Sue Ellen Kovack, 56
Australian Red Cross nurse, Kenema, Sierra Leone
At the start of the day, I check my hands for any cuts or scrapes that will bar me from donning PPE. Entering the centre, I must wash my hands in a 0.05% chlorine solution. I balance on one foot as someone sprays the bottoms of my shoes with 0.5% chlorine before being allowed entry to the low-risk area.
I search for a pair of cold wet boots in my size, which have been soaking in chlorine for the night, and I change into my scrubs. I go straight to the whiteboard to see who has passed away during the night; today, it's one of three nurses who became infected at work. One is on his way to good health, the other is still hanging on.
We need to synchronise putting the PPE on with other team members, because if one is slower than the rest we end up waiting and baking in the sun. We have a dresser to make sure we are completely covered, or we work in pairs and check each other. First on are gloves and a jumpsuit. Then a second pair of gloves, a thick duckbill mask, a hood, and an apron that is tied by the dresser so we can untie it with one pull. Then on go the goggles with a generous drizzle of antifogging spray, a final check in the mirror and a final check with each other. The checking does not stop there, as we must ensure during our time in the high-risk area that we are still covered, that a mask has not slipped, or that a piece of skin has not been exposed. If that happens, we leave the area immediately. We check the time - 45 minutes to one hour is the maximum allowed in the PPE.
We have the luxury of four nurses today. Patients who are feeling well enough are sitting on plastic chairs waiting for a meal. We might offer some pain relief, or a smile from beneath our PPE (yes, you can smile with your eyes).
Hannah (not her real name) is sitting outside, greeting us with a big smile. She has lost all her children to Ebola as well as her husband. And here she is asking me how my evening was. The staff tell me she has had some bad moments, but all they can do is reassure her that she is young and can bear more children.
Others have not fared so well - too weak to sit up, or get to the toilet or the shower block. We do our best to offer fluids, a wash and some paracetamol. The local nursing staff have amazing courage to work in our centre. Their families ostracise them, but they still come, to try to bring an end to this brutal, invisible "war". In Africa, it is usually the family that feeds, washes and comforts the patients. But no family members are allowed inside our treatment centre.
My three key words are warm, dry and comfortable. Patients who are too weak to move away from their own vomit, faeces and urine need the most help. We clean and care for as many as we can, but if we need to leave the area because of heat exhaustion or feeling unwell, the priority is to get out. You are a danger to your colleagues if you go down in your PPE.
After our nursing team goes in, the hygiene team suits up for their rounds. They clean up the vomit, diarrhoea and urine spills, the garbage and the nappies. Their task is monumental and they can be at most risk.
A minimum of five minutes is needed to undress. We have two tents, where the undressers and sprayers need to be on the ball. The urge to just pull the suit off is strong, but we wait. First, the chlorine spray to the hands. Then, feet apart, arms in the air, we are sprayed from head to toe, first the front, then the back. We wash our hands in 0.5% chlorine. Off come the first set of gloves.
We wash our hands again. Off comes the apron and hopefully it was tied perfectly, as we have to blindly reach around to release the knot; we pull it over our heads. Into the chlorine soak it goes. We wash our hands.
Next go the goggles. We bend over, close our eyes and gently remove them, dunk them three times in the strong chlorine-filled bucket, and then place them in water. We wash our hands.
The hood comes off next. Once again, we bend over, closing our eyes to avoid contamination and dispose of the hood in the garbage. We wash our hands.
Next, the removal of our heavy PPE. Moving slowly - we do everything slowly here - we carefully expose the zipper, hidden under a taped-down flap. We wash our hands. Blindly, we have to find the zipper, as our undressers and sprayers guide us. We wash our hands.
As we shimmy out of our PPE, we are soaked to the bone in sweat, but it feels great. This is the hardest part: to ease off the jumpsuit while kicking your legs back, at the same time standing on it so it doesn't fly away from you. It's a balancing act. The sprayer sprays the entire jumpsuit with a stronger chlorine solution and we put it in the garbage. We wash our hands.
Our heavy-duty filtration mask is next. I close my eyes and hope it doesn't catch in my ponytail. We wash our hands.
The last pair of gloves comes off. Our boots are sprayed from all angles and we have to balance on one foot to cross the line from high risk to low risk. We wash our hands and we are done, stripped down to our scrubs, soaked with sweat.
I need a rehydration solution or water. No food is allowed in the low-risk area. It is too risky to put anything near your mouth from your hands. But I still see people biting their nails, touching their face, rubbing their eyes - risky but automatic responses. Your hands have been washed a trillion times in chlorine, but still, you don't know how safe your other colleagues have been. You are literally entrusting your life to your work mates. Before I left Australia, I took to wearing a rubber band and each time I caught myself touching my face, I snapped it painfully so I would remember not to do it.
I hear an ambulance and the siren is going fast - it may pass us and head to the next treatment centre, hours away. But it abruptly turns into our driveway and we run out to greet it. I suit up and prepare for the admissions with a package consisting of a blanket, soap, towel, cup, toothbrush and toothpaste, all in a covered bucket that will be used for vomit/faeces or urine if the person is unable to get to the latrines.
The ambulance door is opened and I can see a man on the stretcher, two legs in the air, stiff as a board. They slowly drop and I realise this patient is dying. But he walked into the ambulance in Freetown. It is a five-hour drive through a dozen checkpoints and deterioration comes rapidly. I pronounce him dead, and move on to the other patient.
The female patient is lying on the floor between the seat and the stretcher, strapped in by seatbelts. She is trapped, a terrorised look in her eyes. She is flailing wildly, a dangerous situation in itself. I try to calm her while maintaining my distance. We move her as best we can, but then I realise that she is just trying to cover her exposed area below her waist. In her last moments, this is her concern. We manage to get her into a tent. We ask her name, if she is married. She responds, "I am married", looks away and dies. All that struggle and desperation in the ambulance and she only wanted to preserve her dignity. That was a tough moment.
http://www.theguardian.com/world/2014/oct/13/ebola-nurses-describe-life-death-on-frontline-liberia-sierra-leone
I'm reading and seeing too many differences between what we say is safe and what they do in Africa.
