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Nursing in the heart of the Ebola epidemic

Red Cross aid worker Marshall Tuck explains what it's like to be a ward nurse in an Ebola treatment facility.

"An oven bag like you'd cook a chicken in"

It is a methodical and careful procedure to don the plastic coveralls, the double layer of gloves, duck-bill mask, hood, apron and finally goggles that protects me in the high-risk area of the Red Cross Ebola treatment centre.

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It is a methodical and careful procedure to don the plastic coveralls, the double layer of gloves, duck-bill mask, hood, apron and finally goggles that protects me in the high-risk area of the Red Cross Ebola treatment centre.

The humidity of Sierra Leone doesn't register with me until I am standing, waiting for my colleagues. Quickly, my increasing body heat starts to condense on my goggles. In this brief moment, before I enter into the hospital's high-risk area, it feels like standing in an oven bag, the kind you'd cook a chicken in.

The health workers here operate on a 'buddy' system to help each other stay safe. My buddy and I do a last visual check to ensure skin around the face is covered and personal protective equipment intact.

Some colleagues with me quickly steal a hug from one another. This is one of the few moments where we can extend a reassuring human touch. Even a hermetically-sealed hug is welcome in an environment where practising no touch keeps us safe from exposure to Ebola. This is something we have all learnt quickly: there are no handshakes, no welcoming embraces of colleagues leaving the mission, and no friendly welcoming touch to those just joining the mission.

Even a hermetically-sealed hug is welcome in an environment where practising no touch keeps us safe from exposure to Ebola.

The intense sweating sensation I feel dissolves as my mind sharpens on the tasks assigned from the afternoon meeting. Today has been difficult at the treatment centre: two ambulances arrived in the morning with 17 patients, all confirmed positive with Ebola.

Opening the back door of the ambulance is always a confronting moment - a vision of men, women and children bundled uncomfortably in a cabin filled with humidity and the smell of sickness and death.

Today my colleagues and I will provide nursing care to some of these patients. It's mostly supportive care we will give; an assessment of their state, encouraging hydration and nutrition, and for those too weak, we will provide comfort and dignity as they deteriorate. In these moments the personal protective equipment allows me to hide my tears, as I fight the thoughts that for these patients, we should be doing so much more.

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Inside an Ebola treatment centre

Patients are scared and getting information at their triage interview is challenging.

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The Red Cross Ebola treatment centre in Sierra Leone is unlike any hospital environment I have ever experienced.

Its layout is carefully designed to protect staff and patients by minimising the risk of contamination and the spread of Ebola. Orange plastic construction fencing controls my movement around the facility. It defines and separates high-risk, low-risk and no-risk areas. Patient stay on one side of the fencing and staff only enter that side if they are wearing personal protective equipment. Nothing worn, eaten or used by patients leaves the high-risk area: it is ultimately burnt in an incinerator.

On entry to the centre, patients are triaged according to the symptoms they are experiencing. Fever is the major symptom for assessment but this is imperfect as fever alone doesn't indicate Ebola. It may suggest malaria, or even an upper respiratory tract infection.

This is a major difficulty for health workers in other health facilities in Sierra Leone - they don't know what the next patient may be sick with. Ironically, working in the Ebola Treatment Centre, I was safer than these doctors and nurses. I knew the patients I was caring for had Ebola and I had the equipment to protect myself at my disposal.

We also collect information on risk factors. At admission, patients are asked about their contact with anyone who has been sick or died from Ebola, and whether they have attended a funeral or eaten bush meat. However patients are scared, and getting this information at their triage interview is challenging. It is not until they are admitted into the facility that they open up and divulge their grandparents, parents, siblings, relatives or neighbours have died with Ebola. In these instances human fears and insecurities are raw and override good reasoning.

For all patients, nursing care is given without judgment. The most we can offer is supportive care, the provision of regular nutritious food and fluid intake for those that survive.

Yet for survivors, the next stage is just as difficult as overcoming Ebola. They then have to return to their families and communities, to show everyone they pose no further risk, and to encourage others to seek care at the facility from which they have come.

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The 'Happy Shower'

There are two 'happy showers' in the Red Cross Ebola treatment centre in Sierra Leone.

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The use of a happy shower is a joyful event for patients and staff alike. It means that a patient has survived Ebola, received medical clearance and been through a final decontamination before leaving the centre.

All the patient's personal belongings are left behind and incinerated. He or she then showers with water that has been chlorinated with a 0.05% solution; then dons new, fresh clothing. As the patient leaves the high-risk area, they are welcomed by the heath care staff who have been providing care and support, week after week.

In these moments there is dancing, laughter, tears of joy and relief. But the moment can be bitter-sweet: patients may have lost family members and friends, or be leaving them behind in the high-risk area.

For staff at the treatment centre, the happy shower vindicates their ongoing work to fight this disease. They can finally interact with former patients without the masks and protective equipment that have defined all contact so far. It's these moments we yearn for: a smile shared.

After discharge, the next stage of the patient's journey begins. Our social workers help them to reintegrate into their community. Sometimes they are welcomed back openly and sometimes now. The stigma surrounding Ebola is strong and the social workers must explain that a recovered patient poses no risk to the community.

I believe these survivors will play an increasingly vital role in responding to the epidemic. They will be the champions and advocates, the positive light that shows Ebola is not always a death sentence.

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Ebola Outbreak 2014 Appeal

Ebola Appeal

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Thank you

Australian Red Cross has now closed the Ebola Outbreak 2014 Appeal.

Thanks to the generosity of the Australian community, we raised $1.2 million to provide humanitarian assistance to communities affected by the spread of the Ebola virus disease.

If you have raised funds for the Ebola Outbreak 2014 Appeal that have not yet been banked, please call us on 1800 811 700.