Training for Ebola

     We started our official cold training today.  In many ways, it is like a medical conference anywhere.  It has classroom instruction on the Ebola virus, transmission, treatment etc with handouts.  It even has the usual pre conference snacks and scheduled coffee breaks.   But it is also different.  1/3 of the class consists of expats, mostly from Sweden, Germany, Ireland, the US and Australia with the rest of the class from Liberia.  Many different organizations are represented, including the Red Cross, Carnitas, the Swedish Civil Contingencies Activity and local Ministry of Health organizations. The classes are held in a large non air conditioned tent with roaring fans in the second half of an ETU compound that was never utilized.  Overall, it was pretty obvious that we weren't in the US.

     Liberian English is a little difficult.  Not so much the idioms, but the pronunciation and diction are different.  Couple that with some of my high frequency hearing loss, and it can be a bit of a struggle to get the full meaning.  However, it is even more difficult for the Swedes and Germans to understand a different variant of a second language.  Thankfully, there are good handouts and the language does become easier to understand the more you hear.   That and motivated students.

     One point raised during one of the Personal Protection talks was to remove all rings when working in an ETU.  Anything that can harbor contamination or induce even microscopic injury to the skin must be avoided.  Those could increase their risk of infection if there was a breach in PPE.   I guess I will be ring free for a while for the first time in 37 years (sorry Jo).

     More classes through the rest of the week are coupled with practice in our PPE.  Thank you everyone for your support.

First time in the Hot Zone

     When we walked through the gate, our CDC status changed immediately from 'no identified risk of Ebola' to 'minimal risk of Ebola'.  Today we entered the 'hot zone' for the first time.  No patient care, it was primarily a drill in donning and doffing our personal protective (PPE) with an extensive tour through the 'hot zone' in the MoD One Ebola Treatment Unit (ETU).  Crossing into the hot zone entails potential exposure to Ebola with intact PPE.  That degree of potential contact raised my risk status to minimal.  It will be raised further once I begin patient care to 'some risk of Ebola'.  

     There are exacting procedures for the placement and removal of these protective suits.  Everyone checks each other and there are safety personnel who monitor you while you don the multiple layers of Tyvek, goggles, mask, gloves and boots.  Removal is even more intense as that is the operation which has resulted in the majority of identified Ebola healthcare provider exposures.  You remove the suit as a team with chlorine sprayers a/hygienists directing your actions.  You can't perform healthcare in an ETU until you have completed training.  We will all be paying close attention in class.

     These suits can be quite warm.  With the temperature in the low nineties and quite muggy, these essentially air tight suits can generate temperatures of over 120 degrees Fahrenheit.   Due to this, we are limited to 45 minutes at a stretch in the suits.  While you know you are hot, you don't have a good feel for how much you are sweating.  When in the hot zone, you don't want your hands to go above your nipple line.  Gloves are the most contaminated part of your suit and you don't want your hands near your face.  You also don't want to let your hands drop onto your apron which is the next most likely contaminated part of your suit.  That leaves you hands held with your forearms level much of the time.  That allows the sweat to accumulate in the arms of your suit and to slosh around when you use your arms.  Altogether, I needed to chug two bottles of water when I had completed disrobing.

     We also toured the U.S. Public Health Service ETU which is located near the airport.  It is a more sophisticated ETU which is staffed entirely by Public Health Service physicians and nurses.  It is there solely to evaluate and take care of health care personnel (of any nationality) who becomes symptomatic.  Usually, it is something other than Ebola, but of course there have been positive cases as well.

     Tomorrow is a light day while we wait for our official cold training to start on Monday.  Please keep everyone here in your prayers.

En route to Liberia

     I am in the waiting area for my flight leaving Kansas City ultimately ending in Monrovia, Liberia.  I will be posting throughout my six week stint with Heart to Heart's Ebola Treatment Unit in Tappita, Liberia.  Waiting in the airport is good practice for working in the developing world (for any purpose).  Construction has moved slowly and the overly optimistic start time for the Heart to Heart ETU of the end of November has come and gone.  Expected opening of the ETU is now 1/5/15.  However, good can come from the delay.  With my prior military and management experience, I may be able to contribute in more than just a clinical way.  

