Monday, February 16, 2015

ABC (Avoid Body Contact) in the Lunsar Market, Hugging while Wearing PPE

Last night storm clouds gathered threatening rain, but this is the dry season here.  However sometimes during the night, I heard loud rain drops.  Opening my door, humid and sultry air greeted me, I saw Shakira running back and forth, not knowing where a safe place was.  Lightning lit up the dark clouds in the sky.  I called to her “Baaaaaah.”  She instinctively answered and her cry sounded desperate and scared.  I was told that she was brought in here to Bai-Suba with a bunch of goats but when two goats died, the rest of the goats were taken away leaving her alone, friendless.

A Sign in Freetown

This morning I went to the market in Lunsar with another doctor who will be on duty with me this afternoon.  Market closes on Sunday afternoon so this morning it was very crowded.  The streets as in most of the streets in Africa, have no sidewalks forcing us to walk on the road, motorcycles and cars honking constantly.  The loudspeaker blared ear-splitting music.  We carefully considered whether we should plunge into the crowds with this dictum of avoiding body contact (ABC) in the Ebola outbreak.  The other doctor is almost finishing up her time here so she led the way.  We tried to wriggle around avoiding skin contact but contact is almost inevitable.  The market has fresh produce, fresh fish and dried ones, bread, spices, palm oil, Kola nuts, as always no shortage of Chinese made goods, basins, buckets, slippers, radios...  Young girls carry basins with fresh mints, potato leaves, onions to sell while the boys follow us around, one of them asking for money.  St. Peter Claver stood guard at the end of one of the streets.  It was closed so we could not take a peek.

The Market

Kola Nuts

Mountain of Red Peppers

Lunsar has not had new cases of Ebola for a few weeks now.  Most of the new cases come from other parts of Port Loko.

In the ETC here the doctors do a six-hour shift in the day, 8am-2pm, 2pm-8pm and the night is 8pm-8a; the nurses do a 12-hour shift just like what we did in Bong ETU.  Today we started our shift with 6 patients, 2 in the Suspected Ward and 4 in the Confirmed Ward.  Shortly after hand-over at two in the afternoon, the ambulance delivered 2 patients from a quarantined area in Lunsar, Doris, 16 and her cousin Fatmata K, 4.  Both were exposed to Doris’s mother who died of Ebola on arrival to the ETC 9 days ago.  Fatmata K becomes sick with a fever and diarrhea. Doris is totally without symptoms but she reported that there is another sick person who lives in the same crowded quarantined area with them.  She has a black hijab studded with silver ornamentation and dresses in a long embroidered sinuous outfit which she will have to part with.  Fatmata K is mute.  She was terrified of us standing by her bed all suited up and worse still she had to have an IV line placed in her arm so we could give her artesunate for treatment of malaria; she reached for her cousin in the next bed.

Mamusa has improved though she remains weak.  Her diaper is soaked with diarrhea.  The Sierra Leonean doctor speaks to her in Temne and makes her walk all the way to the back to sit outside. Joseph is lying on a mattress placed on the gravel.  His abdomen is so distended that he looks like he is 6 months pregnant.  He has not moved his bowels for 6 days.  Why he was admitted yesterday was a mystery.  He does not have any exposure to circumstances suspicious for Ebola.  Examining him, we determine that he may have an incarcerated hernia which could cause intestinal obstruction and thus the distension.  Both the Sierra Leonean doctor and I tried to reduce his hernia without success.  I want to expedite his transfer to Port Loko Hospital for possible surgical intervention.  The quickest way is to get his Ebola test result which turns out negative.  Unfortunately here in Lunsar ETC, a suspected patient has to get 2 negative Ebola tests before he can be discharged.  As we try to get an exception to the rule, the caretaker reports across the fence that he finally moves his bowels!

Again there is no one in the Probable Ward.

Fatmata 1 is gravely ill with agonal breathing, eye balls roll up, only the white of her eyes shows.  She has retained fluids all over her body.  The neck swelling has decreased significantly but she no longer makes any urine.  We are not sure she would last through the night.

Sullieu and Gabriel are doing well.  Sullieu remains weak but seems to have rebounded from his gastrointestinal problem.

Augusta is waiting for her second Ebola test result; her first has been negative a day ago.  In preparation for going home, she has requested to get her hair braided in corn rolls.  Sitting outside at the back of the ETC, the caretaker uses Vaseline to braid her hair.  She looks happy and content.  Tomorrow she will have been in the ETC for 15 days and the staff cannot wait to celebrate her triumphal exit.  She had been "as sick as a dog" said one of the doctors and for a tenuous moment, they feared that she would not make it.  And she is feeling strong and ready to start anew.

It is overcast all day after the rain last night.  A cool breeze blows across the halls of the ETC.  The only time we could touch one another is when we first put on our fresh PPE and so today we did a lot of hugging in the donning area.  Donning PPE today in this unusually pleasant weather gives us no trouble at all with the exception of the fogging of the goggles.  It seems like we could stay in our PPE for a long time.  
The Afternoon Medical Team

Me Doffinng

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