I arrived safe and sound in Kenema, after a few minor hiccups along the way. The drive from Freetown took about 5 hours and was a wonderful way to see the countryside. There were several checkpoints set up along the way intended to contain the spread of Ebola by conducting basic health screenings and restricting population movement. Our Red Cross truck granted us immunity most of the time, requiring only a couple of stops. We arrived at our accommodations late on Monday afternoon, where we were given a briefing and advised that we would start at the ETC first thing Tuesday morning. After a long week of anticipation in Geneva, I was very anxious to get started.
The typical schedule for the international delegates is to meet for a quick breakfast at 7:00, then pile into IFRC vans at 7:30 sharp to leave for the ETC which is about a half hour away. Before entering the centre, your temperature is taken and the bottoms of your shoes are sprayed with chlorine. Then, you wash your hands….also with chlorine. Basically, anytime that I describe doing anything at the centre, assume that vigorous hand washing is involved. You do it A LOT…all the time really, which is necessary to prevent contamination. My two little silver rings were turned black within an hour of being at the centre. Lesson learned: remove all jewellery when dousing oneself in chlorine all day.
Once you are dressed and ready to go, you report for duty at your appropriate tent. As a Psychosocial Support Delegate (PSS), I report to the Community Health/PSS tent – we share a tent because there is considerable overlap in our responsibilities at the centre, so we work very closely together. The tents are all set-up like makeshift offices, complete with electricity, internet (sometimes), desks, computers, and fans…as many as we can fit inside. Did I mention that it is a tad bit warm here? Well, it is. I literally have not stopped sweating since I arrived. You’re welcome for that tid-bit. :)
My wonderful mentor (the only other PSS delegate at the centre) has spent a considerable and much appreciated amount of time showing me the ropes. When I first arrived, we started with a tour of the centre. I have to say, even though I had seen pictures beforehand, I was blown away with how well structured and maintained it is. It runs like a well-oiled machine. Each unit of the ETC plays a critical role in the care of the patients admitted. They include Infection Prevention and Control (IPC), Triage, Admissions, Nursing and Medical, Community Health/PSS, the Pharmacy, the Store (for supplies), the Morgue, the ‘Hotel’ (where patients who have been discharged wait to return home) and finally where the admitted patients are cared for. This area is divided into three sections: Confirmed, Probable and Suspected. Each section is separated from the other by orange fences, to ensure that those who are confirmed with the virus don’t spread it to those who are suspected or probable, but may not actually have it. To go into any of these sections, you must be in full PPE. That said, you can still see and communicate with the patients on the inside over the fence, which is really nice…as long as they are feeling well enough to be sitting or walking around outside. Those who are not doing as well tend to stay inside the tents in the restricted areas and can only be visited by those in PPE. I entered for the first time on my second day to visit with a little girl who had arrived the night before and who was reportedly very traumatized. Sadly, she had been quite ill and died just a few minutes before I entered her tent. This is such a heartbreaking disease.
There is also a cemetery about 100 yards from the ETC, where there are presently over 160 people buried there. I was overwhelmed by how much care was put into creating a respectful and dignified place to lay the deceased. The names are clearly marked on posted signs and against the backdrop of the stunning countryside, I couldn’t help but think that it was… beautiful and serene. This cemetery will be here long after the Red Cross moves on, so they wanted to establish a cemetery fit to honour the innocent lives lost, and one in which their loved ones could return for years and years to come to pay their respects...and I think they have accomplished that.
On my first day, I witnessed my first burial at the centre and sadly, I have since witnessed many more. Supervising burials and supporting family members who may be present for loved ones is part of my role at the centre. Sometimes family can be located, sometimes there is not enough time for them to get to the burial, and sometimes there is no family left. In the absence of family members, any and all staff members are invited to attend. At the ceremonies, both Christian and Muslim prayers are said, as the religion of the person is often unknown, and whatever is known about the person is incorporated into a personalized eulogy.
The discharge process is also really interesting and is also something that falls under the duties of the CHM/PSS. When a confirmed patient recovers from Ebola – first of all, this is always a very joyful occasion at the ETC – he or she must go through something that has been affectionately called the Happy Shower. This is a mandatory process involving the complete decontamination of the patient using 0.05% chlorine water followed by soap and water. When this is complete, the PSS connects with the individual to help prepare him or her to reintegrate into the community. This includes reviewing mental health and general readiness to return to the community, including fears of stigmatization and rejection (which is a major problem) and ensuring that they have a safe place to go.
My PSS partner and I are currently drafting a proposal to increase PSS activities within the ETC – specifically increasing support to patients inside the High Risk area. We are also working on creating a better support system for local staff who experience a high degree of stress in the workplace (especially those who work with the deceased) and in many cases are also stigmatized for their decision to work at the ETC. There is still much misunderstand about this virus, both here in West Africa and back at home. International staff that join the fight against Ebola are (for the most part) revered, but here in Sierra Leone, they are often ostracized. They are the TIME’s Person of the Year… there is no doubt about it.
I am so happy to be here, working alongside such an incredible group of Red Cross staff, both the international delegates and those from the Sierra Leone National Society…and so happy to be back in Africa.
More to come. Thanks for reading,
lj