Penn Nurses have continued to be at the frontlines of the Ebola crisis in Africa. One such alumna is Carolyn “Carrie” Marie Trabka, GNu’10, who since December 2014 has worked at an Ebola Treatment Center (ETC) in Lunsar, Sierra Leone as one of the Emergency Response Nurses. Carrie also plays a role in the training center program as a Nurse Training Manager, working with International Medical Corps.
As the focus of the emergency response changes to reflect the changing Ebola situation and the needs of communities, the role of the Emergency Response Nurse has changed as well.
“Every day can be different and brings new challenges,” said Carrie. “My role includes helping to lead the nursing team, communicating with members of various other teams such as pharmacy or transport, and providing safe and competent care to all of the patients inside their units, both those who test positive for Ebola and those who don’t.”
When Carrie is able, she assists in training new staff members, both international and national. With new cases of Ebola down dramatically, more of the focus is on education and community outreach. She has trained some of the medical staff to be trainers in their Infection Prevention and Control (IPC) program, and she is also involved in organizing and training staff from some of the local health centers in her district on infection prevention and control measures (IPC), which includes Personal Protective Equipment (PPE) training.
From September 2011-July 2013 she was based in Freetown, Sierra Leone and worked at the Faculty of Nursing, at the College of Medicine and Allied Health Sciences (COMAHS). Her role there was head of Pediatrics. Primary responsibilities included developing teaching materials and assignments to deliver the pediatric curriculums, and creating, proctoring and scoring examinations to test students’ knowledge in the subject. Carrie estimates she taught approximately 1200-1500 students during this time. While her experience in Sierra Leone was not her first time working abroad, it has been her most long term placement, and until now, she has considered it to be the most meaningful.
A Return to the Front Lines
After the first few cases of Ebola were identified and diagnosed in Guinea in 2014, Carrie, who was back in the United States, had an immediate fear for its neighboring country, Sierra Leone. She had stayed in touch with some of her former students and friends and heard about some of their struggles and losses.
“As it continued to evolve and spread across Sierra Leone, I struggled with being so far away and unable to help,” said Carrie. “I eventually received word that a former student of mine, who I had taught for two years, had contracted Ebola and died. Having taught so many healthcare professionals, knowing they were now on the frontline fighting this epidemic, I could not just stay at home.”
Carrie began contacting people she knew from her previous experience to see how she could get involved. This led her to the ETC at Lunsar. Now several months later, a majority of Carrie’s day is still spent at the ETC. Even with the overall decreased numbers of Ebola cases, Carrie and her fellow team at the ETC must treat each person that meets case definition as a “suspect” case, meaning full PPE and appropriate protocols. At her busiest, a typical day for her is 12 hours. Carrie will begin her day by heading to the van that will transport her to the ETC. Before getting in the van, someone will take her temperature. As along as she is afebrile, she can get in the van. When she arrives at the ETC, she must wash her hands with 0.05% chlorine, and have it sprayed on the bottom of her shoes. Her temperature is then checked again, and afterwards, she can change into her scrubs and gumboots.
Just like many units in the United States, the night shift medical team and the oncoming day shift medical team will meet to discuss the current patients. Afterwards a head nurse is assigned for the day and assignments for the morning are made. This includes entries into high risk for vital signs and medication administration, phlebotomy and IV placement, meals, patient care, doctors’ rounds and any admissions or discharges. Shift changes will occur again at 2pm and 8pm. No single person can enter the high risk zone alone. They utilize a buddy system and you must always be part of a pair. It doesn’t have to be solely a medical team, but it can include a member of the wash team. There are recommended limits for the amount of time spent inside the high risk zone, which can put a strain on the amount of work that can be accomplished inside.
Carrie initially committed to an eight week contract in Lunsar, but quickly found herself deeply invested in the work. She has continued to extend her contract month after month. She has been hoping to hold out until Sierra Leone was able to declare 42 days with zero cases and be Ebola free, but unfortunately they have recently had a new case test positive. Carrie believes she will head home in early October, before this victory will be declared.
Ebola has no known cure, although with this recent outbreak there have been many new advances in both vaccines and medication that are currently being studied and seem to hold promise. Treatment at Carrie’s ETC is often limited to supportive and symptomatic care.
There are many days that are heartbreaking for Carrie, but there have also been some incredibly meaningful days. For Carrie, it was when a fifteen year old male broke down and cried during his discharge while thanking her and her team for his care – it was being able to visit him at his home after his discharge and being met with a huge grin and seeing the happiness on his face – it was hearing from his uncle about how he sang their praises and said that they had taken great care of him and their other family members – and it was being able to bring his mother and younger brother home, also both survivors, and watching them reunite. These moments, and so many more, have made Carrie realize just how much of an impact she continues to have in Sierra Leone.