Insensible Losses

On this the last day of the year, I started it by running in the dark holding a flashlight.  Red clay dirt and dust clung to my sweat.  And then dawn peeked through, its oozing blush the color you remember from your first born's infant cheek when she had finished crying and fell asleep in your arms.  As the light relieved the darkness (shift change), I caught my breath and gave thanks.  Today was a new day.

The nurses, contract employees of International Medical Corps (IMC), and host country nationals, threatened to go on strike last night over a salary dispute.  Luckily, they still came to work.  Jobs, if scarce before Ebola, would now be on the endangered list were they animals.  Sierra Leone has lost a significant portion of their healthcare workers to Ebola.  Those remaining have signed on with NGO's such as IMC, Doctors without Borders, Partners in Health, GOL, etc and continue their struggle to find work while remaining safe.  Dr. Sensay, one of my Sierra Leonean colleagues, is a tall thin man with high cheek bones and large hands.  He has been working in the Ebola response for one year now and has lost many family members, friends, and colleagues.  He is always smiling on rounds and pumping the patients full of hope, reminding them of their faith and inner strength. Yes.

This evening before I left work we found out that two of the kids tested negative twice for Ebola and could be sent home.  We delivered the news with George, from the "psycho-social" department and the children smiled and looked down at their sandals.  The boy, Momo, has a brother boys who is still in the confirmed ward with Ebola.  The girl, as we were leaving, leaned up against a pole in the yellow and brown printed pattern skirt common to West Africa.  In Krio, a language which sounds a lot like Pidgin English, she called out to George.  I asked George as we continued walking along the chain linked fence what she had said.  "She told me the man in the bed next to her just died."

I will be starting my clinical work soon, having trained now for two days with the personal protective equipment.  We have a large team here now with three other ex-patriate doctors and 4 ex-patriate nurses along with doctors from Sierra Leone and Pakistan.  One of the doctors is a retired surgical oncologist from Freemont, CA and works at Highland Hospital in Oakland.  A brotherhood is forged abruptly in disaster relief I am learning.

I am sitting at my desk listening to Lana Del Rey on my headphones.  The darkness here holds olfactory mysteries and unknown terrain.  You can hear the night bird songs through the window.   I think they are talking about the mystery beyond mystery.  Yes, night birds cut right to the chase.  Was it Emerson who once said that everything that God has made has a crack in it?

Congregants

Our Work Tent

Sign Language

Doffing

The strategically arranged white Unicef tents, tight, windows rolled up and tied, house asynchronous oscillating fans.  Four giant whiteboards serve as the medical command center with columns labeled "S", "P", and "C" for suspect, probable, and confirmed cases of Ebola.  Patients are brought in after being evaluated at an outside screening and referral unit or are brought directly for triage to our unit.  The cachment area serves mostly the Port Loco District about two plus hours north of Freetown.  Once patients arrive they come through either the confirmed cases ambulance bay or the triage bay.  Every motion in the treatment center is calculated with infection control processes that need to be followed.  We have to have our rubber boots sprayed coming into and leaving the center.  The chlorinated water and wet rubber cling to the humid air to create a fragrance of an industrial laundry room on whites day.

Today I practiced putting on and taking off the Personal Protective Equipment (PPE) that will allow me to safely care for patients.  It is a methodical process consisting of two pairs of gloves, a zip up white suit, a hood, a mask, an apron, googles and those rubber boots.  I have had to gown and glove and wear masks before but these conditions are certainly different and demand meticulous attention to detail.  Putting on the equipment is called "donning" and there is a whole team to ensure you put it on correctly.  Today I put the PPE on to get used to the heat and sweating for 65 minutes without going into the unit.  The key is to hydrate well beforehand but not so well as to have to urinate for the 1+ hours you are in the treatment center directly caring for patients.  You are paired up with a buddy to go in and come out who will inspect your equipment every 15 minutes while you are inside.  Any signs of breach in your armor and you will have to leave.

Equally, if not more important, is the taking off or "doffing" of the PPE which involves a step-by-step disrobing of all the gear all the while being sprayed with chlorinated water and carefully doing it in a way so as to not touch any of your clothes or skin.  I have two more days of this training before I am allowed into the confirmed cases ward.

Overnight our unit had 6 patient deaths, ranging in age from 3 yrs old to 60 years old.  Families are ripped apart.  Children become orphans.  We have a baby in the center now with Ebola who has lost both parents and several other family members.  A woman who has recovered from Ebola (and is now protected from being re-infected) takes care of this baby all day and night, feeding and trying to hydrate the baby.  Our essential character is reflected not so much in our prayers but in our acts of love.  I am humbled to be reminded of this, as long as I am open and looking.

Before my shift finished, I met an ambulance in the confirmed bay, yellow and red lights slowly spraying out from the back of a converted land rover.  Inside a mother and her 3 year old daughter who tested positive for Ebola after her husband died recently waited for our nurses to come in full PPE to take them into the treatment center.  As I stood in my rubber boots, aware of my feet resting on newly placed gravel, aware of the white hot mid-day sun, aware of the gurgle and grind of the generator in the distance, I just stood there. And stood there.  And into my inner world flowed currents...

