Ebola Emergency Response with Save the Children
It’s been just about 6 months since I joined Save the Children International and I am now leaving the UK for a few weeks to join the emergency team which is being sent to try and get Ebola under control. Ebola is causing havoc in Liberia, Sierra Leone and Guinea. The UK government is funding a large Ebola Treatment Centre in Kerry Town which is just to the South of the capital
During my deployment, I will be keeping this blog up to date so that people can keep up to date with our progress. Please wish us luck. There is a lot of work to be done to combat Ebola. If we are successful, this awful disease will be stopped. I don’t even want to contemplate failure. Wish us luck!
On the ground in Kerry Town
The UK funded Ebola Treatment Centre (ETC) is about 60 KM to the south of Freetown, the capital of Sierra Leone. I arrived here a few days ago with other team members from Save the Children. The journey from the airport was broken up by checkpoints manned by the local army. Medics were on hand to scan everyone’s temperature. I never managed to get an answer to the question about what they do with the people running a temperature.
This project is a joint effort between DFID who is funding the project and providing logistics, the UK MOD and Save the Children who will run the ETC as soon as it becomes operational.
Construction is underway, but there is still much more construction to finish.
As the site is being built by the UK MOD, there are many other activities taking place at various sites in the neighbourhood. We have medical, HR and training teams recruiting people and training them up ready for when we open the doors for the first patients. The logistics team are handing the supply of goods we will need to run the site. DFID is sending regular 747’s to Freetown with lots of kit and more is on the way.
Vehicles have arrived already and one of my jobs is to ensure that they are all set up with radio and satellite communications. Here are just a small number of what will become a large fleet. Moving people around is a nightmare owned by our very capable fleet manager!
These have radios already set up – but plenty do not – here is all the radio kit in the warehouse ready for installation.
Internet in Sierra Leone is not at the same level as people experience in more developed places. On my arrival here, it was made quite clear that a good internet connection would be required to not only manage the project, but also to allow staff to stay in touch with families back at home. The existing connection was not up to the task, so we brought back an old satellite system into service by connecting the equipment to Geolink Network. Once switched on, people were able to do things online more efficiently. We have been able to send film footage back to London, which will no doubt get to the press in due course.
In the days ahead we have a lot of work to do, its long days but a big effort is needed to get this place up and running and treating people and saving some lives. After the ETC is operational, things will start to get much harder as Ebola is a brutal disease and not all people entering the ECT for treatment will survive.
Making progress
Every couple of days, a plane arrives in Freetown full of kit for the Ebola Treatment Centre. Over the pas 48 hours we have started to receive cold chain drugs. The term “Cold Chain” means a great deal to a professional logistician, but to us humble ordinary folk, we depend on a controlled cold environments each day. How do you think a pint of milk gets to your fridge without going off?
Medical supplies also need to be kept cool. The task of keeping them cool throughout their journey from the UK to West Africa is a big ask. When they eventually arrive, the responsibility is then owned by us at Save the Children. We are keeping medicines in tow locations. The majority are stored in the refrigerated container (called a “reefer”) and we have to keep power supplied to our containers 24/7. Yesterday one generator packed up. I managed to fix that issue. Today, I received an emergency call from Kate, our chief pharmacist telling me that medicines were at risk due to another generator failing. Luckily there was another generator on site, so the day was saved!
As with many developing countries, we have to plan communications well as reliable systems are required to run an operation which will serve around 100 patients. This was brought home to us today when the local mobile service dropped offline!
Over the past few days, I have been building up our communications system. The picture above shows our radio masts so that when we go live, we can stay in touch between our logistics and fleet operation centre, the ETC and the various vehicles and ambulances which are required to move a vast number of staff and collect patients.
Satellite communications is also important. Its really the only way we can get reliable internet access. The system at the hotel is now working well. Tomorrow I will start working on the comms kit at the ETC.
The ETC will come online on the 5th November. Until then, we have a lot of work remaining to get ready. In fact the target date is for the 30th Oct. This gives us time to run practice shifts before we open the doors to real patients.
One month on the ground in West Africa
I have been in Sierra Leone for a month now. Due to the nature of this emergency it was very important to get the Ebola Treatment Centre (ETC) open by the 5th November so that we could start to play our part in the wider response to Ebola. This has meant people have worked long hours 7 days a week so that we opened the ETC on time and started to take in patients.
The day before we opened, we were visited by the president of Sierra Leone, and as you would expect, the media included the BBC was there as well. Here is Clive from BBC News speaking at some cameras.
In September, what is now a 100 bed hospital was just open fields with some buildings nearby. The Royal Engineers (British Army) working with many local contractors build the ETC at an amazing pace. I have never seen such infrastructure built so quickly. In one conversation with the officer in charge of the electrical build, I mentioned that I was really impressed. He just brushed it off with the comment “That’s what we do”.
