In this guest post, Emily from Two Dusty Travelers, tells us what it was like to work as a nurse fighting the horrific ebola outbreak in Sierra Leone:
When I decided to travel to Sierra Leone to help fight the unprecedented Ebola outbreak, people told me I was insane. I told them I was comfortable with the level of risk. One week into my trip, when a late-night power outage left me in pitch blackness, shrouded head-to-toe in a hazmat suit and surrounded by Ebola patients, I began to re-evaluate my definition of “comfortable.”
How Did I End Up Here?
A few months earlier, I’d heard a plea on the radio for healthcare workers willing to fight Ebola in West Africa. As a nurse with a background in medical missions who craves adventure, that actually sounded right up my alley. I applied with the non-profit Partners In Health as soon as I got home.
By the time I set foot in Sierra Leone the outbreak had been rampaging through West Africa for over a year. Before the final case was diagnosed, Ebola would claim over 11,000 lives with a grim mortality rate of 40%. Unlike previous Ebola scares, this time the virus wasn’t isolated to a remote village that would limit its spread. The first case caused a ripple in a major regional trading center in Guinea that would eventually swell and spread across national borders into six countries.
Set a viral hemorrhagic fever loose in the capital city of a developing country, and you’ll swiftly see how basic infrastructure can mean the difference between life and death. In the US, Ebola is fairly easy to contain. Remember the handful of cases which made their way to the States and then never really spread, despite the media hysteria? That wasn’t luck. That was thanks to modern hospitals and highly educated clinicians. But the over-worked and under-resourced health centers in West Africa were no match for Ebola. Without access to gloves, nurses spread the virus from one patient to the next and then to themselves. Without running water to wash their hands, one person could infect their entire household. Without public health education, locals still used traditional burial practices that often included touching the body, which could end up dooming an entire village.
In terms of healthcare, West Africa is quite simply a different world.
It may sound crazy, but I couldn’t wait to get there myself. As anyone who travels to developing countries knows, you’ll often find the most wonderful places hidden by misconceptions and bad press. I had already spent a year in total traveling around Africa, replacing the usual fears of violence and poverty with the reality of incredibly welcoming people and breathtaking natural wonders. Africa had gotten under my skin in a way that no other place had, and I wanted more.
I also wanted to help and knew I was uniquely qualified to do so. I had the time off work and my family supported me. So I had to face the fact that there was only one reason not to go: Fear. It felt wrong to choose that over people’s lives.
When the time came to finally board that plane to Sierra Leone, I won’t pretend I wasn’t scared. I sat in an airport bathroom stall and cried – but only for a minute. Because I honestly believe that the best part about travel is the opportunity to crack yourself open – to push your boundaries, learn something more about yourself and the world, and come back a little different; a little better.
Sure, fighting Ebola is an extreme example of that (as I sat in that airport bathroom, a trip to learn to scuba dive or volunteer at an animal sanctuary started to sound like much better options). But I’ve always found that the best results come from doing something that scares the hell out of me.
On the Ground in Sierra Leone
When our plane touched down in Sierra Leone’s capital, Freetown, excitement took over from fear. The customs area thrummed with energy and anticipation. Any tourists had long since left West Africa, so the only foreigners waiting in line for a Sierra Leonean stamp in their passports were aid workers. We were all part of the same club and we couldn’t wait to get started. It was like checking in for the most dangerous summer camp imaginable.
After a week of training with the World Health Organization in Freetown, I was ready to get my hands dirty with the rest of my team. Or rather, the plan was to keep our hands as clean as humanly possible.
“An hour with Ebola patients in Sierra Leone was enough to make me forget about the suit and the heat and the risk to my health, and just get pumped to get to work fighting the virus.”
Each time we entered an Ebola ward, we were required to put on a complicated getup known as Personal Protective Equipment, or PPE. Here’s what separated me from my patients as I tried to keep them alive and myself un-infected: Two pairs of gloves, an impermeable suit with a hood, a plastic apron, a face mask, a face shield, and rubber boots. To complete the outfit, a coworker would write my name and title in sharpie on my suit so that anyone could tell who was inside, with just my eyes peeking out through the plastic shield.
