Tribute to Oma...

My grandmother (oma) passed away last week and yesterday we laid her body to rest. The funeral was a special time in which we remembered her time here on earth and said our final goodbyes.

Oma was a great grandmother. She was both caring and showed a lot of concern; sometimes maybe a little too much of the latter as she was very cautious and wanted us to be too :) . However, Oma was very much involved in our lives, even though we were often many miles away. She stayed up to date on our latest news, she used to email and send us cards and she kept track of my blog. Even until recently she still had people read to her from my blog. She enjoyed seeing us and always looked forward to phone calls and visits. She loved us and she was proud of each one of us. 

As a child I have great memories of my grandparents even though we were not able to see them often due to us living abroad. I remember sleepovers at their house, going to the petting zoo, picking berries, playing with lots of toys up in their attic, sled riding, story telling, yummy food, and more. One of my favorite most recent memories is the times that I would pray with oma during my visits with her before heading back to Africa. It was a time in which we prayed for each other for encouragement and strength. My grandma had a great faith in God.

After my grandfather passed away in October 2010 my grandmother was quite lonely. In most recent years/months, her health started deteriorating and her eye sight especially got worse to the point that she was totally blind for the last 6-9 months she was alive. This isolated her even more. When I saw my grandmother in January, she told me that she was ready to be with Jesus. And she was ready. I can now celebrate with her that she is with her Savior. I like to imagine that oma is in heaven with my opa and that she can see again. It is well with her soul. 

I love you oma. Goodbye for now, but I will see you again someday.

Ebola: slowly getting prepared...

There are still no confirmed Ebola cases in Sierra Leone! We are happy for that.

Yesterday I was unsuccessful in moving things forward at the hospital as far as Ebola preparation goes. Today, however, was a breakthrough. My colleague, Kate, and I had a meeting with 6 people from both the Children's and Maternity hospitals to discuss our preparedness plans. We ended the meeting with a walk to the radiology building, which is pretty much only being used for ultrasound. (Our digital x-ray is set up elsewhere since this building was supposed to be demolished a year ago). It was decided that the ultrasound would move elsewhere and we would use the building as our Ebola Isolation Area. 

We have identified two rooms: one for the isolation area with two beds for now and one for storage of cleaning supplies and personal protective equipment. We actually had to involve the police, security and a carpenter to break one of the locks to get access to one of the rooms. We got as far as emptying out and cleaning one room today and hopefully the preparation of the rooms will continue in the morning. 

Ebola: some facts to put people at ease, a little...

Here are some facts from the US Embassy in Liberia. My guess is there is a lot of panic in both Guinea and Liberia right now. I think these facts are helpful in helping people realize that yes, Ebola can be dangerous and can lead to many deaths, but that there are also things we can do to keep the virus from spreading. And, we do not need to be fearful that everyone we meet in the streets could be a potential threat. The disease really only is contagious once someone is acutely ill.

Monrovia | April 04, 2014

• The suspected reservoirs for Ebola are fruit bats.
• Transmission to humans is thought to originate from infected bats or primates that have become infected by bats.
• Undercooked infected bat and primate (bush) meat transmits the virus to humans.
• Human to human transmission is only achieved by physical contact with a person who is acutely and gravely ill from the Ebola virus or their body fluids.
• Transmission among humans is almost exclusively among caregiver family members or health care workers tending to the very ill.
• The virus is easily killed by contact with soap, bleach, sunlight, or drying.  A washing machine will kill the virus in clothing saturated with infected body fluids.
• A person can incubate the virus without symptoms for 2-21 days, the average being five to eight days before becoming ill.  THEY ARE NOT CONTAGIOUS until they are acutely ill.
• Only when ill, does the viral load express itself first in the blood and then in other bodily fluids (to include vomit, feces, urine, breast milk, semen and sweat).
• If you are walking around you are not infectious to others.
• There are documented cases from Kikwit, Democratic Republic of Congo of an Ebola outbreak in a village that had the custom of children never touching an ill adult.  Children living for days in small one room huts with parents who died from Ebola did not become infected.
• You cannot contract Ebola by handling money, buying local bread or swimming in a pool.
• At this time, there is no medical reason to stop flights, close borders, restrict travel or close embassies, businesses or schools.
• As always practice good hand washing techniques.  You will not contract Ebola if you do not touch a dying person.

Message for U.S. Citizens: Ebola Hemorrhagic Fever in Guinea (April 04, 2014)

Ebola: the facts so far...

