Greetings from Freetown, Sierra Leone

Chris, Jennifer, Larry, and I arrived in Freetown last night. The first thing everyone had to do after getting off of the plane was wash our hands in chlorinated water. We were given a health screening form to complete. Our temperature was checked before we were allowed to enter the baggage claim area. The airport is across a bay from Freetown, so we took a twenty minute boat ride to get to the city. Upon arrival at our hotel, we had to wash our hands in chlorinated water and our temperature was checked before we were allowed to enter the lobby.

After a briefing at the hotel this morning, we were driven to Connaught Hospital. Riding through Freetown, I was struck by how normal everything looks. People are going about their business as usual, they smile and greet each other, and children are playing. I shouldn't have been surprised. As of November 7^th, there have been 4,862 cases of Ebola virus disease (EVD) in Sierra Leone, a country with a population of 5.74 million people. If you're looking for the sick and dying, you won't find them on the streets of Freetown.

This is a beautiful city. It's topical Africa; the hills are lush green, and there are pleasant beaches. Right now the weather is very similar to summer in New Orleans. The temperature is in the 80s and it's very humid (balmy!).

 

Upon arriving at the hospital we were required to wash our hands in chlorinated water and our temperature was checked before we were allowed through the gates.

After another briefing, we were taken to the Ebola treatment unit (ETU) where we donned personal protective equipment (PPE). I'm pretty heat-tolerant. I enjoyed riding my bicycle in New Orleans in the summer, but wearing head-to-toe PPE in this weather is very uncomfortable. Within a few minutes of donning my PPE my scrubs were drenched with sweat.

 

Jennifer in PPE

 

If you expect me to say something like, "Nothing can prepare you for the first time you see a patient with Ebola," you're going to be disappointed.

I've read several descriptions of the clinical presentation of EVD. In general, there's nothing in the appearance of a person with EVD that distinguishes it from other acute febrile illnesses. That's one of the problems early in an Ebola epidemic. Health care providers are often exposed to ebolavirus before anyone suspects that the ill patients they are seeing have EVD. People with EVD look like they could have malaria, typhoid fever, or any number of infectious diseases that are common in developing countries. Confusing the issue even more, Lassa fever, another viral hemorrhagic fever, is endemic in this part of Africa.

It's not my intention to minimize the seriousness of this disease. It's just not like what you might have seen in a movie. People with EVD are severely ill and the mortality of EVD is extremely high. Most people who die from EVD die because of dehydration and electrolyte disturbances from vomiting and diarrhea. The term "hemorrhagic fever" can be a little misleading. Although bleeding can be part of the clinical picture, not all patients with EVD bleed and most bleeding is into the gastrointestinal tract.

Once we returned to the hotel, we washed our hands in chlorinated water and had our temperatures checked before we were allowed in the lobby.

My beautiful wife and son on Skype