Containing Ebola: helping nurse and save many patients with the Ebola Virus is a source of much pride for one returning New Zealand nurse.
Fortunately, after spending four days in isolation at Christchurch Hospital last month, tests revealed her fever, diarrhoea and vomiting were not due to Ebola. "This was an incredible relief," McBain said. "After working so hard to keep myself safe while caring for the sick and dying at the Ebola treatment centre [ETC] at Hastings Airfields, Freetown, catching Ebola would have been shattering for all concerned."
Christchurch Hospital is one of three centres set up to deal with possible Ebola cases in New Zealand--the other two are in Auckland and Wellington. McBain, who had worked under the most stringent conditions at the ETC, a tented hospital run by Aspen Medical Australia, had nothing but praise for the "exemplary care" she received in Christchurch.
"It was an interesting experience being on the other side. When someone is wearing full personal protective eguipment [PPE], you can only see their eyes. However, even with that single point of contact, it is still possible for a nurse to communicate and deliver compassionate care. All the nine nurses who cared for me over the various shifts had volunteered and changed their shifts to do this work."
McBain was one of nine New Zealand and Australian nurses contracted by their respective governments to work at the newly established ETC. Her initial training, along with the rest of the team, was in Canberra over one and a half days in mid-January. A core component was learning how to don full PPE, coping with the gear in a simulated red zone (where those with Ebola are cared for), while removing medical and patient waste, and dealing with possibly aggressive and uncooperative patients, then spending the last 30 minutes de-robing. "What we couldn't practise was doing all this in temperatures of more than 40degC," she said.
McBain has a real passion for working in developing countries, particularly in Africa, and has made 13 trips overseas working for a variety of organisations including Troppodoc and the Christian charity Serving in Mission. Most of this she does during her annual leave, except for this latest government-sponsored mission.
"I volunteered to go to Sierra Leone because I could see Ebola becoming a worldwide problem. It needs to be dealt with and contained. It's an appalling disease, causing so much suffering and the local national health staff need as much support as the outside world can offer."
When McBain arrived at the ETC on January 19, she found the staff--as at most of the other 31 ETCs in the country--were relying solely on oral rehydration fluids and intensive care therapies. She and some of the expatriate doctors wanted to increase the care they offered to include intravenous (IV) therapy, nasal gastric fluids and intraosseous infusions for children.
"However, a lot of the nurses had little experience with IV therapy or were not comfortable to cannulate patients. Doing these procedures while wearing two pairs of gloves and full PPE, and also dealing with often frightened patients, requires confidence and competence. Your chances of surviving if you do have a needle stick injury are almost zero."
Another very dangerous part of the nurses' role was moving deceased patients from the ward to the mortuary--at the time of death, a patient's viral load is at its highest. Bodies must also be buried within 24 hours, a role assigned to a burial team.
During the seven weeks McBain worked at the ETC, a total of 220 patients were cared for, with around a 60 per cent survival rate--one of the highest among ECTs in Sierra Leone. Patients aged under 12 or over 45 had the poorest prognosis. Patients arriving at the ETC were triaged and then assigned to either the "suspect", the "probable" or the "confirmed" ward, then hopefully to the convalescence ward and home. Some convalescing patients stayed up to three weeks. McBain led a team of 44 national staff which included one other expatriate registered nurse (RN), eight national RNs, 10 hygienists and other support staff. Initially, she had quite a lot of freedom to explore surrounding areas when not at work, but following an outbreak of Ebola in Freetown, the ETC staff were quarantined and became quite isolated.
"Fortunately we were still allowed to travel from our accommodation to the ETC and were not confined to our homes, as tens of thousands of local people were," she said.
Coping with the PPE in the increasing temperatures, particularly on afternoon shift, was particularly challenging, along with the endless hand washing in a 0.05 per cent chlorine solution and being constantly sprayed with a 0.5 per cent chlorine solution when wearing PPE and working in the red zone. "Every one-hour entry I made would see me lose a litre and a half in fluids. At the end of my shift, I could pour the water out of my boots. Some days I would drink four to five litres of water just to maintain my fluids. I also discovered the expat staff moved at twice the speed of the national staff, so you got very fit."
McBain is happy to be back with her family and working at Southland Hospital again. She has brought home with her a full PPE suit which she will use at presentations at various nursing, medical and community events throughout the year. "I loathe public speaking, but I believe it is important to raise people's awareness of the dangers of diseases like Ebola. They will keep cropping up and New Zealand is only a plane trip away from an epidemic arriving here," she said.
By co-editor Anne Manchester
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|Title Annotation:||news focus; Bronni McBain|
|Publication:||Kai Tiaki: Nursing New Zealand|
|Date:||Apr 1, 2015|
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