Comments from the field briefing

In Europe now for several days in preparation for journey to Sierra Leone (SL). On schedule is training on how to protect oneself while in SL, meeting with medical service to ensure readiness to travel, psychologist for stress management support, briefing regarding on-site situation with someone who has just returned from the field.

The protection training was largely infection prevention info which of course I am intimately familiar with. It was an interesting group. There were about 10 others there. I was the only American/Canadian in the group, other countries represented included Spain, Japan, Belgium, Nairobi, France and Switzerland. One gentlemen has just returned from SL and was getting ready to return again. Ages ranged from approximately 30 to perhaps 60. All races were represented. There are 3 main categories of professionals that are being recruited, Infection Prevention Specialists (IPS), epidemiologists, and logistic specialists. There was also an anthropologist in our group. My impression was that she was there to help target the right educational messages to the population (In SL, there are 3 different ethnic groups). Three others will be in SL with me, the others are traveling to either Liberia or Guinea.

There was a lot of discussion about the importance of caring for ourselves. Resources are very limited and they do not need us to become ill as well. It takes 4 days to med-evac someone out of the country. Only one company will do this (others do not want to take risk). Most countries (but not all) will accept their own nationals who are ill with Ebola. Germany has been the most generous, and will take any national.

Here are some interesting facts that I learned during this training:
At one point, women in West Africa (WA) were putting chlorine in their breast milk before feeding their babies (to prevent transmission of Ebola). They are now using formula.
Stool, blood and vomit have the highest viral loads of any body fluid.
People are most infectious right before death.
Bleeding is a less prominent symptom in this particular outbreak (unlike previous outbreaks). Diarrhea is of most concern. It rapidly leads to dehydration which is deadly.
Infected children have been seen to be completely well one day, prostate the next.
In general, people are sick for about 8 days, then they either die or recover.
We do not have any objective criteria to see who may survive, a poor prognosis (i.e. death) is associated with a quick onset, confusion, and/or enlarged liver. If not feeling better by day 8, will most likely die.
For obvious reasons, they supply only supportive care in WA, there is no intubation, dialysis etc.
UN dispensaries are providing non-Ebola care at the moment (injury, pregnancy care, etc. There is a critical need to restart essential services. The US will be building a clinic in Liberia (25 beds I believe) to provide non-Ebola care. This is desperately needed in SL and Guinea right now.
Healthcare workers (non West Africans) who have become ill with Ebola were possibly infected via smoking (did not wash hands properly then touched mucous membranes to smoke), also potentially from a contaminated cell phone. Staff are most likely to become infected at the end of their shift when they are tired.
There are now thousands of workers in the field now but the capacity is not there yet (lack of hotels, food etc).

Note for my students: after my training I was presented with an evaluation form to evaluate the effect of the education (remember how we discussed the fact that we never do anything in public health without evaluating the impact?). They used a likert scale for most questions followed by 2 open response questions. Hope you are hard at work on designing your own evaluation forms for your community diagnosis paper!

Meeting with nurse was great. Received yet another vaccination (polio, several outbreaks going on in the world right now). Obviously had polio vaccinations as child and was sure that I had a booster recently but did not have documentation…better to be safe than sorry. Also discussed the need for the last of my 3 rabies vaccines. There has to be 21 days between 2nd and 3rd dose but just not enough time before I go. It has to be kept refrigerated so I cannot bring a dose with me and it is not available in SL. No cases of animal bites have been reported from workers in WA so far. I will do my best not to touch any animals, no matter how cute and cuddly they are! Rabies is not on my bucket list. Gave me a super cool med kit, will attach pic when able. Also gave me the treatment for malaria, 3 days of medication. This is my highest risk for illness. The man in my protection training mentioned that he had seen few mosquitoes though which is reassuring. I do have my mosquito net and impregnated clothing etc so hopefully I am prepared.

Meeting with counselor was pretty quick. Will have to spend more time with them on my way back. PTSD is a huge issue. I think that with my extensive nursing experience though I will be somewhat prepared for the death scenes and situations.

One last comment, in this large (and unnamed) European city, all of the children that I have seen on bicycles, scooters, and skateboards have been wearing helmets. Obviously they have strong public health laws to prevent injury, I love it!

On my way to the next meeting, more to come.