     I suppose that I should address why I am here in the first place.  Usually, the question is phased something along the lines of 'are you crazy?'.  No, I am not crazy, but I do feel called to help in places where others can't or won't.  Why in Liberia (or Haiti or Uganda etc) and not locally?  I am not sure exactly why (as I do help locally), but it has something to do with the fact that all my experiences throughout my life have been leading in this direction.  I have always viewed my experiences as a gift of God, not that I necessarily appreciated them when they occurred.  I have often wondered how I could honor those gifts by using them in a way that pleases God.  When you combine my military experience (military commander, medical staff officer, unit chemical defense officer, 5 years in special operations, combat experience), my medical degree, continued athletic involvement and church involvement, I seem to be well prepared for service in difficult areas.  I do feel a peace when I deploy.  Not that I am not a bit nervous (it wouldn't be safe to feel complacent), it is just that I do feel that this is what I was meant to do.  

     I will try to update the blog every day or two.  We do have Internet in Tappita, however it can be intermittent.  God bless you all and thank you for your prayers.

Rick

I have walked

Psalm 27:13 I remain confident of this: I will see the goodness of the Lord in the land of the living. 

Yes, I did manage to "walk the last 100 kilometers" into Santiago.

Yes, I have my certificate in Latin (too bad my names does not have a Latin equivalent)

Yes, I am still sorting the walk experience out and think I may be doing it for quite some time.

After arriving in Santiago we went out the next day to Finisterra the actual 0.0 km point of the camino. We were again reminded of the Celtic roots of that are of Spain.  The hills and barrenness of the 'end,' the power of the ocean waves crashing upon the rock, the wind blowing so that one had to touch the other to get one's attention because no one could not hear reminded both of us of Achill island (minus the rain and cold we experienced on the island).

looking East across the Atlantic @ Finisterra

Rick & I at Peace Pole

 Seeing the peace pole (this was the first peace pole located in Spain) reminded us to ask blessings on those at home who pass our peace pole every Sunday and give thanks for their blessings asked for our safe journey. 

Just crossed over this roman bridge

Portugal - Cork tree

Camino even travels under grapevines

More than just 'walking' the camino, this trip was an experience of the history and cultures of the areas we walked through.  Walking the ancient roads, paths and byways allowed for the time to really see and hear and feel the life of creation; not just we pilgrims and the people we came in contact with, but the flora and fauna which make this area a vital living piece of creation.  To see and experience the care with which these peoples continue to companion plant and rotate crops, allowing the land to continue blessing them with beauty and nourishment for millennia.  Each meal we ate was graciously presented and consisted of fresh vegetables from those same farms we had just walked past!

Just one of the many gardens we passed daily

One memory I'll cherish is the incredible hospitality of Fernanda as she opened her kitchen 

Rick & I with Fernanda 

and presented us with more food for lunch than I have seen on some Thanksgiving tables to sustain us in our journey: salad fresh from the garden, roasted potatoes just dug that morning, grilled chicken prepared by her father from the ones that had awakened him just that morning, verde vino decanted from her own barrels into pitchers we passed and shared with one another, all offered with a smile and a blessing on each of us for our 'buen camino'. Walking with the small group of pilgrims I know encouraged me to keep putting one foot in front of the last as we walked slight inclines and just around the curves...being greeted with "BOM DIA' each morning as we tried to wake up and encourage each other that we did it yesterday we can do it again today. Whether it was sunny, misty or downright pouring we all managed to make it to Santiago as the sun shone down on us, letting us know - walk well done!

I leave the camino with memories of the birds singing and chirping, metal windmills clanging to 'scare' the birds from the fields, church bells pealing as we walk into the valley, dogs barking hello and go away, cars honking wishing us buen camino, the stamp received from the patrolman as we stopped by his car in the middle of the camino!  I also leave with HOPE as I work for a sustainable world for all. Encouraged with the experience of the camino where I witnessed the the respect for one another and the respect for the land that CAN nourish all, I saw the goodness of the Lord in the land of the living.

The Atlantic Beach portion of the camino.

Rainy Day picnic lunch in hearth kitchen of the monastery 

Puppies  saying Buen Camino

Fresh Bread Delivery each morning!

