Today wraps up the third day of our “hot zone” training, in the real ETU.  The hot zone, is really termed the Red Zone, as distinct from the Green Zone, where one can walk around without PPE – personal protective equipment – because no potentially infected individuals are allowed in the Green Zone.

We newbies were teamed up with the  experienced folks, and go into the Red Zone, where all patients, whether “suspect” or “confirmed”, are housed in several wards.  Suspects are those with symptoms, whose blood has been drawn and the ETU is awaiting PCR results for Ebola.  Confirmed are those with positive PCR results (I.e. They have been confirmed to be infected with Ebola), they usually have symptoms, and some very sick.  Happily, today, our one confirmed patient is the healthiest guy in the unit, which is pulling up everyone’s spirits, as we had just had three confirmed patients who were alive on our first day, were all dead by the second day.

The most difficult of these deaths for all of us was a little girl, eight years old, who was alive, but breathing hard, when my group went in on our first walk-through. Our objective, as trainees, on that first walk-through was simply to get the lay of the land, and get a feel for how confining and hot the PPE is (it’s very hot!).  We stopped, and talked to her a bit, and tried to be encouraging, but we had no treatment to offer her, as we were there for the primary goal of our training, and our opportunity to aid patients would wait for the next day.  Our trainer assured us that the team with treatment would be here soon, and would attend to her.  We continued through the Red Zone, and exited through decontamination, which is where you really have to take your time and be careful about doffing – removing – every part of your PPE in a logical stepwise fashion that minimizes your potential risk of exposure to any fluids or materials picked up on the exterior of the gown, hood, face shield, mask, gloves or boots.  Each step is punctuated by a 60 second handwashing ritual that we had learned the previous week in the mock ETU.

We had just completed our doffing, when we heard the corpse team being called for – these are staff with sprayers full of chlorine who will thoroughly drench the body with dilute bleach solution to kill any virus remaining on the body.  It is well-known that handling of a body is a highly risky activity which places anyone attending a burial at risk of acquiring Ebola.  And, the traditional burial practices in Sierra Leone, similar to Jewish practice, involve washing the body, usually by family members, and burying the body as soon as possible. Much effort has been made by the government and by the WHO and everyone who is helping control this disease, to make sure that burials are performed safely.

Well, we discovered in due course that the body to be removed was that of that same eight year old girl we had seen alive, barely, just a short time ago.  And I think we all wondered “What might we have done to avert her death?”.  A question that I know has been asked by every doctor and nurse working here multiple times in the past weeks and months.

At the end of three days of training in the Red Zone, we were far more proficient and confident in our PPE, with both donning, wearing, and doffing.  And we had seen 4 patients expire from Ebola.  Sobering.