LIVING WITH EBOLA: update 3 from Sierra Leone

My nurse friend in Sierra Leone has just sent this, covering October up to date:  as I said before, she wishes to remain anonymous.  By the way, £1 sterling is equivalent to 7000 Sierra Leonean Le.   (Apologies for the varying sizes and styles of type – I’ve had a lot of trouble posting this one and it’s been back for endless edits).

“1 OCTOBER: Met Mabinty (1 month old) and her Auntie who claimed to be 19 years but looked about 12 years. Mabinty’s parents died of Ebola.  Both tested negative for Ebola so were discharged from the Holding Centre (HC) on the day we met. The District Nutritionist … asked me to help Mabinty since her Aunt was not lactating.  I bought formula milk, feeding bottles, thermos, packets drinking water, and other baby paraphernalia to tide them over until official support came through the NGOs or Ministry of Social Welfare. The Auntie was given training on how to prepare feeds. She did not want to return to her home village  (where 700 people are quarantined) so opted to go to relatives in Rogbon (which has not had any cases of Ebola). They were well received, no stigma, the baby was passed round several women – she was beautiful and obviously well cared for before the loss of her parents, nice clothes, good size for a month and BCG immunisation scar. The house was cement, one of the best in the village.

What happened next is unclear – on the morning of 3rd October the Auntie reported the baby was ill and was advised to take her to the hospital or back to the HC. She did not and, heartbreakingly, Mabinty died that evening. The burial team took post-mortem oral swabs for Ebola but I’ve not been able to trace the result.

2nd October: Repeat of workshop “Ebola and Teenagers: What Can Be Done” for a second group of around 25 young people. During this week, the U-Team (University of Makeni Ebola sensitisation team) visited churches and mosques to set up appointments to raise Ebola awareness among their peers using video clips and question and answer sessions…  This evening, the U-Team will brief me on where they are going, when and collect the 2nd tranche of their funding.  

3rd October: Forced to supply another week’s worth of drinking water to HCs (she gives the reason) …. Since a Bank Holiday weekend was looming … I bought 200 bundles at a discounted price of Le 750,000 (slightly over £100). Met the Catholic Fathers and briefed them on the quantities needed.

7th October: (interminable Min of Social Welfare weekly meeting) Procured sanitary pads for HCs … only discovered at the weekend that there was no provision and given the role of body fluids in virus transmission, washing out cloths is not desirable. Not everybody in the HCs are that sick and some test negative for Ebola.

9th October:  Transported Abu Bakarr (about 9 years) back to his Dad after he was returned cured of Ebola from the Treatment Centre in Kenema. The child had been solemn and withdrawn throughout the afternoon but burst out laughing when he saw his Dad (who had run out from his bath covered in soap when he heard the commotion of the child’s return). Transport for Ebola activities is another constraint… Catholic Mission provides most of the fuel these days but out-of-office-hours, I still sometimes have to buy it.

Late on 9th: Urgent request from the HC at the Regional Hospital  for … guess what? Patients’ drinking water. The nurse-in-charge … appealed to me directly in some desperation, I have to say. Cash donations from friends enable me to respond immediately to such requests while the bureaucracy of official channels takes it course (patients cannot be left without safe/clean water to drink overnight). When I arrived with 100 bundles of water (after dark) I discovered that the HC did not have electricity – so dangerous when staff need to be meticulous in taking off their protective gear. So, I bought them 8 ‘Chinese lamps’ and 4 dozen batteries as a short term response. Since it was late and raining very heavily, I did not explore why there was no electricity, another time. 

10 October: I was asked back to the Regional Hospital to see their constraints in daylight – as a result I replicated the package of items I supplied to the other HCs since their inception (see table below). Four of everything because the HC takes up four hospital wards: male and female each for ‘awaiting lab results’, ‘Ebola positive awaiting transfer to a Treatment Centre’.

REGIONAL HOSPITAL SUPPORT 9TH / 10TH OCTOBER 2014
ITEM	UNIT COST	QUANTITY	TOTAL
	LE	#	Le
WATER BUNDLES	3,700	100	370,000
CHINESE LAMPS	17,000	4	68,000
BATTERIES, DOZEN	22,000	4	88,000
MOPS	15,000	4	60,000
CLEANING BLADES	15,000	4	60,000
VERONICA BUCKETS WITH ELBOW TAP	60,000	4	240,000
DISINFECTANT 3.5 L	70,000	4	280,000
SOAP POWDER	14,000	4	56,000
MOPPING BUCKETS	65,000	4	260,000
FEMININE HYGIENE PRODUCTS	15,500	8	124,000
(approx. Le 7,000 = £ 1)

 Of course, spending other people’s money is not all that I do – a lot of time goes in meetings listening for gaps we can fill or sometimes offering advice. Last Sunday afternoon, I sat with the WHO rep to draft survivors’ packages by age group. She could have done it alone, but when people are tired and stressed, two heads can be better than one. In fact, I spend quite a lot of time listening – to survivors and to staff/colleagues.  

That’s it for this update.”
(The cheapest way to buy drinking water here is in 500 ml plastic bags which are sold in ‘bundles’ of 20 packets. Patients are told to drink 5 packets/day, each HC has 60 beds = 5 x 60 x 2 = 600 pkts (30 bundles per day, roughly 200 bundles per week – HCs are not always full but the staff sometimes drink).

There is some good news:  it would appear that Sierra Leonean medical staff are much better-trained than their Spanish counterparts: http://www.telegraph.co.uk/news/worldnews/ebola/11155840/Ebola-medics-better-trained-in-Sierra-Leone-than-Spain.