Week #1

George left last Wednesday, the 5th, for a 42 day deployment to Tipeta, Nimba County, Liberia -- an eight hour bumpy ride northeast of Monrovia.  The team of  Americans convened at Dulles late afternoon on Wednesday after getting the call for deployment on Sunday, mid-afternoon, from Heart to Heart out of Lenexa, KS, a USAID grantee tasked with organizing teams into Liberia.  George's group is number one of 17 each to roll out at 4 week intervals over the next months.  There are many other agencies also deploying, including Partners in Health.  Interestingly, George has gotten his initial call-up from PIH since leaving for Liberia, saying they will be in touch soon.  The war on ebola seems to have come into full force this past week and while numbers of new cases are momentarily down in Liberia, Sierra Leone's numbers are increasing.

Here is his team at Dulles,  so you can put faces on these health providers.  Please do not post this photo as I haven't asked member's permission for broad dissemination, though I suspect it would be okay.  And, what follows is a log of emails from George this past week.  He very much wants to share his story in order to educate and humanize the work (that's pretty much like preaching to the choir among our dear friends, though the Red Cross nurse received over 200 hate mails in response to a television PSA about her deployment).  At any rate, read and know.  I shall post every Wednesday for the six weeks of his deployment.  

Thanks for so many positive letters, comments, prayers, and support to George -- and to me.  Betty







November 7

Well, it has been a whirlwind week!  Phone call Sunday, Monday and Tuesday doing paperwork for visas, contracts, etc. and then out early Wednesday.  First to Charlotte, then Dulles, and finally on to Dakar on an overnight flight.  We arrived at 6:00 am to an empty airport, hotel bus to the Radisson Blu and checked in.  It was surreal!  It was one of the swankest hotels I have ever stayed in.  Right on the beach, all in marble, a room overlooking a beachside pool and bar, and an endless breakfast table.  We were all disappointed as it was way too nice for the work we expect to do. Slept until mid afternoon, then read a little and early dinner in downtown Dakar.  Again, over the top.  A long wharf over the ocean with a cool breeze and a sunset on one side and a full moon coming up on the other. Great seafood grill and a cold beer.  Dakar is like most African big cities, packed high-rises, half finished high rises, tuck shops all along the road and people everywhere.  Back to hotel and listened to a small band playing at poolside bar outside my room.

Today up at 5:00 am and at 6:00 to airport for UN flight.  There at 6:30 for 9:00 am flight - nobody in sight and airplane locked tight.  Finally at about 8:00 people showed up to check us in and we left at 9:00 on time.  The plane seated about 50 and there were about 20 of us.  Stopped in Guinea, then Sierra Leon, and finally to Monrovia.  Through passport and an hour drive into Monrovia.  Looked very much like Malawi!  Then to guest house.  Wow, a very nice house that they rented for six months and have been frenetically readying.  Room ACs just installed, new water storage just put on line, new Wifi within the hour after we arrived, still unpacking beds, tables, chairs etc.  Great lunch of rice and fish, plantains, fresh fruits, and salad.  Excellent!  Then to grocery store which has more things in it than Harris-Teeter.  Talk first by Medical Director, Rene Vega, an FP who is Medical Director of a healthcare system in Dallas - committed for the full six months.  Very personable and will be easy to work with.  Then the CEO of Heart to Heart appeared, retired from pharmaceuticals and up working on housing for us in Tapita.  Also, very laid back and committed.  Finally time to unpack.

Off for the weekend (boring but schedule dictated by UN flight schedule on Fridays) and then two days of "cold" training and then three days of "hot" training.  After that we are not sure what next.  The construction of our unit in Tapita is being totally managed by the US military and we are the first of 17 units that they are building so we are the model unit.  But, they have just graded the field!  It will be much like a field hospital with various zones for workers, Suspected cases, and Documented cases.  Actually, a small compound totally enclose with wire fencing.  It sounds like we will be in the hospital grounds. The hospital was built by the Chinese in 2011 and apparently very nice but nobody manning it now.  Unfortunately, I'm not sure it will be ready in one week!  So I'm not sure what we will do if it is not finished.  They did talk of sending us to assist other units.  

The team is very compatible.  An Infectious Disease person from Einstein who has spent a lot of time in Ethiopia, a just-retired Critical Care doctor from KC, an EMT ex-military smoke jumper, a recent graduate of the military nursing program and ex medic, a male ER nurse, and three RNs.  The fourth MD is Dr. Vaga.  We are all chomping at the bit to do something but it sounds like there may be some down time!  O' well.