After spending months watching Ebola responders shuffling around in these suits on the news, it was surreal to actually be inside one myself. It was also very hot. Temperatures in Sierra Leone easily top 80 degrees Fahrenheit, and hastily-constructed Ebola treatment units definitely did not have air conditioning. Add on a plastic suit with no ventilation and a stressful work environment, and it’s not long before you have healthcare workers keeling over in their suits. In an effort to prevent that disaster, clinicians were only allowed to remain in our protective equipment for a maximum of two hours at a time.
However, getting the suit on was the easy part. Removing the suit (or “doffing” as we called it) is the real high-stakes moment. By the time I left the ward after seeing my patients, I’d have plenty of infectious material all over my suit. It doesn’t take much – if a droplet of infected fluid made its way into my eyes, nose, or mouth, I’d be on a countdown to a very unpleasant experience. So doffing was well known to be the riskiest time for exposure to the virus, and we took it extremely seriously.
The process of getting the protective equipment off takes 20 to 30 minutes if done correctly. So if you’re feeling even a little lightheaded in the heat or you think you might have to use the restroom, now’s the time to start getting out. Doffing also ideally requires multiple support staff, from a “sprayer” to douse you with chlorine before you start, to a buddy to talk you through the entire process and nit pick you for perfection from start to finish.
After being doused with chlorine by a coworker, I would enter a doffing station to begin the process of removing my suit. Most doffing stations had been hastily added onto structures that had never needed such a space prior to the outbreak. Ours was a basic shelter made of tarps stretched over a wooden frame. Brightly colored plastic buckets filled with chlorine solution and fitted with taps at the base awaited me on a long wooden bench. I would remove each layer of my protective equipment with painstaking focus and wash my hands with chlorine for a full minute in between removing each piece. The goal: Don’t touch any part of my body with any outside surface of my PPE.
Want a challenge? Put on some gloves, stick your hands in mud, and then try to take those gloves off without getting ANY mud on your skin. (We actually did this in training, and each time our enthusiastic Ugandan instructor found a fleck of mud on our arms, he’d exclaim: “Ah! You’ve got Ebola!”).
Once I had safely maneuvered my way out of the suit and had washed my hands for two more minutes with chlorine and then soap, I was advised not to touch my face for 30 minutes just in case some tiny drop of Ebola had found its way onto my fingers. Again, it’s harder than it sounds.
Then I’d take a break, chug a bottle of water, get back in my suit, and do it all again.
I sound like I’m complaining, but in reality I LOVED it. There aren’t many moments in life when you get to feel like what you’re doing is making a real difference. An hour with Ebola patients in Sierra Leone was enough to make me forget about the suit and the heat and the risk to my health, and just get pumped to get to work fighting the virus.
Facing Ebola in a Blackout
Which is how I found myself in an Ebola ward during a blackout.
I had entered the unit at about 9:45 PM for my second round of the night. Converted from a school after the outbreak brought public education to a sudden halt, the treatment center was made up of several large cement classrooms. Beds lined the walls, offering no privacy for our patients. With no running water, patients relieved themselves in a shared latrine if they were strong enough to make it there.
The ward felt eerie that night under the dim, humming fluorescent bulbs. My coworkers and I carried everything we thought we might need with us, since once you’re inside there’s no way to pop back out for that medicine you forgot. We had two hours ahead of us to try to care for as many patients as best we could before time was up and we had to get out of our suits.
I hurried through the unit in the hopes of finding my favorite patient still alive. Abass (names changed for privacy) was a 10-year-old boy who had been fighting the virus since I’d arrived a few days earlier. He was extremely ill and had become disoriented, so we had moved his mattress onto the floor to prevent him from falling and injuring himself. With such challenging physical conditions and limited resources, there simply weren’t enough clinicians to keep eyes on the patients 24/7, so I breathed a sigh of relief when I saw that Abass was still alive.
“There was no way of knowing if it would be minutes or hours before the lights came back on.”
Unfortunately, he had pulled out his IV line since we’d seen him on our last round. My coworkers and I eyed each other reluctantly, silently wondering which of us would be brave enough to start a new IV on him. If one of us accidentally stuck ourselves with a needle inside an Ebola unit, we would be automatically flown home, since the odds of contracting the virus in that case were enough to make us sweat even more. With two pairs of gloves hampering my mobility, poor visibility through my fogging face shield, and a disoriented patient, I wasn’t too excited about adding a sharp needle to the mix.
