Greetings, once again, from Freetown, Sierra Leone. I should be home in a couple of days.
I have been asked several times if I am coming back to continue working in the Ebola response. The answer is that I am going home to be with my wife and son. One of the doctors who recently arrived in Port Loko remarked that I am "outside of the demographic." It seems that most of the expatriates working in the Ebola response either have no children or have adult children. I am an outlier; the only expat with a young child.
The stories are heartbreaking. I saw people who had lost their spouses to Ebola virus disease (EVD), people who lost children, and children who had lost one or both parents. I saw people of every age die; the elderly, young adults, children, and, yes, infants. One woman, whose baby had died in the confirmed ward, complained that her breasts hurt. She was still producing milk.
I was prepared for the deaths. I came with the awareness that ebolaviruses are highly lethal pathogens and that the mortality of EVD is high. I was most affected by the survivors.
I transferred a three-year-old boy from the suspect ward to the confirmed ward after he had a positive PCR for ebolavirus. Both of his parents had died. I stopped by his bed every time I went in the confirmed ward to get him to drink oral rehydration solution (ORS) and talk to him. I didn't see him get out of bed for several days. I was pleased when I saw him outside playing with some of the other boys. A few days later, those boys were discharged and an older woman started looking after him. Not long after that, the woman taking care of him tested negative and was being discharged. I thanked her for looking after him, but I was afraid he would be left alone again. Fortunately, we received a negative test result for him the same day. I ran out to the street as he was being discharged to say goodbye to him and show him a picture of Andrew. I told the aunt who was there to pick him up that he was a brave little boy. I knew he was frightened, but I never saw him cry. Then I found a place where I could be alone, sat down, and cried.
There's a 9-year-old girl who was brought to the confirmed ward about two weeks ago. She had profound neurological symptoms; nystagmus, tremor, and ataxia. For a while we thought she might be having seizures. We thought she was going to die. We spent a lot of time taking care of her – getting her to drink ORS and take a few bites of food, changing her urine- and diarrhea-soaked clothes, and washing her a couple of times a day. Her symptoms gradually improved. The nystagmus stopped, her tremor improved, and she started eating a little more. Thursday I made my last trip into the confirmed ward and saw her sitting up in bed feeding herself. I asked one of the local nurses to tell her that I was very happy to see her getting better. Then she turned and smiled at me. That was the best going-away gift anyone could have given me.
The work has been challenging. Working in full personal protective equipment (PPE) in the heat and humidity of tropical Africa is uncomfortable. My scrubs were drenched with sweat when I left ward. Sometimes my N95 respirator would become soaked with sweat, making breathing difficult. Working in PPE in an Ebola treatment unit (ETU) is not conducive to proper body mechanics, so my muscles often ached. The chlorine solution used to decontaminate our PPE irritated my lungs and occasionally gave me cough so severe that, the first time it happened, I thought I might have pertussis.
In spite of all of the challenges, this has been one of the most rewarding experiences I have ever had. When we first arrived in Port Loko, no Ebola survivors had ever been discharged from the Maforki ETU. By the time I left, we had discharged 60 survivors.
I love Africa. I became a nurse to work in Africa and I plan to return to this continent whenever I am able to do so. For now, it's time for me to go home and be Holly's husband and Andrew's daddy.
I've worked with a lot of remarkable people here, both local staff and expatriates. All of us have made personal sacrifices to be here. Some of the nurses and doctors with whom I've worked quit their jobs to be here. Everyone I've worked with found ways in which she or he could best serve in this response.
I can't possibly do justice to all of my colleagues in this response by naming them individually and describing their invaluable contributions to this response, however, there are two people whom I would like to thank: Larry, who came here with me, and Christian, who arrived a week later. Both of them worked with me in the confirmed ward, going in twice and sometimes three times nearly every day that we've been here. Christian and Larry helped establish high standards for patient care and there are people who are alive today because of their efforts. I am honored to have had the opportunity to work with Christian and Larry and proud to call them my colleagues.