Update on "Hot Training" in LIberia from Elizabeth Glaser

By Barbara Waldorf Moderator Emeritus | 06 Dec, 2014

I just finished “hot training” in an Ebola treatment unit in a rural county in Liberia. It is not run by Partners In Health, but this ETU is serving as a training site for many groups that are sending staff over to Liberia. As a working ETU, it provides a very good opportunity for incoming clinicians from all over the world to be mentored by more experienced clinicians.

During our first shift, the staff brought us down to the graveyard. Away from the noise and bustle of the ETU, we stood at dusk and read the markers and saw four empty holes, newly dug, for the deaths yet to come. I cried; I just let it happen there, before taking a deep breath and going in to care for our patients who did not need my tears or sympathy, just good, competent care.

Inside the ETU is a different world, where a clinician moves through the heat and humidity looking like an alien while trying to do the most human of actions, to nurse the sick.

While there, one can observe signs and ask about symptoms, learning how much they may vary in this disease. People may present with symptoms very similar to gastroenteritis or malaria. They feel tired, headachy, feverish, with a sore throat. Some have lots of vomiting and diarrhea, some have a little but can still drink oral ready-made solution (ORS) and keep in food.

Then a few days later they get sicker, with abdominal pain, weakness, and a flat affect. Some have bloody diarrhea, a few may have a bloody nose, but most do not have any overt hemorrhagic signs. If a person complains of gastrointestinal pain later in the course, though, it usually means internal bleeding is going on with a poor outcome.
The disease will be brought under control, but some days the gains are hard to see.

Even though we could see that some of our patients were doing poorly, their demise could still come as an unexpected event. I would sit and converse with someone in the a.m. who was weak but receiving IV fluids and sipping ORS with assistance, then on the next shift that person was dead. Conversely, there were men and women who appeared very critical who seemed to hang on by sheer force of will.

Ebola is slowly coming under control in Liberia, through joint efforts with government and county health departments, working with local groups, international nongovernmental organizations, and community members to prevent Ebola where possible, identify it early, and provide state-of-the-art treatment and supportive measures.

The disease will be brought under control, but some days the gains are hard to see. In the 25-bed unit where we trained, five people died in 48 hours despite best efforts at fluid and electrolyte replacement. By the end of our stay, there were more graves filled and, sadly, we knew that the burial team would have work for some time.

As much as the training was to help reinforce infection control protocols and increase our endurance to working in personal protective equipment, it also functioned to remind us of the humility we have to bring if we are to do this work.



Tess Panizales, DNP, MSN, RN Replied at 8:59 PM, 6 Dec 2014

Thanks for sharing! Prayers to all of you.

Sent from my iPhone, please excuse any typos.


Deborah Wilson Replied at 7:17 AM, 7 Dec 2014

Hi Elizabeth,
Very very moved to read your piece. It brought up so much as i have still not stopped thinking about how much this disease would take people away who I thought would survive and others would pull through who I was sure would not. The ETU I worked in closed down a couple of days ago after zero admissions for a month. So I am glad to hear that it is also your experience that numbers are decreasing elsewhere. Stay safe, sending you a big hug and I look forward to seeing you when you return.

Susan Wood, PNP-BC, MPH, IBCLC Replied at 2:29 PM, 7 Dec 2014

I am glad there is so much improvement in Liberia, although the front page of the New York Times today


reports a very different situation in Sierra Leone: increased numbers of confirmed Ebola cases, poor distribution of services and supplies, with governmental corruption mixed in to further complicate the poor coordination of care. It's sad but also enlightening to learn how the colonial past impacts so dearly the present situation. According to the NYT, since Sierra Leone was a former British colony, the emergency Ebola response there is coordinated by Britain, whereas the Ebola response in Liberia (with its history of being founded by former American slaves) is more reliant on US aid, and Guinea relies on France (as a former French colony.) Apparently, this is how the Ebola response was divided up several months ago by Western powers.
Given the success of the control efforts in Liberia, let's hope that Sierra Leone can benefit from US as well as other international teams to bring their Ebola tragedy under control.

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