Liberia Week #6

Happy Holidays to all!  I have decided to move these last three installments to Tuesday nights.  Wednesdays, for the next two weeks, are “Eves” – and I suspect all will be way too busy to read these missives once relatives have arrived.  At any rate, George has only two more weeks in Liberia.  I shall ask him to write his last installment on Tuesday night, December 30^th, once safely home.

Many of you have said such kind words about George’s service.  In his behalf, let me say what George would say, that medicine, the art of healing, is the universal language. The transfer from culture to culture, from country to country, is simple, sometimes just the healer’s hand placed on that of the “other”.  George is blessed by his profession’s unique privilege, allowing him to participate in the lives of others, anywhere, at a very intimate level.  bsp

December 10, 2014

Did you see, the Person of the Year are all of the volunteer who have worked in an ETU in the war on Ebola!

Later,

Back to the ETU in the morning to troubleshoot.  It turns out that the electrical supplies that are on hand are all substandard.  The breaker boxes say Snider (a well-known American product) but when you open them, the insides are Chinese but say made in Liberia.  They apparently are not short protected or even have an inspection panel to keep you from sticking your hand directly into the hot wires.  The onsite electrical team refuses to use them stating they are "knock-offs" and are unsafe, pirated the Snider name.  

They have apparently located some left over supplies from other ETUs and are having them shipped up.  Also, we are still waiting for the supplies in Brussels.  Around noon, a full Colonel appeared somewhat in a heat over all of this and said he would resolve the problem.  We shall see.  There is also a shortage of gravel to cover the grounds so that we are not in mud after a rain.  

We did go to the second day of the Community Meeting but today was the gathering of donors - so we paid our fare and immediately left.  We did not wait an hour and a half this time for the meeting to start!

The work on the second guesthouse has progressed amazingly well!  Windows came last night and are already set in place and plastered in.  It actually may be ready by Sunday.  We are expecting three expat nurses Sat so they should have housing ready.  And this evening we received three National nurses who will locate there own housing in town.  They are staying in one of the rooms with four bunk beds tonight and will get a home in town tomorrow.   

I am really touched by TIME's "Person of the Year" award.  I have had a sense that we have been viewed somewhat as pariahs for "subjecting" the USA to the threat of Ebola.  At least TIME is championing for us.  It's a job that has to be done or Ebola will truly be an international threat.  I think we have demonstrated in Liberia that it can be controlled through the hard work of locals and others. It is not going to go away on its own!

Tapita  reminds me of how attached we have been to Embangweni, Malawi, and Africa.  I get the same feeling when I go to these meetings and walk around town. Everyone is so friendly and says, “Hello”, not even "Give me money, give me sweeties."

December 11, 2014

I see that I did not report on the status of Baby Nancy - a two year old whose mother died in an ETU but who wanted to hold her daughter for an hour before she left for the ETU.  Unfortunately, in that hour, or sometime in the previous 24 hrs, the mother transmitted Ebola to Baby Nancy.  Nancy came to the Kakata ETU where I admitted her and one other 23 y/o gentleman with  Ebola - Junior. Junior has done well but Nancy, unfortunately, just died after a progressive downhill course.  

Ebola is especially unkind to the young, old, and pregnant.  It is extremely rare that a term mother with Ebola will deliver a live child, and if it is born alive, that child is destined to die.  It is also a given that mothers with Ebola, in their first trimester of pregnancy, will abort a nonviable child.  Ebola is very much like malari as it seems to accumulate in the placenta and cause first and second trimester abortions and third trimester stillborns.  No Ebola mother will name a third trimester child after delivery, or even ask to hold the child, knowing the child will die.  Likewise, Ebola concentrates in the breastmilk so she cannot nurse - sure death in third world countries from eventual diarrheal disease from unclean water or lack of formula while trying to bottle feed. In Malawi, infant mortality was one in five -- I don't know what this outbreak is doing to Liberia.  In addition, the absence of trained healthcare workers has to increase the probability of infant death with any complicated delivery.  Life is hard here - if its not recovering from a civil war over a dictatorial government, it is a devastating Ebola crisis!

December 12, 2014

Morning rounds down to ETU construction site.  At around 10:00, we received a truckload of supplies - plastic buckets, foot wash basins, mattresses, etc. Unloaded and went to town to help nurses locate housing and to find a plug adapter so we can run our scanner / copier - which took over an hour to find. After lunch back to ETU - still issues over electrical supplies.  They are supposed to have one shipment up today and flight in from Brussels with second load. When we got back to the house, a list of all supplies, including drugs, arrived so I spent the rest of the day working on our Daily Drug Regimen and our Formulary (one of my goals for staying on).  Next, I will start developing our medical record sheets incorporating these daily guidelines.  Tomorrow, a General is arriving at noon to inspect the project with reporters.  So clean shirt and pants!

