First day of training, Sierra Leone

2/2/15 – First day of training in Sierra Leone! After our late arrival last night (and some watching of the beginning phases of the super bowl by some of us), we got up before sunrise to be ready to go to the stadium by 7. Turned out we were an hour or so early, which gave us time to look over the Olympic swimming and diving pools (unused since at least the start of the outbreak but likely a whole lot longer than that, by the look of them) to the shanties lining the watercourse below. Sierra Leone is supposed to be the wettest country in West Africa and among the poorest countries in the world, and the crop fields along the (trash-filled) stream looked very lush, even if the living quarters beside them did not.

It was clear when we got underway that the training (by WHO and the International Organization for Migration) was not just for us. There were maybe twice as many Sierra-Leoneans (or Saloneans, I think they say), most of them nurses, many of them already working in Ebola Treatment Units (ETUs) and so a great resource for us new folks. A large group – maybe 60 people – but the training was really well run and useful.

Along with briefings on the disease and workshops on useful topics like correct hand washing (you'd be surprised how much of your hand you can miss if you don’t do it systematically!) and how to remove gloves (yes, there is a right way, and it makes a difference!), this was our first chance to actually put on PPE – “personal protective gear,” our new friend. This is the combination of boots, Tyvek suit, mask, face shield, multiple gloves, and hood that is supposed to keep us from contracting Ebola even as we work with patients who have it. You have probably seen pictures – more or less, you end up looking like an Empire storm-trooper from Star Wars, except more colorful.

It’s amazing the amount of anxiety that comes up as you contemplate putting this stuff on. First of all, it makes it 100% clear that you are getting ready to go into close contact with a deadly disease. I think that, as with being mortal in general, it is amazingly easy to pretend it doesn’t really apply to you even though you know the whole time that it does. Second, as you know from every last person who has ever spoken to you about it, the gear is incredibly HOT. I mean, hotter than the 90 degrees hot that the air is here already. Apparently, more like 120 degrees hot. Several people have spoken about feeling faint, feeling like they can’t breathe, having panic attacks, etc. while wearing it. Third – putting it on and, especially, taking it off involve many, many steps which you are supposed to do in the same order every time, while simultaneously keeping in mind adamant prohibitions, such as you are never supposed to touch the outside of the suit and never supposed to touch anywhere near your face. Finally, all kinds of things can happen while you are wearing it which can be anything from irritating to dangerous, and you are supposed to respond correctly to all of them. Face shield fogs up? Can’t wipe it. Mask slides up toward your eyes? You can try blinking it away, but you can’t reach up and touch it. Itchy nose? Try to think about something else, because you aren’t going to scratch it. Tiny patch of skin appears between glove and sleeve? Out you go, no matter what you are in the middle of doing; you have to completely remove and re-put-on the gear, with a good scrub of the exposed skin in between. 

In other words – in addition to the deadly-disease aspect, and the suffocation aspect, there are just a lot of ways you can screw up.

As it turned out, the first run went pretty darn well! You realize that, between you, the “buddy” with whom you are joined at the hip whenever you are in the ETU, and a third person who is there to coach you, it’s not that hard to follow the prescribed steps in order. It is INCREDIBLY hot (it’s like wearing a thick plastic bag) – after 30 minutes or so, my shirt was dripping wet, and we are going to be wearing it for 90 or more minutes at a time. And you do feel like you can’t breathe. But here’s where the three-minute meditation techniques they taught us in Boston come in handy. Breathe, settle down, and you realize you’re not going to suffocate. The shield does fog up – but, at least for those 30 minutes, I always could find some patch that was clear enough that I thought I could look through it to put in an IV. I still worry about screwing up – not pulling my gloves up high enough, touching my hair as I take off my mask – but they’re always telling us to do everything SLOWLY, and I suppose if I can overcome my habitual klutzy haste, I’ll manage to do things the right way.

Don’t know what we’re doing tomorrow, but they ARE giving us a break from putting on the PPE!