November 8

The CEO for HTH has been here for about three weeks working on the logistics and said today that the completion date for the ETC has been pushed back to the 23rd and he thinks maybe as late as 1 Dec.  He apologized for getting us here on such short notice but said that for HTH to get the honor of opening the first unit they needed to have troops on the ground.  We will continue to train this next week with "cold" training (classroom) for 2-3 days here and then we move to Bong for our "hot" training - a live unit.  THEN, we may continue to help at Bong, come back here and sit, or go on to Tapita and help set up the ETC.  There is a temporary unit, 15 beds, in Tapita attached to the hospital that we might take over.  But because the hospital is basically shut down, no one with Ebola comes there. So far 10 suspected cases and only 3 confirmed!  They do think that once the word is out that we are there the numbers will increase. And, with dry season now, the roads have become passible so people may try to escape Monrovia and will bring the virus with them.  We shall see!  

This new ETC unit is to be a model for the next 16 -17 built by the US and includes many new features that the existing MSF units do not have.  We don't know what that means.  It will be exciting to be the creators of this first unit - we have already started to explore scenarios - what if a term pregnant lady comes in (Rene or I will deliver), what if a three month pregnancy miscarries and continues to bleed - D & C (no) or what (drugs), HIV pts. on RVU's can have false negative tests, what to do?  (only 1.9% of Liberians have HIV - 70,000 and 40% are on ARVs) not likely to see, etc.  So the discussions have been helpful.  Just today new guidelines for PPEs (Personal Protection Equipment)  full face shield instead of goggles (it won't fog up so easily).  Will we get them with our new equipment?  So far we have stayed busy - but it could get slow.  Well, this will also definitely reduce our risk of exposure!  

Nothing planed for tomorrow and told not to go to town or church since we are viewed as someone who may have had contact with Ebola.  Hang out and read!

As usual, everything could change.  Will keep you up to date.

Photo of our guesthouse


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November 9
Rene is the leader, a FP from Texas, active practice for about 15 years in California, then into AAFP residency, international medicine, alternative medicine, etc and past several years working for several managed care groups.  Very personable - easy going and knowledgable with lots of international work.  Good general medicine knowledge and skills with OB and minor surgery skills.  Here for six months or to end of crisis.

George, just retired as chair of Dept. of Medicine at UMKC with training in pulmonary and critical care.  Has been to Cameroon twice and has seen the same Africa that we know.  Wife is a Dermatologist and twin sons - one in fourth year of medical school at Univ of Kansas and the other is economic consulting.  Great to be with and we will make a good team.  No technical skills beyond general medicine but knows basic African medicine

Carol, specializes in Infectious Diseases  at Einstein with lots of experience in Ethiopia focusing on Women's Rights and children.  She heads up Einstein's Global Health Initiative, as well. Shehas a son in California trying to get into film.

Davis, ex Army airborne in 70' and 80', Special Forces reservist for several years, then a smoke jumper and EMT.  Is an artist on the side!  Also very easy going but no international experience.

Lucille, a Nurse with the Red Cross. From Rochester and got the hate mail when she did a PR airing for HTH.  They are very chagrined, not expecting that response.  She does not seem to have much international experience but willing to do her best.  

Marge, married 50 yrs.  She and her husband have spent time in Vietnam, Cambodia and Tibet working for Salvation Army.  Still active in nursing, very spry, religious, with a can-do mind set.

John, an ER nurse.  Very quiet and distant with a sort of military presence, though no military background. Probably very good at what he does but no international experience.  Married with two younger children - eight and I think a teenager.

Aaron, the youngest and his only overseas trip was to Israel and Jerusalem two years ago.  Active Army and then reserve where he was first a medic and, I'm not sure, if RN or Nursing assistant.  Very gung ho, always doing exercises, wears military like clothes but wan's to do good.  Really lacks experience and may be a bit green but will work very hard.

I think that is everyone except for staff - more on them later.

November 9. . . later in the day

Well, I guess you saw, we have a week of cold training, 3-5 days of hot training and it sounds like on up to Tapita to set up the ETU.  I sense it may be slow at first but our role is very important because we will start the routine which we will pass on to the next team.  They will do cold training here and come directly to Tapita for hot training and turn over.  Even if the unit is finished by the 23rd, as planned, we would still only get in three weeks.  And, it may not be ready until the first of December - I  believe that we all feel our role is important though.

November 10
I will write about my training later - by military.  The first presenter was an FP doc at Womack doing his residency there. He couldn't wait to come tell me during break how nice I was to his family once when his child was sick.  A really nice young man - you would be awed at how well they ran the training.

