Nurse Malcolm Chalk's Sierra Leone Diary

Journal extracts from Emergency nurse, Malcolm Chalk, who spent time in Sierra Leone helping to fight the Ebola epidemic

Here is a journal entry from 15/12/14, my first day working on the wards at Kerrytown ETC.


'My first day on the ward as a nurse at Kerrytown ETC. It is a very busy, doctors and nurses all preparing to go onto the wards.


 I go into ward 6 with Ben a nurse from the 1st NHS deployment and Gabriel a Sierra Leonean CHO - community health officer, CHO's are similar to the American 'Physicians Assistants'.


We don the PPE, have it checked by a buddy and in we go. Medicines and equipment are taken in with us, everything planned ahead, you can't stay on the ward to long in 30c heat in full PPE.


We go on to the ward give patients their meds, make sure they have had breakfast and help wash patients. It was shocking to see some of these patients, so poorly and with constant D&V making life pretty unbearable for many of them on the ward. We help clean and change them, give them anti-emetics, analgesia and make sure they have IV fluids going. There are children here too, very harrowing to see them suffering; Christian a 10 year old looked so ill, he was bleeding from his gums, haemorrhage is a nasty symptom in stage 3 of Ebola, we organise Vit K for him to be passed over from the nurses station and administer it to him. He was quite unwell for at least another week, but then seemed to improve. 


I was so surprised by how compliant children were in the treatment centre, we took blood and cannulated them without any real problems and I cannulated my youngest ever patient there, a 6 year old girl.


We complete around 1.45hrs and go and 'doff' the PPE, go back to nurses station and update and decide further treatment for patients, such as a transfusion for Christian. Time to get another 2 litres of water down and some oral rehydration salts - ORS, before going in again.


Incredibly difficult and hard nursing today.




In the attached picture Gabriel the CHO is to my left; we are in the nurses station at Kerrytown Ebola Treatment Centre.


'Frances Tucker'


In the red Zone at Kerry Town Ebola treatment centre I worked as part of team 2 and we generally kept to the same ward, which was ward 3. My team colleagues were the Cubans Dr Raul and Orlando a specialist ITU nurse; me, the NHS nurse and two Sierra Leonean nurses Margaret and Frances and Francis a male Community Health officer for the Sierra Leonean ministry of health. We ran a tight ship and worked really well together and once completed our own ward tasks would help in the other wards until the heat eventually won.


Between going onto the wards we would have teaching sessions, as part of theses sessions I taught Margaret and Frances how to cannulate and they were able to carry out the procedure under observation in the red zone and very good they both were too.


We also chatted about everyday things such as family and often about Sierra Leone. There are many towns and villages with British type names, or named after some significant event. Waterloo is a village about 10 minutes from Kerry Town. I asked Frances if she knew about the battle of Waterloo and showed her a battle scene painting on my Kindle, very seriously she asked 'were you there', I explained the battle was in 1815.


Many Sierra Leoneans have family names such as Bangura or Kamara, I asked Frances hers, she said it was Tucker. 'Tucker' I enquired, 'my neighbour is Tucker' I told her; she proudly went on to tell me that her great, great, great etc grandfather was a British settler and her family kept the name!



I have attached some pictures of Frances Tucker, Orlando and Raul the Cubans.



Donning and Doffing Personal Protective Equipment (PPE)


Dressing in personal protective equipment (donning PPE) before entering an Ebola confirmed ward is an obvious important procedure, and taking it off is even more important and dangerous.



Donning at Kerry Town Ebola treatment centre is done in the dressing room just outside the red zone wards; Terracotta scrubs, Wellies, suit, hood, goggles and double gloves completely covering all exposed skin and a buddy or dresser would help you put it all on and check for any gaps.


There was this huge Cuban nurse - Roberto, almost like ‘The Thing’ out of ‘The fantastic Four’ whom would pull your outer long gloves quite literally up to your armpits, sometimes painful, but without doubt safe and worth the discomfort.


We had demister for the goggles until it ran out, then it meant either holding your breath for an hour, or squeezing the metal nose clamp on the mask so your breath is directed down.


In the dressing room the Sierra Leoneans had a big Hi-Fi, with the local radio station playing a mostly Sierra Leonean type of Reggae. After they got used to me (and I take a lot of getting used to, according to Mrs Chalk) the Sierra Leonean staff enjoyed the ‘Chalky disco dance’ in full PPE; they did laugh I can tell you.


Doffing is taking it all off again. At Kerry Town we doffed in the ‘Water and Sanitation Hygiene’ (WASH) decontamination area, firstly you are sprayed with 0.5% Chlorine, then the WASH man or woman directs you in taking off the ppe, piece by piece and in between they shout ‘Washyands’ in Krio, a type of English that has become a language of its own, over many years of adaptation. The important thing is not to let anything touch your skin, it’s a careful procedure.


More often than not we would have bodily fluids on us of one sort or another and it seems strange now, but you almost got used to it, an unhealthy complacency, but the WASH made sure they blasted everything off us first.


I Donned and Doffed more times than I can remember, but a big thanks to the dressers and WASH team helping keep me and my colleagues safe.