My role here has been to build the technical infrastructure at two sites for Save the Children. We quickly established a satellite link at our logistics based in Tokeh so that we had communications in place to handle the international logistics. This was then followed rapidly by another satellite link at the ETC so that the Labs can get test results to the UK and to the local community as soon as they are ready.
Radio communications have been set up at both sites. This is really important for command and control of this operation. 30 VHF handsets are provided to various teams to coordinate the activities of the doctors, nurses, hygienists and the people who will feed our patients. At the ETC, VHF proved essential as the local mobile system does not cover the ETC very well at all.
Wireless networks have been set up. For a hospital where we deal with just one but extremely deadly disease, traditional methods of managing information is not possible. Prescriptions and patient notes cannot be sent from the wards (red zone) to the safe area (Green zone). We cannot risk the prospect of infecting health staff with contaminated paperwork. Instead, we are establishing solutions where we transmit the information from the wards to the green zone electronically. I will come back to this in a future blog.
Power supplies are important as well. At Tokeh, we have three refrigerated containers where we keep some drugs. We have had some problems with the generators and I have received a number of emergency calls to fix a broken generator. A rapid response is essential as we cannot afford the risk of running the drugs.
The switch from building site to becoming an operational hospital took just about 48 hours. We are not at full capacity, but in our first day, we got to 7 patients. So in that short period, I managed to roll out all the IT cables and wireless, but also managed to take pictures in the red zone before it became contaminated with Ebola.
So here is a very quick tour of a patient’s journey through our hospital:
The patient will arrive at a special entrance by ambulance, whilst we are set up to take patients who are already confirmed with Ebola from the national system, we did accept some walk in patients.
On the day we opened, the ambulance below which delivered samples from the lab was used to move a patient from the hospital grounds to the correct entrance where he was dealt with by our medical teams.
There are two wings to the hospital, but both operate on the same principles. We have an 80 bed unit for the community and a 12 bed unit for health workers.
When a patient arrives, if they have not been confirmed to have Ebola, they will be sent to an assessment ward. The main purpose of this ward is to confirm why the patient is unwell as there are other diseases which presents the same symptoms as Ebola. Malaria is one example. We had a four year old admitted as an Ebola suspect last week. She was discharged a few days later when we confirmed that was not an Ebola victim but was suffering from Malaria. Still serious, but she is doing really well and will make a full recovery.
The key purpose of the assessment wards is to ensure that we do not allow Ebola suspects to come into contact with each other. This is why the place is set out with some single bed units. It would be a tragedy if someone came in with malaria and then contracted Ebola whilst under our care. The medical teams are especially careful when treating patients under assessment. As medics move from patient to patient, there is a lot of cleaning going on in between.
For confirmed patients, they go to confirmed cases wards where there are more beds. There is no cross infection risk in this area, but the staff treating confirmed patients will need to take special care to protect themselves with PPE. In the sweltering heat and high humidity, wearing what looks like a spacesuit is really hard work. Googles steam up, staff have fainted. Make no mistake, this is very difficult work.
There are two ways out from the ETC for a patient. For survivors, there is a final shower – It was reported by the BBC when they visited as the “Happy Shower”. For those who do not make it, they end up here. Sadly we have lost a few patients as they got to us to late. Ebola was too far advanced.
The personal protective equipment is used in vast quantities. Each worker in the red zone will make around four visits a day. This means that they will use four sets of kit. Some of it is recycled – boots and goggles, but some of the inner suits need to be incinerated. The workforce operating in the red zone will be over three hundred by the time we are fully operational. Vast quantities of kit is being consumed round the clock every day. This is why we have a logistics team with warehousing to support the supply of protective gear, medicines, food and much more.
DFID is running supply fights from the UK to Freetown a number of times each week to keep the supplies coming not just to our hospital, but the other ETC which DFID is supporting in other parts of Sierra Leone.
Working the night shift in Sierra Leone as “Duty Ops”
An Ebola Treatment Center is a 24 hour operation. Tonight its my turn to take the helm for a few hours until one of my colleagues relieves at six in the morning. This evening we are two patients less that when we started the day. They were discharged from hospital this afternoon as “Ebola Survivors” and will be at home with their families. It was great to receive such good news this evening.
The shift starts of quite. One minor technical issue with an alarm on on air-con in the red zone. As it’s still pumping out cool air, there is no need for me to dig one of the “Sparkies” out of bed.