It is public news that Ebola has reached West Africa for the first time in history. Both Guinea and Liberia have confirmed cases. Sierra Leone has no confirmed cases. Some facts that might be of interest especially related to Sierra Leone are as follows:

• 15 March: Sierra Leone Ministry was alerted by Guinean health authorities about an unknown outbreak leading to deaths.
• 19 March: WHO confirmed cases in Guinea were hemorrhagic fever.
• 22 March: WHO confirmed cases in Guinea were Ebola - Zaire strain.
• The National Ebola Task Force in Sierra Leone was engaged and four groups meet regularly.
• There has been increased surveillance, especially near the border.
• There are no confirmed cases in Sierra Leone as of the 5th of April.
• There were two Sierra Leoneans in one family that died in Guinea and were probably cases of Ebola and their bodies were repatriated to Sierra Leone (1 1/2 miles across the border). The contacts of said Sierra Leonean family have been traced and tested throughout the incubation period (21 days) and are all negative. 
• Sierra Leone may be better prepared due to our ongoing surveillance for Lassa Fever (a different hemorrhagic fever endemic in Sierra Leone) and due to our state of the art Lassa Fever unit in Kenema who can perform Ebola testing.
• Each district has designated surveillance officers that can be called upon at any time.
• Isolation areas will be/are set up in health facilities as a precautionary measure.
• In the current case definition the key point is travel history to Guinea or Liberia or contact with someone from their with history of febrile illness.
• During the 2-21 day incubation period a person is NOT infectious (contagious). It is when someone starts having symptoms that transmission of the virus starts, usually when they are very ill and need support in coming to the hospital. Transmission of disease is highest in very late stage of disease (hemorrhagic state) and when dealing with a corpse.

(sources: Ministry of Health and Sanitation, WHO)

Ebola: my role...

Ebola. It's a hot topic. For now, Sierra Leone is still Ebola free but it may only be a matter of time. We need to prepare. Just in case.

At the Children's hospital we are not yet ready for a potential outbreak. Don't worry, we have starting preparing but we need to speed it up a notch. Yes, we have the case definitions up on the walls, but once the patients are identified, what next? It's time to allocate an isolation room, get it set up, train staff, ensure we have protective gear, etc. That's on the agenda for tomorrow.

Why am I involved?
Well, it's not in my job description, but it won't be in anyones. This is one of those situations in which everyone needs to pull together and that includes me. I would like to work with hospital staff to make sure the hospital is ready and people feel safe and confident. I won't be the one dealing with the cases, but I do want to make sure that those who do are well prepared.

If the hospital is not ready, it would be a disaster; that's what we need to avoid. So that means I spend some of my time doing various Ebola related things:
- Laminating and posting case definitions.
- Discussing a plan with the medical superintendent.
- Whatsapping numbers for surveillance officers in the district to house officers.
- Testing the Ebola hotline phone number.
- Attending an Ebola meeting at the Ministry with senior doctors
- And more will follow like attending the Ebola Task Force meetings, setting up the isolation area, possibly help with staff training but at least getting experienced people in to train, etc.

My prayer is that Ebola is contained and dealt with in Guinea and Liberia and that it never reaches Sierra Leone. But if it does, I pray we are ready.

Ebola: fascinating and terrifying...

Ebola. Ebola. Ebola.

For the past 2 weeks Ebola tends to come up in most conversations. At the hospital, in the office, at home, in transport, at international church, etc. Years ago (1995) after seeing the movie 'Outbreak' I remember being fascinated by Ebola. Now I think it is fascinating when reading about it in Central Africa, but when it could potentially cross my border, it's terrifying.

In some ways it really is a fascinating disease - what a powerful virus! There is so much we do not know about it. However, the fact remains that this particular strain (Zaire) has a case fatality rate of up to 90% and that makes it terrifying.

Thankfully to date there are no confirmed cases in Sierra Leone but the numbers in Guinea and Liberia continue to increase. We need to do what we can in Sierra Leone to prepare for what may come our way. 

Preparation is key in managing a potential outbreak. We need the healthcare providers to feel safe and confident. We don't want anyone abandoning their posts and we want excellent safety measures to be put in place. I am hoping that experienced NGOs and partners will ensure that this is the case for all health facilities. I feel very much out of my depth in even being a part of this, but all of us need to play a role. I will do what I can and pull in the experts where I can!

(map from April 3, 2014)