Welcome to your Ebola Isolation Unit

A few people have been asking about what actually happens on the unit, so in an attempt to describe it, here’s a condensed guide to what you might expect, if you came into our unit.

In Connaught, KSLP run an isolation unit, as opposed to a Ebola treatment unit (ETU). This is essentially a screening and testing point for Ebola. Anyone that comes through the doors of the hospital passes a guy with a screening sheet and temperature gun. If you score enough symptoms you get put in a tent outside, if you are a contact or from a “hot spot” you’re streamed with a much higher index of suspicion. In general however, suspicion is high as at the moment things are concentrated on finding every single last case…

You get screened on the left and then wait in the tent on the right

If you’ve screened positive you’re now in the tent and one of us will then come out in “half PPE” (personal protective equipment) – face mask, visor, apron, gloves – to take a bit more of history, to help streamline treatment inside. No touching at this stage. You’re then admitted to the isolation unit. This is when you’d meet their first space man, “full PPE”. From the top down this is… mask +visor, full body suit, inside gloves, forearm length gloves, outside gloves and apron. We’d take you inside and if you’re vomiting or have diarrhoea place you in the “Wet” area. If not you’d go to the “Dry” area. We have started putting drips in people, so if you are unwell or can’t hold anything down then one of our Ebola Survivors (or sometimes one of the rest of us) would put a drip in you. At this point, you’d get the same treatment as every other admission – a buttock injection (intramuscular) of Ceftriaxone (antibiotic), an antimalarial, a 1.5 L bottle of rehydration solution and some paracetamol. We can give a few other things; anti-sickness, heartburn medication and sometimes if people are very confused and potentially a danger to themselves of others, some calming medication. This is a really trick one but you can imagine that its is more of a risk than in a normal ward, as you or anyone you touch may have Ebola, so we try to keep things calm and separate if we can.

As you’re being taken into the unit, we try and explain a few things. Firstly, try not to be scared by all the suits and by all the other people in the unit, some of whom may be quite unwell. The suits are just for our protection. We will keep you separated from other patients and won’t be re-using any of the same equipment. Once you are in, we’ll give you some medication (as listed above), try to drink as much as possible. If you want to use the toilet, there are two small buckets next to your bed, sorry that its not so private but I’m sure you can appreciate, we can’t have everyone using the same toilet. We will bring you breakfast, lunch and dinner. Your family can bring you food as well, but any containers they bring will have to be thrown away. On that note, all your clothes will also be thrown away at the end, we’ll give you some new ones to go home with. We can decontaminate your money, jewelry and phone. Someone will be coming in to take a blood test shortly. If it comes back positive, we will treat you for Ebola and you will be sent to one of our Ebola Treatment Centres where all the other positive patients go (ETU), if not you will be discharged either home if you’re better or into the hospital if not. Unfortunately if you’re symptoms have been around for less than 48 hrs, we’ll need to keep you to repeat your test, as early test may be negative. Finally, I’m really sorry but if none of us are here inside the unit we will need to lock the doors to your rooms. Just to warn you, the main door is quite stiff so makes a bang when we close it. We’ve had some people try to escape and I’m afraid this is potentially very dangerous for the hospital and the local area. Its a really difficult time for the whole country so please bear with us for this. If you really need something, people will be passing through frequently during the day, or otherwise please shout loudly.

Door to "Orange zone" for dressing and then "Red zone"

After this initial interaction we’ll largely leave you be, unless you are unwell when we can do whatever we are able to do, although we are slightly limited – we can’t take blood tests, or test your blood sugars, a this is too much of an infection risk. We will also come and change you if are incontinent. We’ll bring you medications (a daily bum injection of antibiotic, anti-malarials and some paracetamol), food and change your toilet buckets. All of this until you finally get the good news: Your test is negative! We (still in our space suits) take you to our shower room, and you have a final shower before being given new clothes and being picked up by another of the staff at the clean entrance. As a negative patient you get your “Negative” certificate and 10,000 (1.50) for transport home.

There is lots of stuff that goes on behind the scenes, obviously we CANNOT run out of chlorine, water or PPE, and there is a team of people dedicated to this and other logistics. On a busy 6 hr shift each person uses approximately 40 pairs of gloves and washes their hands at least 50 times per day; the decontamination process alone includes washing your hands 10 times.

Ebola isolation units, not a place for people with OCD

I guess you (as the patient) might think its all a bit overkill and even a little inhumane? And I totally see where you’re coming from on this. But, as far as I can tell, you and your family don’t. You all seem to understand the pickle of a situation the country is in and you all deal with the dehumanizing process much better than I imagine I could. So well done, thanks for doing your bit by getting checked out and congratulations on being Ebola negative!

