Missive #1 – December 9, 2014

Point of no return

I arrived at my Ebola assignment in Bo, Sierra Leone on Monday, December 8th. The weather is very hot (35-40°C) and humid but the countryside is interesting and the people are nice. There are around 40 international staff (expats) here at Bo and 500+ national staff (Sierra Leoneans). The Bo Ebola Management Centre (EMC) is a couple of kilometers outside of town and there are 100 inpatient beds in a secure, double-fenced and guarded compound. Currently, we have 60 patients including 11 children and 1 infant. There are several family groups in the EMC, often a mother, father and child. The mortality rate is around 50% and most patients stay 5-10 days. There is a short party each time someone recovers and leaves. They even get an “Ebola Free” government certificate.

I haven’t gone into the EMC itself yet but I will do that for the first time today. It’s a big deal. Entering the EMC requires correctly donning the PPE (personal protective equipment) guided by a national staff member and going in with a partner or a small group. One is only allowed to be in the EMC for 45-60 minutes at a time because it gets extremely hot in the PPE – sometimes 55°C. The weather is hot, the interior of the EMC tents is hot and the PPE itself is suffocating. The PPE consist of 2 pairs of gloves, a hood, goggles, boots, a full-body containment suit and an apron. All skin must be covered and if there is any skin showing at any time, you and your partner must exit the EMC immediately. Exiting is a complicated process that takes 10-15 minutes and follows a set routine of taking off the equipment one piece at a time (doffing) with Chlorine spraying and hand washing in between each removal. You can lose 2-3 litres of fluid each time you enter the EMC in PPE.

The living arrangements are reasonable. MSF has taken over a small country inn where most people stay and eat and where there are frequent medical meetings. There are 4 other houses for overflow and for visitors. We have electricity most of the time, fans and clean water that is not heated … but who needs that! The food is good so far and there is plenty of beer. I’ll probably gain weight. Fortunately, we have regular internet. Most expats are here for 4-8 weeks but some of the support staff are here for a longer period. I suspect the time will fly by and I will learn a lot.

Take care

Mike