One item that I don't think that I have commented on is the the ubiquitous smell of chlorine. Chlorine is the disinfectant of choice here. It is inexpensive, easy to handle and effective against the Ebola virus. Most of the time, it is used for hand washing. You will see it in front of restaurants, grocery stores and public buildings. There is a hand washing station at the entrance to our guest house. Usually you use a 0.05% strength for hand washing and a 0.5% strength for cleaning equipment. However apparently under the theory if a little is good, more must be better, you occasionally run into more highly concentrated solutions. You can tell pretty rapidly by the feel and smell. Hopefully you have some normal water to rinse off with afterwards. But at least in the ETU, it is the smell of security.
Today, we had mock 'patients' in triage. These were 'patients' who would have just come to the ETU to be evaluated. The first case was pretty straight forward and we were able to question him and see that he needed to be admitted. The second case did not speak English and I was without a translator. After an initial huh?, I basically started playing Charades with the patient to try to obtain the history. Not my strongest suit but made even more interesting by needing to coach the use of a thermometer and to pantomime diarrhea. I think the rest of the team was amused but also thankful that this wasn't their patient. The hardest part was when the 'patient' sat down, the plastic chair collapsed and unconsciously, I reached out to catch him. Of course, you shouldn't do that since you will only be in light PPE (gloves, apron, mask and goggles) and not fully protected agains Ebola. But it is just hard to suppress something that happens so quickly that you don't have time to consciously consider. Structurally, most triage areas are set up with a barrier between the triage officer and the patient. Originally, I thought that this was to keep the patient away from the triage provider, but I see how that can work the other way as well.
The ETU here has a motto: "We protect ourselves so that we can save lives." It is interesting that the emphasis is on the protection of the provider first and then on the patient. This was followed later with the statement that 'A life lost is bad, but a lost health care worker is much worse'. It is an interesting inversion of many concepts of service in the US. 'Service above self' for Rotary and Jesus' admonition to love your neighbor as yourself. I certainly see the reason for this from a utilitarian point of view. The early loss of health care providers has proven disastrous over the course of this epidemic and has cost many more lives. I have no problem adopting the motto, however it still feels a little funny.
More training on Friday then a ten hour drive to Tapeta on Saturday. Thanks for your prayers.
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