“I go na I de come back”: First impressions of being back in Sierra Leone

Despite what I might write in the next few hundred words, it is good to be back in SL. The last time I was here was in 2007, as part of the Adventures of Paddy and Rob. It was a carefree time, for us a healthy mix of cycling around the country, swimming across rivers to pick up canoes for transporting bikes, visiting dodgy Lebanese diamond dealers through four levels of armed security and catching world breaking barracudas. For the country of Salone, it heralded the first free and fair elections since the Civil War, an event that erupted into a 2 day street party across the capital. After 3 months in the country, I left instilled with a feeling of hope for this young democracy, compact and filled with natural resources (gold, diamonds, aluminum, and oil and iron ore about to come online) was going places. However, after 7 years of being away, my first impressions one week in are a bitter pill to swallow. Although the tragedy Ebola still dominates the news and being here only makes it all seem more real, for me the backdrop is the more depressing story.

Kroo Town through the old army bridge

I won’t re-run all of the catastrophic stories of Ebola, many people have written about it with much more first hand experience. So many elements of it make it such an agonizing experience for the country of Sierra Leone – the pain that patients endure is amplified by the fear and isolation they, their families and communities experience. As always the personal stories are the most heart-breaking, across Connaught hospital posters commemorate doctors, nurses, staff and students – all heroic workers in the prime of their lives, cut short too soon.  For those many workers that have so far survived the epidemic there is no accolade (yes, even Time People of Year) too high. From my colleagues in the Kings Sierra Leone Partnership here from the very start of the outbreak, to 2 the 2^nd year qualified Doctors from the Sierra Leone army who, from scratch, set up and ran 2 treatment centres – seeing over 600 Ebola positive patients – I take my hat off to you. 

One of several commemorative boards in the hospital

When Rob and I visited before, I remember poverty; I remember seeing basic rural dwellings upcountry, and the slums of Freetown. I remember a city that, although busy with street hawkers, still wasn’t yet an over populated and chaotic scrum (maybe these are a rose tinted reflection?) With that sprig of hope I mentioned before and the stories of 6, 7, 8% growth I read in the papers, I thought when I came back this time, despite the Ebola epidemic, things would be better. And better to me, I guess, looks like something in line with my experiences in E Africa capital cites, slums that have waste management systems, basic sanitation, provision of schools and healthcare, and with some evidence of urban planning and infrastructure projects going on. In the capital, things for a burgeoning middle class to spend money on whether it’s shops and leisure, or (as in most African countries) a higher class of schools and healthcare.  But, it wasn’t here and isn’t here, Sierra Leone was poor and is poor, so poor it’s difficult to know where to start to describe the inequity that people here experience compared to almost any other country in the world. And I really don’t mean this in a patronizing “wow, it’s such a poor country, they really need help kind of way”, or in any way mean to dent the pride of a country rich in other aspects of life. But, in terms of the opportunities available to Average Joe and Jane Salone, things are tough. Tougher than most could imagine and, in my experience so far, with limited change over the past few years and, unless there is a seismic shift post Ebola, not much likelihood post Ebola.  There are stats that support this by placing Salone down the international scales, healthcare wise its maternal death rates and doctors per person, economics wise GDP person and world development index but for now, I’m just basing these, albeit limited, first experiences of being back.   

The picture I’m trying to paint is inextricably linked to but is also independent of Ebola, and should change with or without Ebola. The poor sanitation and lack of education are part of the reason it started and spread. The lack of influence and purchasing power on a global (pharma) market and absence of health infrastructure are the reason there is no vaccine already and part of the reason that the level of care that’s provided in many places is so basic that the best you can hope for (and don’t always achieve) is to give someone a clean sheet to die on.

If I left seven years ago with a feeling of hope, that one day I’d get to come back to a country flourishing, instead I’ve come back to country that I feel has been downtrodden, forgotten and then, when its completely down, kicked even harder.

Before I left, a friend told me try and tell the good news stories of Sierra Leone, I’ve failed miserably (sorry buddy!). So before I go and so I can try start where I left off, here is something positive. At the moment, all shops are meant to close on Sundays and after 7 pm, and a normally busy thoroughfare street became quiet. These kids took the opportunity to play an adapted game of British Bulldog and, by the looks of it were #lovinglife despite #ebola.

British Bulldog in Kroo Town slum

From the Ebola standpoint, I echo the hopes of many others by saying that maybe Ebola can be the ill wind that blows some good and be the catalyst for the world to act together and bring about some change, although this will require massive global commitment, as one article puts is a post-Ebola “Marshal Plan”. Personally, I feel it’s the least we owe these forgotten countries.