I am on the field team.
The field team heads out every day to check in and check up on pre-assigned Community Care Centers, known as “CCC’s.” Locally they are known as “Holding Centers,” and culturally they are known as a place where people go to die. Hastily constructed by NGOs, staffed by national staff with minimal training, and forgotten by the logistical NGO assigned to them, they are a dangerous, under-supplied, badly under-served, and absolutely critical link in the fight against Ebola in Sierra Leone.
So each morning we pack our 4×4 to the gills with supplies from the main ETU. PPE. Water. Buckets. Medications. Forms and flowsheets. Lapas. And off we drive, more than an hour, through multiple district checkpoints, and visit one of our assigned CCCs. And try to make it better.
Several days ago we pulled up to our CCC just as an ambulance pulled up from the opposite direction. Another nurse from the field team approached the driver.
“How many patients?”
“Can they walk?”
“Are they bleeding?”
The directive for our district is that if a patient is showing “wet” symptoms — diarrhea, vomiting, bleeding – that they are to be transported immediately to our main ETU, bypassing the CCC completely, as the patient needs the type of advanced care that only the main ETU can provide. It’s the same as the trauma system in the United States — if the patient is a trauma victim, the local hospital should be bypassed to get the patient to the large trauma center.
“You need to take the patient to the ETU.”
“I cannot do that, I have to drop this patient off and pick up another patient!”
“NO, you MUST take them directly to the ETU, no stops!”
This quickly devolved into a roadside argument that involved three expat nurses, a community health officer, two local nurses, the ambulance driver, the security officer at the CCC, our own personal driver, and about seventeen cell phones.
After twenty minutes, my coworker gave up. “Look, there’s a human being bleeding and roasting in the back of that metal box there, and I bet the vent fan isn’t turned on. Let’s get her out, start an IV, and call dispatch for another ambulance.”
I agreed, and she and I went to suit up. One of the local sprayers agreed to help, and once we donned our PPE, we entered the hot zone, and motioned for the ambulance to back up. It stopped, our sprayer sprayed chlorine all over the back, and we opened the door.
Inside, easily visible from the triage area in the green zone where all the local nurses were standing, we could see blood dripping off the gurney onto the floor of the ambulance.
The local nurses started screaming. “SHE IS TOO SICK! SHE IS TOO SICK! TAKE HER TO THE ETU!”
Our sprayer started shrieking, “NURSE MARTHA, NURSE MARTHA, DO NOT GO IN THAT AMBULANCE!” He was gesticulating wildly with his spray hose, and accidentally sprayed my coworker in the face with 0.5% chlorine.
Fortunately her splash shield protected her eyes, and she turned furiously toward him, ready to tear a strip off his hide. She stopped before she could say a word, as she suddenly realized his eyes were the size of saucers.
He was terrified. Petrified that he was standing five feet away from someone dying of Ebola.
She went over to him to reassure him that we would be ok.
I jumped into the back of the ambulance.
An emaciated woman, who looked to be in her mid-forties, threw her hands up in fear as the apato in the spacesuit suddenly came into view. She cried out, and grabbed an interior bar of the ambulance, and would not let go. Blood dripped from her mouth, from her gums.
“It’s OK, ma, it’s OK, diray sekeh, ma, diray sekeh, how de body, auntie, how de body?” I took her hand and endlessly repeated the most basic greetings in Temne and Krio, trying to soothe and reassure her that she was ok, that I wouldn’t hurt her. I sat with her for a minute as she relaxed and calmed, and then my coworker hopped into the back of the ambulance with me.
The terrified screaming of the nurses had resolved in five minutes what twenty minutes of roadside debate could not. The ambulance driver agreed to transport the patient directly to the ETU.
My coworker had grabbed IV supplies, tubing, and a litre of Ringers Lactate. “She’s going to go to the ETU. Let’s get a line in her now, get a bag up, and get the hydration going as she’s heading down the road.”
I nodded in agreement, took her other hand, and extended her arm down by her side.
We froze, and stared at her arm.
She had an IV catheter in place.
Someone, somewhere, had placed an IV line into an Ebola patient outside of an ETU.
We hung the litre bag, secured her arm with an impromptu armboard made of cardboard (natch) and tape, and shut the ambulance door.
My coworker ran to the ambulance driver before he could take off.
“WHERE DID THIS PATIENT COME FROM?” she screamed from behind her mask.
He rolled his window down about one centimeter. “The hospital!” he replied. He rolled up his window, turned on the siren, and floored it. The ambulance took off down the road in a cloud of dust.
We doffed safely, and walked to the nurses station in quiet horror.
A nurse at the local hospital had started an IV line on an Ebola patient.
The local hospital had been exposed.