This picture is the view from the operations room. To the left, is a group of Cuban doctors, they are taking a break whilst one of the other teams are in the wards treating the patients. In the distance there is the double fence that separates the red zone with confirmed Ebola patients and our working area. We have very strict procures for entering and leaving this area.
Whilst we are running a hospital which treats just one disease, its a very complex machine. The staffing levels per patient is much higher than you would expect to see in a normal hospital. This is mainly because it a tough working environment. Currently the temperature is a cool 25º C. But inside a PPE suit its very hot, hence our people will do just one hour before the next team goes in to take over.
The Lab provides a very important service to the hospital and also to the Ministry of Health in Sierra Leone. The staff all work for Public Health England and have volunteered to run tests for Ebola for 4 weeks. Today a new batch of lab-techs have arrived and will be taking over from the current team who will be heading off to the UK.
The lab is well set up with all the kit they need to test the results. This is really important work as they need to provide accurate results so that an Ebola suspect is not released with an diagnosed infection. As the machines produce the results, its going to be mixed feelings as the lab-techs release the results. For some people the news is good, for others, the task of delivering the news to a patient that they have confirmed Ebola is tough.
The media in the UK have done a good job at highlighting the work of the doctors and nurses that treat the patients, but they have missed out a large number of other people that work here. In this article, I would like to spend a few moments to tell you about the WASH team (That’s another acronym for Water, Sanitation and Hygiene). The Wash have a very important job which is to ensure that the hospital is provided with clean water. They also keep the place clean, decontaminate spills and they also have the dreadful task of removing the poor people who do not survive Ebola to the morgue and then onto the burial site.
The work of the wash team is very physical and equally as risky as those that treat the patients.
We also have staff to feed the patients. They are not the sort of people you might find cooking you meals at the local pub, we have highly qualified nutritionist planning menus for each patient individually. Nutrition is just as important as the medicines as it gives the patient a good better chance of survival. Where patients are really poorly, there are special formulas used by the nutrition team to get some feed into the patients. By 0530, work is underway to prepare the first meal of the day.
For new recruits to the ETC, we have a training team. Waring what is sometimes called a space suit is not normal practice for medical staff. So before we let people loose on the wards, we train people how to put on PPE, how to wear it and then more importantly how to take it off without contaminating themselves. When training is complete, people are tested by assessors. If they pass, they can join the teams and start to work on the wards. If people fail the assessment, they go back to the training class.
After a fairly quiet night, its always nice to round it off with a nice sunrise!
Building a new team
This is week 6 on the ground and things are still moving forward at a hectic place. When I arrived in Sierra Leone, there was just one Save the Children technician for the entire country. Now that we are operating across 5 locations, and one of those locations is a hospital operating 24 hours each day, we need a larger team to ensure that communications, IT and power systems just keep running.
On Friday, we installed a new satellite connection. I took the opportunity to run the installation as a training course and the entire technical team qualified as SCI VSAT installers !
From the left IT Offices Ibrahim and Ina, then Radio Supervisor Ishmael, followed by IT Officer Lamin and then some random bloke at the end (Me!)
Our satellite service is provided by Geolink (www.geolink.com). I have been really impressed with the technical team as they have been super helpful and above all, easy to reach. During the set up, there has to be a number of calls made to the teleport team in the EU. This is so much easier when you deal with a named person on a fixed line rather than have to go via a call center each time the phone line drops!
The big dish is the satellite internet which will provide essential communications to the site over the next few months as we take in more patients. Here the team is assembling the heavy 2.4m satellite dish with a little help from one of the chaps from 22 Field Hospital Ops (British Army). NGOs and Army working together was almost unheard of until Ebola. The size of the operation requires the old rule book to be ripped up. The chap watching the team from the left of the picture is one of the Cuban Doctors who is between shifts.
The dish and the electronics were sent from France. The red stand was designed by me and I managed to find a local welder to make it. The stand costs $300, which is much cheaper than it would costs to fly a pre-made unit from Europe.
A hospital needs much more that internet to run! The kitchen is tuning out meals throughout the day and night for the patients. Here is the procession of staff carrying food towards the hatch which separates the infected red zone from the safe green zone. 
Reliable communications is essential to the smooth running of the hospital and the fleet of vehicles that provide support. Radio is used by various teams in the ETC to send information about prescriptions, coordinate decontamination teams, manage security and to coordinate the movements in inbound patients. Moving patients around has to be done in a very controlled way as we need to ensure that we do not spread infection. We have some very strict protocols.
We have a large fleet of vehicles to move people and supplies between our logs base 35 mins away to the ETC. Radio officers will manage the coordination of vehicles as well as being a communications focal point. They will also be trained to tell people off if they are too chatty on the radio net.
Here, the radio operators are being trained in the use of satellite telephones by Tom from the Operations Team.