December 13, 2014

Rene is driving to Bong to pick up three nurses so I won't have internet all day. His phone is the Hotspot but we may be getting a US Army satellite link in the next few days.  I will be at the ETU most of the day as well as doing laundry and writing some letters.  Might have a printer so can work on developing some of the new records.  I can develop now but no way to print and even then will have to send as an email attachment to a computer that is linked to the printer - a bit convoluted.  

December 14, 2014

An off and on day.  We went down to the ETU and worked with the electricians on light placements and breaker panel placements.  A two star General was supposed to come in at noon and everybody was on edge.  Then at 11:45, they announced that because of bad weather, they had turned back.  So after all this waiting, we left to go eat lunch and see if he would come in the afternoon.  At 2:00 pm, he cancelled.  There is a rumor that some Senator will be coming soon. I could take pictures and save them a lot of money!

I worked on pt. records sheet for the rest of the afternoon, but it is very frustrating -- I can't print from the iPad and I am not good with the iPad word graphs program.  I am then trying to attach to an email and will send to Rene's computer which can then print, butt only when we gets the correct driver to allow him to connect to the printer.  AND, then we can scan the draft page to KC to have them set up and print all cleaned up, return to us, and then copy.  Nothing easy!  

At 5:00 we had a "staff meeting" at the downtown cafe / bar - over a bottle of Club Beer.  Two more National nurses came in last night and Rene is picking up three expat nurses today.  The electrical crates arrived from Brussels today and are to come up tomorrow. I think it will take them the rest of the week to finish the project before it is turned over to us.  Then, there will be another week to finish the interior to our specifications.  But, during that time we can be training and coordinating activities.  We will go from 10 workers (us included) to over 100 in one week!

It is hard to describe what my role is here.  I walk around with Rene and am available for "consultation".  But it does happen!  I worked with the electrical crew trying to lay out lighting and had them move all of the breaker boxes out of the Hot Zone.  I will work with the Pharmacist when she gets here on Thursday on  medication protocols and procedures, as well as medical records.  And, I  have spent time with the HR person outlining staffing needs and job descriptions.  All of this comes from my time in Kakata in the ETU  -- experience that  no one else has done.

Two weeks left - I'm not sure I will see opening day but I think it will be ready to open by the time I leave.  It is probably a good time to slip out of town and leave it to the next team.

Later,

Work on the ETU has been slow but steady.  A big chinook helicopter came in twice yesterday with supplies -- courtesy of the US Army.  I went to the LZ and it was amazing how loud and blowing it was when landing -- dust and rocks everywhere.  Most of the electrical supplies came in so we are off and running on finishing the ETU.  

We took a tour of the beautiful Chinese built hospital next to our ETU.  What is sad is that there are no doctors - with the Ebola crisis all of the foreign doctors (China, Ethiopia, Egyptian, etc) left immediately.  At one point the Chief Medical Officer, a Liberian trained MD who has lived in the US, was the only doctor in the hospital.  He now has four interns from the Liberian medical school covering the wards.  How would you like to have an intern as your primary surgical, obstetrical, medical, or pediatric hospital provider?  Great training for them but without supervision.  

The healthcare system of Liberia has been devastated by the outbreak.  Some of the first people to die were the doctors and nurses who weren't aware of what they were treating.  We were told that one of our Liberian nurses didn't feel well and what should we do?  To us that is a bigger threat than the ETU!  We said to go to the ER and don't come back until you are well.  Our lead cook, Mariah, then showed us a picture on her cell phone of a handsome Liberian doctor and his wife who she knew well and both died in September of Ebola.  There are now less than 50 doctors in the country to treat a population of 4 million.  Even when Ebola is gone, it will take years to rebuild and repopulate the healthcare system. Once again the effects of poverty will express itself in many ways for years after this outbreak.  How lucky we are!   

December 16, 2014

Very busy two days --JIm is now here (my new roommate- in the top bunk) until he and I leave together on the 27th.  We have moved forward on planning the interior of all of the units.  We are supposed to get the shell on Friday after a walk-through with the military.  Then, Saturday to correct the deficiencies, then Sunday a Senator from Delaware and two-star General are coming for a show and tell.  So, there is  lots of planning in anticipation of the turnover.