ebola 2A childhood neighbor and friend has been a missionary nurse in Madagascar all of our adult lives. She’s seventy-two now. She retired from her paid position as a missionary a couple of years ago and now continues to work with the same hospitals and schools in Madagascar as a volunteer.
For all practical purposes, Madagascar became her home many years ago and, even though she has come ‘back home’ every couple of years over the last forty-five years to reconnect with her own family and her support base, her professional and personal relationships are in Madagascar.
She spent a couple of days with DH and I four years ago and we visited  about the work she was doing.  Her responsibilities have included teaching at the national schools. She helped organize the nursing schools and construct the curriculum.
She told us that it has always been and still is a never-ending battle to get the nurse trainees (and nurses on staff) to accept the reality of the need to wash hands, be careful about medicine dosages, keep accurate records on patients, and accept the realities of communicable diseases, recognition of serious symptoms, and providing treatment for diseases that are easily managed in early stages but become deadly if they are ignored.
When a new group of nurses comes in the problems of persuading them about wearing gloves for procedures, washing their hands between patients, being sure that equipment was properly sterilized, etc. were very similar in quality and quantity to what they were a couple of generations earlier. The culture doesn’t get it. She didn’t know why. All she knew was that was the norm, so they just kept on plugging away.
ebola 4
Fifteen months ago when DH was working his part time job at Home Depot he waited on a lady who had a most interesting shopping list. He was intrigued and visited with her as he assisted her.
It was obvious she wasn’t shopping for home improvements in Oregon.
She introduced herself as a 50-something MD (I’ve forgotten her specialty) who had practiced many years here in Oregon and, having arrived at some financial security and never married,  made the choice to offer her services to a mission board. She had just finished some years with a mission hospital in Pakistan. At the time he met her, she was shopping for a new assignment: she was en route to Liberia to assist in developing a hospital that had been started (in a fashion) but was struggling under the lack of comprehension on the part of the Liberian “medical professionals” and simply was not actually effective.
Her responsibility would be to supervise the completion of the facility, supervise the building of a small house for her to live in, review present staffing, introduce In Service protocols and trainings to get the doctors up to an adequate level of service delivery, and supervise and train the nursing staff. We visited with her a couple of times before she left Oregon last July.
I stayed in touch with her by email as well as receiving email updates from Sudan Interior Mission (now short-named SIM) which is her sponsoring organization. Samaritan’s Purse is one of their prime sources for equipment and supplies and has partnered with their hospital for long range support.
ebola one
The hospital is located in one of the smaller cities of Liberia. About three months ago emails and newsletters began to reflect a high alert with regard to ebola. They had started the training of the staff for what they expected to be coming their way.
Because of the problems my friend in Madagascar had faced for decades re awareness need regarding cleanliness as related to disease transmission and the need for sanitary conditions in medical facilities, I asked our new doctor friend if she was facing the same issues in Liberia. I was careful how I asked because I didn’t want to assume that because I understood a bit about Madagascar culture that it translated to Liberia, thousands of miles across Africa, on the west coast.
I need not have been concerned. What she has been facing in Liberia in the last twelve+ months since she arrived there was/is precisely the same as what my friend in Madagascar describes.
She has had to do polite but determined battle even with the doctors on staff at the fledgling hospital regarding washing hands and doing procedures properly, not taking short cuts in surgery because of frustration, enforcing 100% performance with regard to sterilized instruments in surgery, etc.
When the ebola menace appeared on their radar this spring she had had about ten months with that hospital, those doctors, and the nursing staff.
When they began their ramp-up in May or so, they had to force the understanding that the completely suit-up in the space suits was not optional where ebola was concerned. It was a flat requirement. No, the families would not be allowed to come and squat in the hospital with their family member who would be in isolation. No, they would not be allowed to touch them or cook for them.
This is the battleground in Liberia and Madagascar. There’s no evidence of ebola in Madagascar that I’ve heard of – just acknowledging those are my two points of first hand information from medical professionals on the scene.
So when you hear about the Nigerian government taking action, or a certain measure being imposed in Monrovia – that’s fine. But it’s not significant in terms of practical impact when you consider what the reality is throughout the nation(s) as soon as you’ve passed the city limits.
This horse is already way out of the barn. The announcements, pronouncements, and edicts being issued now are for PR purposes. They may have limited effect in limited situations. May have.
 

Share