Fortunately, one of the Sierra Leonean nurses stepped forward without missing a beat. Showing absolutely no fear, she found a vein and had a line back in Abass’s arm in no time. It was moments like that one which left me in awe of my Sierra Leonean coworkers; I didn’t know many nurses back home who could start an IV on an agitated, dehydrated kid with two pairs of gloves in the way.
We hurried to hook Abass back up to IV fluids and were feeling quite pleased with ourselves when the unit’s fluorescent lights suddenly sputtered, flickered, and went out.
Everyone froze. In the long seconds it took for my eyes to adjust to the darkness, I tried to slow my breathing while I listened intently for anything that sounded like movement. If someone tripped and fell, or a confused patient reached out for help, it would be only too easy to accidentally tear my suit or let my face mask slip, and that could be the ball game.
We had been prepared for this in training, since power outages aren’t uncommon in Sierra Leone. There was no way of knowing if it would be minutes or hours before the lights came back on. We knew this meant we had to stop what we were doing and leave the unit as quickly as possible for our own safety. But we had only just begun caring for our patients! Leaving now would mean Abass could go hours before another nurse cared for him.
As we reluctantly trudged toward the exit, the lights flickered back to life as suddenly as they’d gone out. We didn’t need any more motivation than that to get back to work. Unsure of how long our good fortune would last, we immediately went about tending to our very ill patients.
I returned to Abass’s side and found him awake and calm. Since we know so little about Ebola, I had no medicine to offer him that could treat the disease directly. Our best bet was to support him with IV fluids, nutrition, and antibiotics to keep his immune system strong in the hopes that he could fight the virus off himself. Noting his chapped lips and sunken eyes, I drew up some baby formula in a syringe, squatted next to his bed, and held it to his mouth. To my surprise and elation, he swallowed it.
I spent the rest of my round enthusiastically cheering Abass on as I painstakingly fed him a few drops at a time. I couldn’t imagine how terrified he must be, alone and on the verge of death while being poked and prodded by strangers dressed like aliens. I wanted to tell him that we’d take care of him, but we didn’t speak the same language. With only my eyes showing through my suit, he couldn’t even tell that I was smiling at him. I did a silly dance and sang him songs, eliciting a few brilliant grins that gave me a hint of the playful boy he’d been before he was sick. All too soon our time was up, and we were forced to leave Abass to fight his battle alone.
I didn’t really mind the heat and the bugs and the risk of Ebola. Watching people die who would have survived if they’d been treated in America was what really got under my skin.
Why I Loved Sierra Leone
People still tell me I was insane to go to West Africa during the Ebola outbreak, but I’m so incredibly glad I did. It confirmed what I’ve experienced on every trip I’ve ever taken to a location that frightens people: That behind the scary stories, you’ll find a beautiful country and people who are just like you. In the worst of circumstances, I got to see the very best that humanity has to offer. I got to meet people who traveled from all over the world to help perfect strangers. I got to work with Sierra Leonean nurses and doctors who risked their lives to save their country. In between shifts, I caught glimpses of Sierra Leone’s gorgeous beaches, unique foods, and bustling marketplaces. Now that the outbreak is long over, I’d love to return and see the country as it recovers.
On the night of our surprise blackout, it was nearly midnight by the time I headed to the doffing station to begin the process of removing my PPE. The bustle of activity and noise that swirled around the unit during the day had evaporated. Skeleton staff remained for night shift, so when the stream from my bucket of chlorine slowed to a trickle and then ran empty halfway through doffing, nobody was immediately available to remedy the situation. I shouted for assistance and waited patiently as a coworker darted off for more chlorine.
I held completely still, my hands out in front of me. Despite the late hour, a drop of sweat carved a slow path down my back. A shrewd mosquito landed on my arm and took advantage of my inability to swat it away.
Clouds passed as I waited, allowing moonlight to illuminate the doffing station and my team members waiting behind me. A cool breeze offered sweet relief. I looked up to see the moon peaking through a gap in the makeshift roof, and smiled to myself at how lucky I felt to be where I was at that moment.
Comfortable is over-rated.
About the Author
To read the whole story on Emily’s experiences fighting Ebola in Sierra Leone, check out the series of posts she wrote while she was on the ground there.
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