The Lunsar ETC

Dear Lunsar, my son Charles says “Hi”.

Sleep was difficult to come by.  Bai Suba where we stay seems to be newly built and devoid of trees.  The compound was big but dusty.  We are close to the iron ore mines which I was told suffuse the air with iron dusts.  Bai Suba has spacious comfortable rooms except that mine was placed close to the gigantic generators churning out loud droning noise all night.  Like the Princess and the Pea, I could not sleep for the mattress on which I was sleeping was actually a hard box spring, rigid and unforgiving, stubbornly refusing to have any give.  I tossed and turned all night long hoping that jet lag would take over but it did not.

The ETC Wards

The Boots and Gloves

Since this ETC in Lunsar was opened in the beginning of December, it has the advantage of learning from the other units around West Africa.  It has the same number of beds as the Bong ETU, 52, but the lay-out is not as congested and instead of blue tarpaulin, it is of white heavy duty plastic tents, like the ETU in Margibi in Liberia.  I kind of miss the blueness and intimacy of Bong ETU.  As we walked into the ETC, our temperature was taken; we washed our hands and had the bottoms of our shoes or boots sprayed, then into a room where we changed into scrubs and boots.  Unfortunately like Bong, the scrubs are mostly of large sizes, drowning me completely. 

When we stepped out of the changing area, we were greeted by the “Welcome to Lunsar ETC” sign in English and Krio.  The gravel paths of Bong are replaced by concrete corridors under tinned roof, in Bong we only have unmarked and unsheltered gravel paths.  On the right side is the WASH tent followed by the medical tent where sign-out happens and where the healthcare personnel gather; on the other side are the donning and doffing areas.  Both are partially open allowing ventilation of light breezes.  There are shelf spaces in the donning area for organizing all the supplies. Donning in such open area is less hurried and cooler.  Behind these areas are the wards.  Further down the corridor is the impressively organized, spacious pharmacy and it does have morphine and tramadol. 

Here there is also a kitchen where food is cooked for the staff and a separate dining area, whereas in Bong, we do practically everything in the congested doctor’s office.  Behind the wards are the visitors’ tents with the morgue tent on one side.  The ancient rusty-looking structure, resembling a squat tin man, is the incinerator which has not been busy of late.

At the ETC, we did not arrive early enough for the sign-out but there are only 8 patients, evenly split between the Suspected and Confirmed Wards.  Here the ETC has three units: the Suspected, Probable and Confirmed Wards.  The Probable Ward houses mainly patients with more symptoms of Ebola especially if they display “wet symptoms” such as diarrhea, vomiting, and bleeding while the Suspected Ward keeps patient with low probability of Ebola.

The Incinerator

Today another new doctor was with me and we were just made to go through a dry run of donning and doffing, which has some minor differences from Bong.  Later the trainer took us outside the ETC to look at the new training center, the classrooms and dormitories are already up but the mock ETC is still being constructed.  Evidently there is going to be ongoing training for personnel savvy in Ebola.  We walked around in full PPE but not in the hot zone for an hour and a half but the weather was kind at 77 degrees Fahrenheit, overcast.

Later in the afternoon, there were three discharges.  One by one they emerged from the shower, weak and visibly shaken from their days of ordeal.  First it was a young girl, thin and unsteady on her legs, greeted by singing, dancing, and drumming.  Then came a little boy, unsmiling, and did not appear to be joyful at all.  Finally a teenager thin but was steadier than the first two.   After a while we saw a faint fleeting smile coming across the young girl's face.  The staff gathered to celebrate with them and they all marched down the corridor to another tent by the exit of the ETC where the psychosocial staff would counsel them after they had their lunch and they would receive their Ebola-free certificates.  Here the boy was given a ball but he remained sad.  They would all be returning to their villages to be with relatives.  It was bittersweet.

A two-month pregnant patient who has recovered from Ebola will be transferred to an MSF-operated center to get an abortion.  According to one nurse she is not happy with the decision but her husband thinks it is the safest alternative for their family with their other children in the house.  MSF is not willing to keep her for the duration of her pregnancy.  The rationale is that no newborns have ever survived Ebola.  The difficult choice she has to make brought back the memory of the premature baby who was born in the back yard of Bong ETU.