose
that’s what the media has taken grip of unfortunately. All I can do is be
respectful of how this pathogen makes even the most sensible of us feel and try
not to be too judgemental or condescending! </div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com2tag:blogger.com,1999:blog-3254486670151822403.post-61516497681711817402014-12-06T15:00:00.000-08:002014-12-08T07:25:46.512-08:00I'd be nothing without my family... <div class="MsoNormal">
One of the first questions most people ask me when they find
out I’m going to help with the ebola crisis is “ What do your parents think? “
I am extremely fortunate to have a very supportive family who are behind me all
the way. That doesn’t meant they are not nervous, obviously they are. The two
are not mutually exclusive. Actually, I think my mum’s doing remarkably well
keeping her worries mainly to herself. The occasional bubbling thought, “have
you got your malaria tablets yet?” or “will you be ok getting from the airport
to the boat at 4am, when you arrive?” pops out somewhat accidentally.<br />
<br />
My nephews on the other hand were a bit more blatant with
their fears, little cries of “Auntie Claire, don’t die, don’t get ebola, come
back!” accompanied by humongous hugs around the waist. This was the goodbye I
got in the A&E reception of Nottingham Queens Medical Centre (where my
littlest nephew had just been admitted with croup the day the family were all
together at the end of November – he’s fully recovered now). I found myself
fighting back the tears. I didn’t want the boys to see that “cool” Auntie
Claire is actually quite nervous about getting ebola and does very much want to
come back. Children really do have an uncanny way of saying exactly what’s on their
mind, and yours, with no holding back. I love them to pieces.</div>
<div class="MsoNormal">
<br />
I think one of the toughest things I’m going to find when
I’m working in Connaught Hospital is looking after children with ebola. My
nephews’ fear pale into insignificance in contrast to the reality of so many
children who are fighting ebola themselves or are orphaned and vulnerable
having witnessed their whole families torn apart by the disease. I read a
wonderful light and cheerful <a href="http://www.telegraph.co.uk/news/worldnews/ebola/11267741/Ebola-Diary-The-survivors-who-go-back-to-the-front.html">blog</a> by one of the volunteers at KSLP at the
moment who is a paediatrician. I’m so looking forward to meeting all these
amazing people that I am going to work with.</div>
Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-27354341488306841202014-12-01T09:45:00.001-08:002014-12-01T09:45:50.216-08:00I want to be an Ebola doctor....Back in August when the world was slowly waking up to the scale of this epidemic in West Africa, I started thinking about how I could help. I started looking at MSF recruitment but they required doctors with 5 years training and infectious diseases specialists. No-one else seemed to be recruiting. I was stuck, I would have to resort to watching it unsatisfactorily unfold on the tv screen.<br />
<br />
Then on 22nd September this <a href="https://www.gov.uk/government/publications/to-nhs-staff-about-volunteering-to-help-with-ebola-outbreak">email</a> arrived in my work inbox and within 24 hours I had applied. In October, I also applied to the Kings Sierra Leone Partnership. To be honest, I wasn't sure if I would be qualified enough to go so it seemed like quite a distant idea at the time. Ever since that time though, with every article and news programme I watched about the increasing numbers of patients affected and the relief efforts struggling to control it, I knew I wanted to go and help and the sooner the better.<br />
<br />
I had my interview with KSLP on the 30th October, and a few days later it was confirmed that I would be ready for deployment at the beginning of December. Since then the weeks have been dragging by somewhat and now I'm just eager to get out there, do my PPE training, meet my colleagues, learn some Krio and help in the little way I can. Obviously as the time creeps closer, there have also been emotional ups and downs, fears coming and going, and recently a few teary goodbyes.<br />
<br />
I recognise that I am in quite an unusually convenient position in my career to be able to volunteer. I am currently on a year 'out' of training with no family or financial dependence, giving me a huge degree of flexibility. At a discussion panel run by Alma Mata on Thursday night it was frustrating to hear that a number of doctors 'in' training who wanted to volunteer were struggling to be released from their NHS commitments. There are <a href="http://almamata.org.uk/alma-mata-call-for-evidence-for-barriers-to-responding-to-the-ebola-outbreak/">all sorts of barriers</a> such as missing out on training, covering the rota, the threat of being quarantined on return (which currently doesn't and shouldn't happen, by the way, as it makes no sense from a public health perspective - there's no transmission in the asymptomatic incubation phase). Financial reasons shouldn't be one because DFiD is reimbursing the cost of replacing the doctors so that routine NHS care can continue. (I love the NHS!) The sooner we sort out some of these barriers the quicker more volunteers can be deployed and help in the efforts to contain the epidemic.<br />
<br />
Meanwhile, I have my flights booked... I leave on the 10th December, eek!<br />
<br />
<br />Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com0tag:blogger.com,1999:blog-3254486670151822403.post-70103663166462829072014-11-12T08:22:00.000-08:002014-11-19T02:42:54.370-08:00A bit about me, this blog and Ebola...Welcome to my new blog! Last week I found out I am due to start volunteering with the Kings Sierra Leone Partnership Ebola Isolation Unit in Freetown from December. I am equally nervous and excited and just feel really privileged to be in a position to offer assistance in this devastating epidemic. I hope to use this blog to track the ups and downs of my experiences and offer a bit of reflection on the situation on the ground whilst I'm there.<br />
<br />
So to introduce myself... I am Claire, a junior doctor living and working in East London. I trained in Newcastle which was fantastic; a medical school which generates well-rounded, academically competent but modest doctors who are really encouraged to focus on patient-centred care. I moved to London two years ago and have been working in Homerton Hospital where the population could not be more different from Newcastle if it tried! Personally, this is the best bit of my job; I love the fact that culture and society plays such a huge role in health beliefs and working in a hospital where most patients do not have English as their first language adds a certain complexity and excitement to the job.<br />
<br />
I've always been passionate about travel and global health. I think it's thanks to my family being seasoned travellers. My gap year teaching in a rural village school in Myanmar and exploring less frequented areas of Central Asia certainly set me off to a good start in independent travel. See my <a href="http://www.cferraro.blogspot.com/">travel blog</a> for more info. At med school, <a href="http://www.medsin.org/">Medsin</a> (a global health network of students) allowed me to channel this experience into focusing on education and advocacy of reducing health inequalities around the globe and on a local basis. My Masters in Control of Infectious Diseases at the London School of Hygiene & Tropical Medicine in 2010 was the biggest step in shaping my career so far.<br />
<br />
Now, as a qualified doctor, I'm really looking forward to applying the skills I've developed and the opportunity to learn from those in the thick of the Ebola response. I have certainly a steep learning curve ahead of me... from using personal protective equipment to learning some Krio, from logistic planning with other agencies to emotionally coping being away for Christmas for the first time in my life. So wish me luck and watch this space!Anonymoushttp://www.blogger.com/profile/02536862605462597126noreply@blogger.com1