November 10. . . later in the day
We left the Guest house at 7:15 after learning that the generator had run out of diesel and therefore no Wifi or water pump for water to shower in.  Drove to the National Police Academy and it looked like a US Army encampment. Tents, water bladders, Humvees, and swarming with US soldiers.  We were ushered to a boma-like classroom with about 100 individuals.  Eight from our team, twenty US from Americare, six Germans, and the rest Liberian.  It was run totally military style - WHO guidelines, with handouts, booklets, slides, pre-test, evaluation, etc.  The initial speaker was the FP who did his residency at Womack when I was there - very nice guy.  Also there was an Infectious Disease / Tropical Disease specialist from the Uniformed Services Medical School who was a true expert. Very impressive!  And out of the hundred, there were our three doctors and one other!  They walked us through the donning and doffing of the PPE (Personal Protection Equipment).  Complicated, but by the numbers and always with an observer.  It sounds like about an hour to one and one-half hours is all one can stay in the Hot ward due to heat.  So in and out of the ward twice a day.  We will continue with the Cold Training for the rest of the week including putting on and taking off the PPE and working in a mock-up ETU.  Very useful training!

Back to the house - new water pump, fuel for the generator - no water in the tank (city water is now off).  So two days without a shower - we went to the hotel where the women are staying and used their showers.

Plans are still to go to Bong, now  for only four days of Hot training, then back here to pack up and move to Tapita.  If it opens as scheduled, our timing will be perfect, but that seems very optimistic.  They now have procured two homes on the hospital grounds for us with AC, electricity and water from the hospital, and are working on Wifi.  So far facilities have been excellent - they have taken very good care of us.

Monrovia looks like most big cities in poor countries of Africa.  Half the street lights are out, endless traffic of beat-up smoking cars, lots of tuck-shops, and then dark side streets with trash and potholes and swarming with people.  The locals are very friendly,  speaking English, so communication is not difficult.  Our cook is local and cooks with lots of local spices - tonight a meat and vegetarian pasts but very hot.  Salad of tomatoes, avocados, and lettuces and fruit for dessert.  

The group has stayed together fairly well.  George, Carol, and I tend to cluster because we are always talking "What Ifs", then the two women nurses, then the other three guys who are less medically inclined and seem to be a bit more loners.  George and I are on the same wavelength about everything so we get along great.  

Please share as you wish, all or parts of my e-mails.


November 11

Another day of exceptional training.  We learned how to put on our PPE - totally encased in plastic.  Hot, but not bad, and immediately fogged up my goggles.  Easy to put on since sterility is not an issue going in but very hard to remove.  Doffing is critical, you assume you are contaminated and have to remove step by step without touching yourself.  I will need, and get, much practice.  Also spent more time on 7-step hand washing in 0.05% chlorine solution.  I smell like a swimming pool.  Then we did some case studies of triage - who needs to be admitted and who is not a case.  All real scenarios and very difficult, still no agreement on some of them between us, but good discussion.  We also queried some of the WHO standards i.e. Why do suits have to be a terrorizing white, orange, or yellow like spacemen.  What about a more muted color for the units - maybe more acceptable to the patient and to be admitted?  What about drawing a unit of blood from each survivor and administering to the marginal patients?   Can we add electrolytes to IV solutions since fluid loss with severe dehydration and shock is the cause of death - not the virus itself?  Etc.

Just back and power off and so I had to start the generator and water pump.  It's good to have a little Malawi experience in such issues.  

November 12

Just got up and starting to move around.  Leave for the training in about an hour.  Slept well and will get breakfast at the training.  I just forwarded the first three e-mails to Mike [ a colleague that George has done work with in refugee camps and they are scheduled in Haiti together in February though Haiti may not be open to George's coming now]].   Isolation begins from the last day I see a pt. with Ebola so it may be over sooner than the 10th - won't know until the next team arrives and takes over.  Everyone on team has said they would stay an extra week if they needed us but so far it doesn't appear that they do.  There will be a new arriving team for cold training here and then they come up to Tapita for their hot training with us.  Patrick's [Craft, MD, one of George's first ECU residents who heads up medicine at Butner Federal Facility here in NC]  Public Health Service  doctors and workers on loan from Butner are our escape route if we become ill. There is a full PHS hospital at the airport along with the Army's and they are the  center for any US person infected - free, solo flight out of the country to hospital of your choice equipped to care for you - so worst case scenario - Duke.  We are going to that facility on Sat for a tour.  More later today.