training day 2

     More training today on how to protect yourself while in Liberia.  Some of it was more mundane and directed primarily at the expat personnel.  Simple things such as malaria prevention and rest cycle management.  One interesting change is that no one shakes hands upon greeting each other, whether at the ETU or on the street.  Shaking hands has the risk of spreading Ebola if one of the parties is infected.  Most commonly, people now bump the outside of each other's elbows in greeting.  It gets more natural with repetition but I might still extend my hand if the other did so.  Others areas of instruction were more specific to ETU's such as heat stress.  One thing to realize about the PPE is that it is impermeable and lacks any sort of ventilation.  Once you are zipped in, there is no exposed skin and the effective humidity in the suit is 100%.  Couple that with ambient temperatures into the low 90's yields effective (wet bulb) temperatures in excess of 120 degrees.  This limits the time in the suit for patient care and puts a premium on efficiency to reduce the amount of time in PPE to prevent fatigue induced errors in technique.  Another interesting tidbit is that a common route of infection for health care providers is through the eyes and mucus membranes of the nose and mouth.  Have you ever checked to see how often you unconciously rub your nose or eyes?  This is something that you really have to suppress while you are in PPE since it usually occurs without concious intent.  

     The set up of the ETU is interesting.  It is engineered to reduce the risk to the patients and staff through contamination and cross contamination.  There are many fences with specific gates and procedures so that you can only cross from a cleaner area to a more contaminated area.  Also, you can only exit the hot zone through specific decontamination stations.  Maybe it isn't the easiest system, but it is the safest system for both the patients and the staff.

     Arrangements have been made for my transportation to Tapeta on Saturday.  It will be an 8 to 10 hour drive over some pretty rough roads.  But that is where the action is.  Thanks for your prayers.