With the planned opening hit by sniper fire on the first day, the rest of week crawls along on its hands and knees in search of cover.
Finally by Friday the civil war is over and everything is set for our first patient - just four days late, though it feels like four weeks.
However perfection continues to be the enemy of the good, and our infection control team (watsan/WASH/IPC - lots of different names for essentially showering us with chlorine in the red zone) still has final changes and rehearsals that they want to finish before kick off. They agree to stick with the day but want to postpone until 2pm.
I offer 10am. They offer 1pm. I offer 11am. They revert to 2pm. Do they not know how bargaining works?
We settle on a ‘review at 10am and if all is ready we will admit the first patient at midday approach’, although I can tell from the way they avoid my gaze that they are already thinking of another week-long rehearsal.
Off to Command and Control to see if I can engineer a mid-morning referral and then use emotional blackmail to settle the deal. Having worked in the NHS for 20 years I know how to manipulate waiting lists and admissions.
Three Ebola-positive patients are waiting for us in the Holding Centre. All are reported to be clinically stable. The group is impatient about the suggested 2pm transfer, and I do everything in my power to stir things up as much as I can. Pretty soon the Sierra Leonean army is brandishing AK47s and shouting ‘Death to the Medics’. I think I might have pushed things a little too far.
Three stable, confirmed patients are the perfect test for our opening, so I rush back the hospital to try to get an early admission, but the best I can do is 1.30pm. So the patients languish for a few more hours in poor conditions while we rearrange the plastic chairs in the doffing area.
The entire Norwegian team awaits with nervous excitement. This is the moment they have been practicing for six weeks. It’s E-Day.
Inevitably for our first night performance everything goes wrong.
The ambulance drives to the wrong entrance. A group of local health staff drive along behind taking photos of the great occasion, rather morbid tourists, who we have to chase away. The ambulance stands for too long in the mid-afternoon heat while the team dresses in PPE. There is no security guard to open the external gate to get access. But all in all our rehearsals pay off and we have our first patients safety admitted and under treatment.
The three patients are not as stable as we anticipated. All are 4/5 days into symptoms at the critical phase when they can rapidly deteriorate, but they are in the safest possible place.
The Norwegian team are desperate for front-line red zone action, having waited so long. They get their adrenaline fix and do a great job. There are lots of things we need to improve, but this is really a continuous quality and safety improvement cycle and we will get better and better.
We practice the use of mobile phones to take images of the medical notes that cannot leave the red zone and this works well. The patients get their meds and their fluids, a wash and a rest. We have lift off!
Meanwhile, back at our Norwegian base camp we have the internet. Just a trickle, but enough for emails, and if you are very patient, an occasional glimpse of the web.
In the evening we no longer sit around under the African stars sharing tales and cultures. Such carefreeness is replaced with solitary staring into the screens of phones and tablets. Ahhh, it’s just like being home.
MORE BLOG POSTS FROM PROFESSOR JOHN WRIGHT
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