Guest Blog: Pete’s Journal of life in Sierra Leone 2014 (Part 3)

Pete SimpsonBefore Ebola there was no ambulance service in Sierra Leone. To most people the concept of no ambulance service seems unreal.

When I arrived at the Fire Station Headquarters on my first day at work I found 16 ambulances, 16 drivers and 22 nurses sheltering from the burning sun in the back of an old truck. This was the Sierra Leone Ambulance Service (Freetown & Western Area Division).

Why were they sitting in the back of an old truck? It’s obvious really when you think about it. No ambulance service means no ambulance headquarters, no ambulance station, no training school, and no recruitment process. Nothing! No infrastructure to support these poor souls sitting in the back of an old truck trying to keep out of the sun.

The enormity of the task ahead suddenly seemed to magnify tenfold. This is going to take some serious tweaking to iron out the creases. How do you create an ambulance service in a foreign country from scratch? Especially in a country crippled by the Ebola crisis.

As I was to find out in my first week, the economy had been infected by the virus too. It had killed off tourism in a week. No tourists means no money. What little money this country does have is being spent on personal protective equipment (PPE) for the medical staff and burial teams. The scale of the operation here is enormous and the cost to the country is astronomical.

I walked over the sun-baked car park to meet the ambulance crews. Initially they seemed pleased to see me; someone had turned up to see them and he seemed to show genuine concern for their plight.  “Okay” I said. “Give it to me straight, how are things for you?”

The roar of 38 voices all talking at once was defending. Everyone had an opinion, a viewpoint, a complaint, a chance to moan. “Stop!” I pleaded in vain.  Does anyone have any suggestions on how we can fix these problems? Silence……

So we started to talk things through. It turns out the team sits in a dusty, sun-baked car park round the back of a fire station waiting for a call. They currently have no access to food, water or toilets despite facilities being a few metres away in a fire station that won’t let them in. The only shelter they have from the burning midday sun is hiding in or under an old truck.

My heart was breaking in two and I have to admit the call of “come home” was ringing very loudly in my ears.

Team members can’t clean or wash the ambulances and when they approached the fire station for water they will only let them have it in return for 500 Sierra Leonean Leones (around seven pence) a bucket despite staff earning just less than 80 pence a day. This scenario is the stuff that nightmares are made of and one that emergency medical services (EMS) staff across the world will read in utter disbelief.

After a while the crews wandered off back to their broken truck to shelter from the burning midday sun.  It was 96 degrees and because they come into contact with patients with suspected and confirmed Ebola no one will sell them food and water. To conserve their strength they crawl under the truck to hide from the sun and sadly, I think, to hide from society – and these the very people who put their lives on the line for every day.

Right, I thought, first things first: Water and food for the troops. Thirty minutes later an Olympic-sized swimming pool of water and enough food to feed an army arrived in the car park. If they are risking their lives to help fight Ebola, if they are likely to die if they catch this horrendous disease then they were going to be fed twice a day, food and water – the stuff we all take for granted. Disgruntled fire-fighters looked out the window. No more 500 Leone buckets of water would be heading their way anytime soon if I could help it.

The magnitude of the problem was made clear on that first afternoon. I needed some serious help and quickly. I needed to let the world know that the Sierra Leone Ambulance Service, the “Ebola Warriors”, needed help to fight Ebola. They need training, they need leadership, they need equipment, they need you and they need you now.

My first week in Sierra Leone was beyond doubt one of the most emotional weeks of my life and one I will never forget. On the first Monday, two days after I had arrived, I went to Connaught Hospital in the capital city of Freetown to meet the King’s Sierra Leone Partnership team (from King’s College London) who appear to have a grip on all things Ebola. They pretty much seem to advise the Sierra Leone government on most of the treatment protocols and most importantly how to stay safe.

“This is Will”, said Suzanne, a lovely lady and like all of them here working ridiculous number of hours each day in a very cramped office. “He is going to take you down to the isolation unit”.

Straight up, the one and only William Pooley, the UK Ebola survivor, was going to take me round the isolation unit! This guy was a legend back home in the UK and here I was standing next to him.

I quickly learnt that the intense heat inside the PPE suit is what leads to profound user dehydration, which can cause the user to make possible mistakes when going through the disrobing/decontamination process.

“We only stay in the PPE suits for an hour when working in the isolation unit, it gets too hot inside,” he said, adding that temperatures inside can reach 40 degrees Celsius. “The face mask fogs up and you can’t see what you are doing. Then you get dehydrated, we call it the “Ebola Shower” and you are more at risk of making mistakes.”

Sixty minutes later I totally knew what he meant. The isolation unit does not have air conditioning – that is a luxury that this country can’t afford – and the heat inside the suits was overwhelming. My face mask was all fogged up and I was exhausted.

Will then took Claire, a lovely Nurse from the UK, and I through the entire decontamination protocol.

“If you are going to get infected it is at this point,” he said. “You have to follow the protocol. You need a buddy to watch you and make sure you have followed the decontamination protocol. Do you understand that? You have to follow the protocol.”

I understood exactly what he had said: You must follow the decontamination protocol. Do it and you will be safe, miss out a section and you increase your risk of getting infected.

Over the next ten minutes or so Claire and I, like school children on our first day in school, followed Will’s decontamination instructions to the letter. Eventually we departed from the isolation centre and headed back out into the sunshine. “Will,” I asked, “how many times do you robe and disrobe each day?”

“Depends,” he said, “maybe four.”

“You must be exhausted,” I replied. “The heat inside those suits is unbearable.”

I quickly learnt that Will and the other doctors and nurses here are working around the clock to keep the isolation unit functioning. They need more help, more doctors, more nurses, more lab technicians, more of every skill you can think off that helps a hospital function efficiently.

To me, this guy Will is a legend and seeing his care and compassion for the sick patients inside the isolation unit only confirmed it.

Will, I salute you. You are a top nurse and a great guy to know.

More soon……..

About East of England Ambulance Service

Our aim is to be the recognised leader in emergency, urgent and out of hospital care in the East of England....
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