Missive #5 – December 19, 2014

A day in the life

My day usually starts around 6:30 am and I don’t need an alarm clock. A local choir of roosters fills that niche. A bucket shower with cold water reliably rids me of all remnants of drowsiness and I trundle off for breakfast at the group kitchen. The offerings at our morning repast include coffee (instant Nescafe, of course), milk (sometimes liquid, sometimes powder), cereal (mainly corn flakes), local bread (similar to an elongated hotdog bun but delicious), butter, jam, Laughing Cow ‘cheese’, yogurt and Nutella™ We sometimes have those individually packaged single slices of orange-colored cheese that my son Eddy once told me were one molecule away from plastic.

Our distinctive MSF Land Cruisers leave the compound for the EMC every half-hour and I board the 7:30 so that I have time to change and attend morning EMC rounds scheduled for 8 am. Things change rapidly with Ebola and all too often there have been deaths overnight. Borbor Winston died last evening along with three other adults whose passing was also not unexpected. The good news is that we have not had many admissions recently because Freetown (Sierra Leone’s capital) now has an adequate supply of Ebola beds and patients are no longer being sent to us in stiflingly hot and over-crowded ambulances. As well, perhaps the epidemic is abruptly subsiding as Ebola outbreaks often do without rhyme or reason. Most of our patients are now from Bo town itself and, because MSF has recently initiated outreach activities, we are expecting more. For the time being, our patient load has dropped to 29 and this break will be used for training, education and to put down on paper everything that we are supposed to do when working in the EMC. In MSF lingo, these are referred to as SOPs – standard operating procedures.

After morning rounds, I don my PPE and enter the EMC patient tents around 9 am with a community health officer (CHO) to attempt specific tasks such as placing IV cannulas, starting or stopping IV fluids, giving morphine, assessing clinical status especially hydration, and sometimes to declare a death. I myself haven’t declared a death yet and I am not looking forward to it. Usually, we can complete our tasks within an hour but we have to keep track of the minutes and each other. If sweat streams out of your surgical gloves when you raise your hand or if your boots begin to emit sloshing sounds as you walk, that is the time to check the clock. They say there is no emergency when dealing with Ebola patients and, strange as that sounds, it is good advice to move slowly and act deliberately. When you hurry, you are more likely to put yourself and others at risk.

After my first entry, I head straight for the fridge in the pharmacy to grab a litre of filtered water and I plop down on a plastic chair in my soaked scrubs. Initially, it’s hard to focus my mind on what has just happened, and not happened, but after 10 minutes I can report my successes, failures, findings, and recommendations to the other expats and to the Sierra Leonean nursing team leader. Before my second and final entry around noon, I have time to admit new patients, to discuss cases, to check the useful and practical MSF handbooks for guidance, and to rehydrate. My second entry is similar to my first but, due to the time of day, it is much hotter and somewhat shorter. At around 10 am, the day shift arrives (an expat doctor and an expat nurse) and at 2 pm the afternoon shift gets there. We have hand-over rounds at 2:30 pm. I have to admit that I glad to go home and get some R&R before my next assignment. However, the younger doctors (Ben from Holland and Christophe from Germany) seem never to get tired and they often come to the EMC in their free time looking to do something. And, they consume enormous amounts of food and beer. I guess I was like ‘back in the day’.

In the evening, we usually gather around the pool, have dinner together, quaff a few beers, listen to someone’s iPod playlist, discuss the events of the day, and compare past missions. These impromptu get-togethers are one of the things that I like the most about MSF. The only downside is that so many MSFers smoke!