View out one of our hotel windows

                   

                   Our small pilgrim group as we finished - in front of Santiago Cathedral

Rick's thoughts at the end of the camino

This has been a wonderful trip.  Like many new things, it was full of exciting experiences as well as the unexpected.  It was a good, long walk with the change of perspective that comes with reaching a goal.  Was it what I expected?  Not exactly, but as I said before, I tried to approach this without expectations.  I certainly wasn't a tabla rasa, as my perceptions had been colored by books written by others who had walked the French Camino with the hardship, suffering and penitence.  We didn't have that.  We didn't have to put up with the snoring of others in the alberge (communal pilgrim lodging), the hotels we had were excellent and often sited in the most amazing places (fortresses, monasteries etc).  The food was excellent and plenty.  One would think with the amount of walking that we did, we would lose significant weight.  Well, we may have lost some, but not the amount I would have expected because of the excellent food and generous proportions.  No penitence, although there was certainly time for reflection.  I loved the conversation with each person in our small group and I loved learning about northern Portugal and Galicia (northwest Spain).  We were lead by guides with intimate knowledge of the area and the other members of the tour brought interesting viewpoints on many different issues.  Would I do it again?  No, but only because this was a trip to share with Jo.  Will I take other hiking trips to interesting places?  Yes, because this one has been so rewarding, physically, mentally and spiritually

Camino Musings

Some sights and thoughts as we review a few of the pictures and memories of the past days...

the cathedral in Porto where we obtained our compestela passport and our first stamp.    

the first picnic in the rain

walking into Barcelos as they were preparing for their Medieval faire - costumes, jousts smoked meats and all...

walking down into the valley as the church bell chimes the noon hour and them plays a hymn with birds chirping along 

Flowers grow everywhere even coming out of the walls smells lovely

our small group of pilgrims walking this walk together-the 100 kilometer point...from this point you are to walk the 100 kilometers into Santiago in order to earn your Compestela certificate.. 

the animals we have seen include rabbits, chickens, swans, horses and these very shy long-horns

Just the facts...

Be careful what you post.....

Experiencing a plane problem in Charlotte, we had to change to another plane and missed our connection in Lisbon to Porto. As the door opened after landing in Lisbon, a steward was there with boarding passes in hand. We had been reconnected to a (much) later flight. Although 5 hours later I do think it helped adjust to the time difference and we got to stretch the legs. Arriving in Porto, we were able to purchase a ticket, get on the right train in the right direction even changing lines and arriving to our hotel with only a 3 block down hill walk...7 hours later than we had planned but we made it.   The next morning I realized my watch seemed to be slow, never thought to replace the battery before leaving, oh well who needs time on 'holiday', except someone who has group to meet, dinner times servings, wandering villages to meet bus at... hmmm oh right that's why Rick is with me and the phone works and we have been able to keep electronics charged quite well so far. 

Had a wonderful time slept in a bit, toured and wandered Porto, had a port wine tour and tasting, dinner by the river and then overnight I was sick (Rick believes it may have been food poising, but we did eat the same things). Thank goodness we had planned extra days before meeting the group and beginning the walk. I was able to sleep in and rest before meeting the group at 1 that afternoon. An interesting group of 11 of us, from Canada, NJ and KS. We also have three guides with us an Australian, Gary, a Brit, Deborah, and her Argentinian husband, Pablo. We are very well covered in languages spoken and understood. It works well to have three so we can trek at the pace most comfortable to us with one in front so we don't miss our way markings and one guide in back to make sure we all make it and usually Deborah, as she says working like a sheep dog, making sure everyone is coming along and is doing well. 

Guess this means I have nothing to do but let go and  walk - everything is pretty much taken care for us! The rest stops for coffee and potty breaks seem to come just in time. Hotels are bit fancier class than our usual abodes and lets just say, losing weight will problem NOT be an option.  One thing is the dinner meals are late, as in starting at 8 or 8:30 and going until past 10 - way past my bedtime. And the next morning we are usually headed out by 8:30.   I am very glad we DID NOT decide to walk it with everything on our back and hopeing to find meals and accommodations when we are ready to stop!

I have been wearing a fitbit measuring the steps/miles walked and floors climbed. And some times the 'about ___kms' that Gary states is not quite as 'about'..more often longer. (which may be good since the first actual distance walked on the first day walk was what the tour brochure states will be the last 'Long Walk in to Santiago' and we have accomplished that distance in the rain no less! My measurements, as of tuesday evening crawling into bed, we have walked 67.96 miles both on the camino and walking the towns we stay in (city guide tours and to and from dinner). Oh and we have climber 486 'floors'.

We are off again and on our last 100 kilometers that must be walked to qualify for the compestela certificate. Have been watching the kilometers count down....step by step...  Jo

one of the kilometer countdown markers