Dr. Jeff Deal, WMI’s Director of Health Studies, has returned after working on the ground in Liberia teaching health care workers how to use a germ-fighting robot (TRU-D Smart UVCTM) that disinfects hospitals. These are excerpts from his correspondence with us. While on the ground, he learned of the need for safe water, especially amongst the quarantined areas. Read about our response as we mobilize to help here.
9.02.14 | Stateside
President Ellen Sirleaf with me and the Tru-D. She is a truly inspirational person and a Nobel Peace Prize Laureate, a prize she earned. Glad to be home now, but very concerned with conditions in West Africa. I have appreciated all of the encouragement and prayers.
The past 48 hours has been a wild ride to say the least. Friday, I had finished working and was walking to get something to eat when I got a call from the President’s office. Within an hour, Bobby, one of the President’s security staff, showed up. In minutes, I was talking to President Sirleaf and one of her medical advisers. She is a very impressive person who is obviously quite weighted down over the Ebola epidemic that is ravaging her people, its economy, and its fragile health care system.
The next morning, I went to check into the staff at ELWA and Bobby came up and greeted me. Quite by chance, I found myself lining up with the staff and applauding as two survivors walked out of the ETU alive and well. President Sirleaf herself met them and spoke to her country via a large press gathering. She then walked over to me and said, “So, Dr. Deal. This is your machine?” The staff had brought out the TRU-D and we stood around it.
She then turned to the crowd and told them how this machine was sent to help them. “This man is a friend of Liberia,” she said. I was moved, to say the least. We had spoken at length the evening before and on this morning I said only seven words to her which she then turned and repeated in a near shout. I told her, “Madam President, you will win this war.”
I am writing this from the airport waiting to leave and having the usual feelings of guilt for not staying to fight with them. A piece of great news is that Water Missions International has already started sending over the much needed water treatment systems. Perhaps that is why I was here all along.
The Ebola Treatment Unit at ELWA is the using the TRU-D almost continually. They use it after each patient (living or dead) is moved. We also use it for the dressing areas and the personal decontamination areas. After spending a few shifts inside with them, I decided to show them how to reprogram a viral dose to save time. Because of the physical and emotional stresses of being among so many ill patients and under so many layers of protective gear, the shifts are only two hours long. So I sped it up and reprogrammed to an antiviral setting.
The incubation time for this strain of Ebola is 10-21 days, so there is not really time to tell yet what the impact will be, and data of this sort is very difficult to obtain. So far, around 10-15% of all of the cases have been among healthcare workers, likely to be in the hundreds at least. So far in Liberia, around 200 deaths have been among the HC workers. Three just yesterday.
But (and I need everyone to remember this) when they wear proper gear and decontamination procedures have been followed, no healthcare workers have contracted the illness. This means I expect some hugs when I get back. It has been a couple of weeks since I’ve had any human contact except through layers of latex. Also, clinical illness precedes an infectious viral load by days, so no fever, and no risk. I am tired but not sick, but I will understand if some keep their distance. The same type of stigmata is being seen in survivors who return to their villages. No one will come near to them.
I also used the machine to decontaminate myself while still in my gear. At least a couple of dozen of the workers expressed to me that they felt more confident in working in the ETU’s since we deployed the TRU-D’s. They love the idea that they are getting access to the same technology that the more advanced hospitals in the US use. Some workers have fled, but there is actually a waiting list of workers volunteering to work in the ETU’s. Many work without pay. Heroes, all of them.
When the Ebola crisis ends, and it will, they will redeploy the units to the hospitals. Women continue to give birth, malaria season is here, and auto accidents continue to happen. The Ebola epidemic has increased the fatality rates of all the other diseases because so many facilities had closed. The TRU-D will help.
Also, the water situation in all of the ETU’s is desperate. The WMI systems will, in the long run, save more lives than any other intervention. Cholera is here now and being neglected because of Ebola.
The situation here is about as dire as an infectious problem can be. I helped design a new ETU yesterday at a new location. One thing I recommended and was done is to create a morgue close to an exit so that patients will not have to see the bodies being loaded into trucks. They need hope not despair.
It will take massive aid to interrupt this killer. As a sign of this, they are running short of body bags.
1 John 3:17-18.
That’s me using the TRU-D in the Ebola Treatment Unit of Elwa. The staff there are going great with it. It is a VERY well run unit with caring staff that work hard. I was able to get photos because I took in an underwater camera that I could drop in a bucket of chlorine on the way out.
