Liberia tries to fool you.
You arrive late in the evening to the training center, and the sun is setting and the sky is orange and spectacular and seems to stretch away from you forever. The air is cool and there are insects whirring and birds chirping and there is that moment, just before it is completely dark and the bugs come out in hordes, where it is perfect and you wonder why anyone would live anywhere else.
The next morning is cool and calm, and the fog is thick in the hills, and everything is verdant and green and the clouds cover the sky. It is lovely and temperate.
At this moment, Liberia is laughing at you, because the mid-day sun is about to come out.
Everyone warns you that it will be hot in the PPE that you wear into the ETU. You are told that the first few times you go in, you will need to leave within 30 minutes; you will be too hot, too dehydrated, too close to collapse if you stay in. Your doffing process takes 15 minutes and you must have enough gas left in the tank to get through it.
And they are right.
The first thing I noticed – my arms are hot. What a strange sensation for only my arms to be hot. Breathing through your nose is partially obstructed by two masks and heavy goggles, so you focus on breathing through your mouth, which is unnatural for adults and makes us feel slightly suffocated. Then you walk into the ETU, into the tent, and suddenly all of you is hot. Every part of your body is hot, and sweating. And then your goggles start to fog, even after you’ve defogged them in the donning area.
I wished desperately that this was a real ETU, that I had patients to focus on, to have work to focus on, so my energies would not be focused inward on how uncomfortable I was.
We stayed in the mock ETU for less than five minutes, came out, and went through the decontamination process. The sprayer and doffing coach sprays your front and back with 0.5% chlorine solution, and it feels cool and wonderful. Every piece of gear off is like taking a new breath. At the end, when you wash your face, arms, hands, and hairline with chlorine, it smells wonderful. It smells like safety and comfort.
I will never be able to smell an American swimming pool the same way again.
The training program is extraordinary. Organized, well-run, comprehensive. The best moment this morning was realizing that the response to the call for assistance is truly multi-national. We saw Swedes and Germans and Chinese in the airplane. There are Americans, Kenyans, Ugandans, and Liberians training together. Despite the subtle (and occasionally overt) jockying between NGOs trying to establish their “cred” within the country, in the end, it is somehow touching that when a country in distress calls for aid, there is a worldwide response. There is a hint in there of what global peace, though far beyond our reach at this time, would feel like.
The exchange of ideas is tremendous and rapid; you are given a huge tankard of new information and you are trying to gulp it down as fast as possible.
Why are patients not infectious during the incubation period? Because the virus lives and replicates, initially, in the endothelial cells, before bursting out of them and entering the bloodstream, and only then do we become symptomatic. Thank you to a doctor from Los Angeles.
Why do Ebola patients hiccup, and why is it an ominous sign? (this is an unusual symptom that other hemorrhagic viruses do not share). Because Ebola patients almost all have severe hepatomegaly, and this is irritating to the phrenic nerve, causing hiccups. There is some thought that many have paralytic ileus, and the gastric distention associated with this contributes as well. Thank you to a doctor from Kenya.
I met a survivor. They are being trained as a psychosocial counselor for patients, families, communities, other survivors. I did not even know they were in my class, and when it was disclosed to me, I suddenly realized that many of the other national staff in counselling jobs are also likely survivors. They told me they were just recovering when their spouse got sick, and then died. They took out their phone and showed me pictures of their spouse, happy and well back in June. Just four months ago. And of their children, thankfully healthy and never infected.
They shared their spouses name with me. So now I carry that name, in every motion and every thought in class, with every other patient I see and touch, with every word I speak here. How easy it would be for me to revert to the gallows humor we use in the ER, to deal with stress and exhaustion that way.
How unspeakably awful it would be to say something like that in front of a survivor.
I have startling revelations about how I have internalized race and culture every day, and it is deeply shameful, and deeply important.