So, the last two days of training with IOM involved wearing the full PPE and going through simulated cases with our very generous survivor-teachers in the mock ETU which is set up in the stadium where the training took place.  Thursday, we spent about 30 minutes in the ETU, and say two patients in the Suspected Ward, evaluating them to determine whether they really had EVD – Ebola virus disease – or not.  It was a fairly easy afternoon, and we had lots of help and tips from our preceptors in each case, with many good teaching tips along the way.  It’s interesting to be on the other end of such a training, as these are precisely the kinds of trainings that I was involved in teaching when my full-time job was with PEPFAR (President’s Emergency Plan For AIDS Relief), and we were training clinical staff at all levels to understand and manage HIV/AIDS.  The difference here is that everyone has a strong vested interest in our individual safety, and everyone knows that the stakes are so high.  The other interesting distinction is that we had many of our fellow students who have been working in the ETUs over the past 3-6 months without any training, doing the best they could, and in some measure making up the rules as they went along.  They were hugely helpful to us who were new to the environment, as they had practical experience with the clinical algorithms, and the pitfalls that we could run into.

Today (Friday), we knew was going to be a bit tougher.  We knew we were expected to be in the full PPE for 1 1/2 hours (the usual recommended time to stay in the “Red Zone”, where confirmed and suspected Ebola-infected patients reside and are treated), and we expected the cases to be tougher than the previous day.  And, all that was true.  And each of us came through without difficulty.  Yes, it was hot. Yes, the clinical scenarios were stressful, and the preceptors were not helping us as much today, as grading our performance to ensure that we had internalized enough of the concepts presented during the week to be safe as we go forward.  Thankfully, as the epidemic is winding down, many of us will not be involved in as hazardous conditions as I heard described by my colleagues this week.  Many of the nationals (those who live in Sierra Leone), were taking the training as more of a matter of meeting requirements set by their employers, or the government, and did not expect to be participating in direct clinical care.  The goal is to prepare the clinical front-line to be ready should this epidemic flare up again, or return sometime in the future.

After we had all completed our “practical exams”, we loaded up in the PIH van, and drove 2.5 hours to Port Loko, where we will all go through three additional days of “Hot Zone” training – we will be in full PPE, in the real ETU here, and work beside the experienced clinicians who have been battling this infection for the last 6 weeks and more.  We met some of our colleagues and future trainers tonight after we had settled into our digs.  I am the lucky one in our group who is staying at the “Sugar Shack”!  Rumor has it that this was a former house of ill repute, but, as such, each little room has it’s own bathroom. However, the presence of a bathroom does not guarantee running water!!  So my ablutions on arrival were performed with water from the well in a plastic bucket:

 And here’s the lovely bed, complete with gorgeous pink walls!  In fact, the whole place is pink!  Never my favorite color, but somehow I do find it sort of appealing!!  Maybe I’m just tired.

Good night, from the Sugar Shack – more after the “Hot Zone” training this weekend.