I pretty much reached my physical limits today. By the time I went through the 20+ minute decontamination procedure I was getting a little dizzy. Fortunately, the ETU at JFK had a delay and I spent the rest of the afternoon trying to make contacts for the Water Missions International staff as they prepare to send in badly needed water systems.
Lots of people dying, but lots of people surviving because of the staff. After we suit up and before we go in, the staff form a circle and pray for protection and God’s blessing on their work. I think He’s listening. I know I am.
Frankly, I am very tired. I have decided that I can only do a single shift in the Ebola Treatment Units per day. The suits are hot and it is so hard to breath that I was dragging a bit at the end of my shift at ELWA ETU and struggled a little for a shift at JFK’s ETU. I don’t think I will try that again. Just too old and soft, I think.
The staff at ELWA are doing great, and we’ve got a good plan for the TRU-D. I trained the second and third shift so they know the process about as well as me. The doctor, Dr. Park, is very much on-board. All of them appreciate the donation of the TRU-D as the number of healthcare workers who have succumbed to the disease continues to rise. I fear that this epidemic is completely out of control.
This entire country has become instant germophobes. No one shakes hands. You have to wash your hands in bleach water before entering any building and in most you also have your temperature taken. I think Liberia is now the most hygienic place on earth.
The people here are kind and gracious (I could not resist the selfie with one staff member). They are putting up a valiant fight against this epidemic with very limited resources.
Great day in Liberia. Both units are now operating perfectly. I spent the afternoon in all the gear (that is me, the tall guy on the left) working in the Ebola Treatment Unit in ELWA. This is the same facility in which the Samaritan’s Purse doctor who ended up at Emory was working when he contracted the disease. The staff is great, and we’ve worked out most of the protocols for the TRU-D’s use. I am not worried as the staff watch me like a hawk to make sure I follow all of the decontamination procedures and frankly, we now have the TRU-D working for us as well. The suits are quite hot and after a few hours, I was beat.
I watched a Liberian nurse in full hazmat gear coaxing a two-year-old patient into drinking rehydration salt solutions while her mom lay on a mattress on the floor beside her very ill. She stayed there on her knees with the child until he had drunk the whole cup. I was decontaminating the next room with the TRU-D while she was with the child.
I saw a 12-year-old boy in the Confirmed Cases Ward washing plastic mattress covers. He had recovered and just wanted to work until he was released.
A beautiful nurse walked up and smiled at me. My first thought was “Why is she not in her protective gear?!!!!” But they said she had recovered and was waiting for release. She looked full of joy.
Protected in Liberia by God, my family and friends who pray for me, my hazmat suit that David Deal helped me pick out, and the TRU-D.
Amazing day. The most sophisticated automatic room decontamination system on the planet was deployed at an Ebola Treatment Unit today. Ran though some short cycles. We delivered the second unit but I did not have time to unpack and activate. Doing tomorrow. Things are a bit tense here as I am about 400 meters from West Point, an impoverished community of 50,000 people who are quarantined in an effort to stem the epidemic.
I sat through many meetings with the Liberian Government officials, and they are very compassionate and working diligently to tend to the people’s needs. I am proud to work along with them. The Ebola units are a bit grim, patients packed close, no human contact, very ill and often entire families together and ill. WHO, CDC, UNICEF, and MSF are all here in mass and working hard.
Likely the best thing is that Water Missions International is mobilizing to send five emergency water treatment systems here. Doctors are having a hard time differentiating Ebola from cholera, now also showing up. In the long run this will save many more lives than will the Tru-D, but both have a role.
I am now sitting in an office waiting for the customs clearing documents. This morning I met with the Ebola Task force. Present were representatives from the World Health Organization, Centers for Disease Control and Prevention, Doctors Without Borders, UNICEF, World Food Programme, and the Chief of Police. We were cordially greeted and everyone is excited about the devices and most had already learned of them. In moments, we head to the airport with a truck to pick them up. Right now we are slated to install them at JFK and another facility in Monrovia. Doctors Without Borders piqued up when I mentioned that they will work in tents.
The situation here is grim to say the least. A large slum of about 50,000 people is now quarantined. The security forces are struggling to get food and water to them before more armed riots break out. Three healthcare worker died yesterday of Ebola. On top of all of this, it’s rainy season and clinical cases of cholera have erupted, and they are having a hard time differentiating cholera from malaria from Ebola as the labs are overwhelmed with specimens.
I sat in on a report on some remote areas that sounds pretty rough, especially among pregnant women. Some of the statements I recorded:
‘Women are scared, very scared. I saw women dying from bleeding without help for fear of Ebola.’
‘How do you give emotional support without touching?’
Very heartbreaking things.