After a long captive journey by air, bus, boat, and car I arrived early this AM to Freetown, Sierra Leone.  Along the way I ran into a former resident I used to work with from Santa Rosa, CA named Cathryn Christensen while waiting for my flight in Brussels.  She was headed back to Burundi where she currently works.  Random international crossing of paths always me make take pause, as if somehow the intersection holds deeper meaning if I just analyzed it correctly.  Or not.

The Ebola presence was immediately announced at the airport when we had to wash our hands in chlorinated water on the tarmac.  Then our foreheads were scanned for fever.  A group of Norwegian humanitarians clad in light brown dungarees with green back packs, topped with berets, huddled just in front of me as I looked for my Visa waiver, yellow fever card and other documents I would need to get into Sierra Leone.  In the customs area there were relief workers from Ireland, France, Italy, and Canada in varying degrees of uniform dress.  All converging in Freetown for one cause.  Infectious core particles. Virions.

Then it was onto a boat to take me into town to a place called the Family Kingdom Resort where I would crash for the night.  Security guards at the gate carried thermal scanners instead of guns in their holsters and captured my temperature by pointing one at my forehead before I could enter. " 36 degrees celsius- proceed sir," the boyish guard told me.  Then more hand-washing with chlorinated water from a big gatorade style cooler before I could enter the office.  People are reluctant to even share pens.  Schools have been closed here since the epidemic began.  Stores, shops and all transit only run from 9-5 in order to be monitored with Ebola checkpoints.  There are signs and billboards everywhere: "Ebola starts with me!", "Ebola survivors are heroes!", and African pictographs of characters vomiting, shaking with fever, or having diarrhea urging people to know the symptoms.   I asked the driver, Augustine, what "NHS" meant on a lot of signage.  "No hand shakes".  Ebola may not be airborne but is has suffocated this country.

Before driving 2 hours north of Freetown to Lunsar where I will be working, I had coffee with a Pakistani logistician, met with a Croatian quality control manager, and talked international football with a group of Sierra Leonean drivers, all of whom hold advanced degrees but cannot find work in their fields.  Community. Global community.

As I write here from Lunsar after visiting the Ebola Treatment Unit (ETU), the African sun burns down defiantly through an ashen haze of humidity smoked in exhaust and the plumes of prescribed burns rising from the distance.  There is an ancient ceremony here I begin to recognize again, a marriage between new, exotic attention and the skeletal bride of neglect, waiting at the altar yet again.
Evening songs, like butterflies, rise up from behind the thatched roof dining hall, just in time to cut through the last fading blood orange clouds.  I take it all in. And stamp it onto the first page of my missalette.

My room in Freetown

View from IMC headquarters

Ebola Treatment Unit Lunsar

It is the day after Christmas in Northern California and the lights are still strung up on houses and in trees.  They look different in the way that things do when they represent something in the past.  Children on our street are embarking on their maiden voyages on a range of new scooters, bicycles and skateboards.  Through my window I can see Mount Tamalpais clearly tonight.  It wears a warm, new green coat thanks to recent heavy rains.  My name is Andy Desruisseau and I am leaving tomorrow to travel to Sierra Leone to work in an Ebola treatment unit.  

The government of Sierra Leone last week banned any large church or familial gatherings during the Christmas season.  The core elements of African culture, family and gathered faith, became the latest victim of this the 25th Ebola epidemic.

This is the first time I have even considered writing a blog.  The crisis seems to warrant it.  I don't intend to make this a medical blog, beholden to data, protocols or science.  That being said, I think the name of the blog deserves some attention.  

Virion,  an entire virus particle, is made up of a outer protein shell (capsid) and  an inner core of nucleic acid (either RNA or DNA but in the case of Ebola RNA). The core confers infectivity, and the capsid provides specificity to the virus.   The core can be infectious in a positive, hopeful way in the figurative sense.  International communities answering the call and bringing what Rumi, the 13th century Persian poet,  has termed "mighty kindness", drew me in.  If not me, then who?

"Be helpless, dumbfounded,
Unable to say yes or no.
Then a stretcher will come from grace
to gather us up.

We are too dull-eyed to see that beauty.
If we say we can, we’re lying.
If we say No, we don’t see it,
That No will behead us
And shut tight our window onto spirit.

So let us rather not be sure of anything,
Beside ourselves, and only that, so
Miraculous beings come running to help.
Crazed, lying in a zero circle, mute,
We shall be saying finally,
With tremendous eloquence, Lead us.
When we have totally surrendered to that beauty,
We shall be a mighty kindness."

Which leads to the second term in the blog, "missalette", a periodic prayerbook containing hymns or prayers for the season. Despair, which in latin translates into loss of hope, is met in the villages of the world with morning songs of faith, strength, and community.  To me virionmissalette made sense.  Amplified mighty kindness.

Tonight I pack up to leave in the AM for Freetown, Sierra Leone with International Medical Corps.  I arrive Sunday night to find out at which Ebola Treatment Unit I will be working for the next six weeks. A brief time but something.  While I was packing my backpack my children brought some of their stuffed animals up to send to children infected in Sierra Leone camps.  Curious George.  A pig with gigantic pink feet.  Crayons.  Kaleidoscopes. 

Whatever I bring into the Ebola Treatment Unit stays in the unit.  I hope it is enough...