We began at 6:45 am when the sky brightened very quickly. Morning hand-over given by the night shift of one death. There were 33 patients, 15 confirmed and 18 suspects. This is a 52-bed ETU, just opened in mid-September.
There were a lot of handwashing in 0.05% chorine and 0.5% footbaths moving from one place to another but today I was only to go through the donning and doffing processes. So many things happened that we did not get to this exercise till the hottest part of the day. There were only x-large sizes of the more impermeable yellow Tychem suit so I wore the more breathable white Tyvek personal protective equipment (PPE). Here we wear three pairs of gloves for the donning, the first and third pairs are surgical and these are securely duct-taped to our suits. The sequence of donning is first a pair of surgical gloves then non-sterile gloves, space suit, N-95 mask, hood, apron, goggles and lastly the third pair of gloves again duct-taped to the gown. This could take about fifteen to twenty minutes to put on and checking is done carefully by a couple of monitors in the changing room.
The doffing procedure starts with the sprayer spraying our suit and gloves with 0.5% chorine and each step is interrupted with handwashing with chorine, third pair of gloves off after the duct-tape is removed, apron, goggles, hood, duct-tape, suit, N-95 mask, the last two pairs of gloves then handwashing in 0.5% chlorine and then rinsed with water.
In the heat of the afternoon, we walked a ways from the ETU to a forested area where the cemetery is. Four men in PPE just returned from the cemetery with an empty stretcher. A group of men, skin glistening with sweat have been hired to dig graves for the burial. Since the ETU opened on September 15, there have been close to thirty deaths. The men have dug several graves and they were in the process of burying a patient who died last night. A relative stood silently and watched. Apparently, many choose not to come to say their last good-bye in the ETU, it is uncertain whether it is the fear of Ebola that keeps them away or for other reasons. A baby died 13 days short of his first year. Some of the patients were related.
Closer to the evening hours, the results of the Ebola PCR came in, several patients in the Suspect ward were negative but it was too late to discharge most of them. Before the US navy came to set up the Ebola laboratory, it took four days for the test result to come from Monrovia, now it takes 4 to 6 hours. There was a positive patient that needed to be moved to the Confirmed Ward. So we gowned up in PPE to round up the respective patients. The goggles given to me were so huge that they pinched my nostrils making breathing difficult. Soon, it fogged up making me feel like I was under water snorkeling, I gazed at my surroundings through a thick haze.
In the midst of this flurry of activities, a patient in triage met the criteria for suspected Ebola. I went with another nurse to fetch him. Either he was too weak to get up to walk or he was absolutely petrified at the sight of us in our full PPE. With the dark ominous rain clouds hanging very low in the sky, harbinger of a severe rainstorm; we must look like hovering specters or apparitions. We helped him into the ward, pants soiled with loose stool, changed and cleaned him. He was breathing fast and looked dehydrated, a definite glint of fear in his eyes. We gave him a bottle of oral rehydration solution and the night shift would start an IV. What was it like to be cared for by us all dressed up in hazmat suits when the comfort of human touch was gone? As we departed, the rain came pelting loudly down on the tinned roof offering little solace to this lonely man covered by a white sheet sick as he was, left in a strange blue-tarped Spartan room lit by a squiggly energy-saving bulb. Deep in my heart I feared the worst for him. Death lurked around the corner. The fear in his eyes foretold his fate.
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