Over the next few weeks, we are ramping up our operation as we get more staff. The target is to get to 80 beds which is our full capacity. An Ebola Treatment Center is a very complex beast and it needs to be run using very strict protocols so that people do not become infected. Some sectors of the media have been giving us a rather hard time as in their opinion we are not expanding quick enough. The true facts is this, it takes time to train people. They have to be assessed after training so that we can be sure that they can put protective kit on properly and then remove it safely. One small mistake and people will become infected. So it takes time, but we need to do this properly. This is why the team is working 7 days a week, long hours to get the hospital at full capacity.
Hopefully the media will in due course will understand the challenges we face and give us the space we need to get the job done safely.
The Ebola Treatment Center has been open for one month
The ETC has been open for one month and we now have 30 beds available for patients. Plans are in place to rapidly ramp up to our full capacity of 80 beds. To get to full capacity, we are continuing to train new staff in the use of PPE. The picture below is of our Cuban doctor colleagues going through their training session.
In addition to the Cuban Doctors, we also have doctors and nurses joining us from the NHS in the UK, As we ramp up, we will continue to need more doctors and nurses to provide the care needed as well as all of the other staff required to make this hospital run well.
Between the red zone, where patients are printed and the safe green zone where some of us work, there is the yellow zone, a sort of no mans land where some of the stuff people wear is deep cleaned with chlorine. The picture below is evidence that we grow our own boots on special plants in the yellow zone!
The stuff we can not recycle, we burn. Its not very friendly to the environment, but fabrics covered in Ebola infected fluids has to be dealt with properly. On site we have four incinerators. Our experts tell is that its not normal for flames to appear out of the top of the chimneys. When we first fired them up, a call was received from the Sierra Leone Army base just up the road check that all was well with us!
I also had further challenges with the refrigerated containers. In the past I have seen ships carrying containers by the hundreds, but I never realized how complex the refrigerated ones were. They are highly computerized and equipped with data loggers and GPS. The ones we have are old and probably cast offs from the commercial lines. The ones we have are very high maintenance and from time to time, one or more of them will have a problem requiring attention. Problems range from software problems to blown fuses. We also have more than our fair share of troubles with the generators that power the containers.
We keep a very close eye on the containers as this is where we store drugs. This week I have been called out on four occasions to sort out a container or a generator!
The ETC is very close to the sea. Here the community is affected very severely by Ebola. The is a genuine fear, hence many cars showing “STOP EBOLA” stickers. Ebola is constantly a main topic of conversation the local people have. On radio Ebola features in many programs and news reports.
Yesterday whilst travelling between sites, there was a radio program on the radio teaching 5-7 year olds how to spell. With so many schools and universities closed due to the Ebola, people have to find other ways such as radio to continue the important task of educating the nations children.
Back to the sea, the fishermen are still at work and I would like to end this article with a nice picture of fishermen prepaying nets for the next days voyage out to sea.
Back to the UK- but the work continues!
I have just arrived back in the UK after spending 8 weeks in Sierra Leone. So this is my last article on Ebola.
The trip back was long and frustrating. A trip from Freetown to Lungi on a boat which did not have engines matched to the boat was quite interesting. Two propellers were not deep so sucked in air, and the skipper was not skilled enough to understand that he had to build up the revs more slowly to get the boat moving!
Forms to fill in at Brussels Airport, and the forms we were given to fill in for the UK were rejected as the PHE had changed them the day before. My advise to travellers is to ensure that they allow at least 90 mins to get through the airport. Done get people to pick you up too early as they will pay a kings ransom in parking charges as they wait!
It has been a good week for the ETC. Bed capacity is increasing by the day and we have the capacity to accept 30 patients as long as the 117 service keeps sending us people to treat. We will be ramping up to our full capacity very quickly now.
The British Army has been playing a major role in this response. The Royal Army Medical Corp has been running a 12 bed units for health workers. The Royal Engineers who built our ETC are still constructing other centres. The Gurkhas have also been working hard with our logistics team. In the early days, they helped us to get our warehouses under control.
Each day our colleagues from the British Army have arrived in a local school bus!
We have also started the construction of a new unit called the OICC. I never asked what the acronym actually stands for, but is a separate treatment unit to look after children who have been diagnosed with Ebola.
The medical team who wear PPE have had a challenge in operating radios. As they move between patients, there is a danger of leaving contaminant on the radio handset, so I identified some parts that could be used to resolve this issue. This resulted in a request to TSF-Supply in Belgium who made up some foot switches to operate our radios;
The idea is that the board is placed on the floor and that the radio stays on a shelf and stays connected to a charger. Medics can then walk to the radio and step on the foot switch each time they need to operate the radio.
