- Associated Press - Saturday, October 18, 2014

ST. PAUL, Minn. (AP) - Carrie Jo Cain knows the Ebola epidemic in West Africa is frightening, even to an emergency room nurse.

“It’s a virulent hemorrhagic fever,” said Cain, who works at Children’s Hospital in St. Paul. “I think Ebola is scary to anybody.”

But Cain said she is accepting an invitation from God to go to Africa to help, the St. Paul Pioneer Press (https://bit.ly/1tyg6Cr ) reported.

As a nurse, she knows about sanitation and decontamination, how to set up an isolation unit and how to train health care workers in infectious disease protection.

As the child of missionaries, the 48-year-old Fridley woman grew up in Sierra Leone, one of the countries in the region hardest hit by the Ebola outbreak. She knows the local language and customs and has been there numerous times on aid and mission trips.

“God couldn’t have written a more perfect invitation that said, ‘Carrie Jo, I need you to do this,’” Cain said. “I have the skills and I have the open door to go in and impact that situation. I feel strongly that I need to.”

That’s why she was in Sierra Leone last month for a two-week trip to help train the staff at a rural hospital to handle an oncoming wave of Ebola cases.

And it’s why she’s preparing to move to the country next year with her husband and 7-year-old daughter to take a job at the hospital.

Cain’s parents are originally from the Twin Cities, but she was born in Marion, Indiana. When she was 6 months old, she and her parents and two older brothers moved to Sierra Leone.

Her father, a pastor in the Wesleyan Church, became the principal at a Sierra Leone Bible college, and her mother taught classes there.

Cain lived there for the first 11 years of her life and returned to the country with her parents as a teenager and during summers when she was in college.

When she was 16, she accompanied a missionary nurse on extended clinics in the country. That influenced her decision to become a nurse.

“I knew some day I’d go back to Africa and work,” she said.

She was a young nurse when she spent six months in the northern part of Sierra Leone working at a Wesleyan hospital in the town of Kamakwie. She also did public health work in villages in the region, traveling by canoe and motorcycle.

“I grew up riding a motorcycle in Africa,” she said. “I love adventure. It’s part of my personality.”

Over the years, she’s been back several times as a volunteer with World Hope International, the humanitarian arm of the Wesleyan Church. Some of the work included helping to rebuild the country after a brutal decade-long civil war that ended in 2002.

But her last trip, from Aug. 26 to Sept. 9, was focused directly on the Ebola crisis.

The trip, sponsored in part by World Hope International, involved transporting nearly a semitrailer load of personal protective gear to the hospital in Kamakwie.

The hospital is about 55 miles — four hours over rough roads — from the next biggest town, Makeni.

The equipment included Tyvek suits, aprons, boots, goggles, hoods, masks, body bags, chlorine spray canisters and “gloves, gloves, gloves, gloves,” Cain said.

Because the Kamakwie hospital is a mission hospital, it isn’t getting protective gear from the government, Cain said.

Then Cain trained the hospital staff on how to use the gear. At the time she was there, the hospital hadn’t yet seen a confirmed Ebola case.

“We had a couple suspected cases, but they ended up testing negative,” she said.

“The biggest potential weakness is: ‘Is it really going to come to us? Do we really need to do this all the time yet?’” Cain said.

She said the attitude was “No one’s died yet, so it’s not a big deal.”

Cain said she was there to tell the staff that they needed to be protecting themselves from infection.

“Before, we had one box of gloves and we wanted to make it last a week,” Cain said. “Now we’re going to wear gloves every time we touch a patient.”

“It’s body fluids,” Cain said of the way the virus is spread. “The virus makes you do things that share the virus really well, like throw up, have diarrhea and have a high fever, so you sweat.”

The little rural hospital didn’t have a water tap in every ward, Cain said.

“They don’t wash hands between every patient,” she said. “We made water tap buckets in every station.

“That was my role, to be the hard hammer, to teach it and teach it well,” Cain said.

She said the hospital is the only one in a region that has about 600,000 people. There are 56 people on the hospital staff, including one doctor, one registered nurse, three licensed practical nurses and 15 nursing assistants. If one person on staff gets infected, it could hinder its ability to keep operating, Cain said.

She also helped to build an isolation unit at the hospital and identify a burial place and a burial team for “Ebola bodies.”

“We have to bury them differently,” she said.

In Sierra Leone, when someone dies, it’s very important not to die alone.

“To die alone is worse than to die,” Cain said. But if it’s an Ebola death, traditional mourning rituals have to be modified.

“They can be there, but they can’t touch,” she said.

Cain said she worked with local leaders to try to get the local community ready to respond to the disease and to correct misconceptions.

She said some people think that washing their hands with chlorine amounts to an inoculation to the disease and they didn’t have to take further precautions.

If a quarantine has to be established for the disease’s 21-day incubation period, the concept of counting 21 days needs to be learned among a population that doesn’t live by a Sunday-to-Saturday sort of schedule.

“It’s rural, it’s old time, by-the-farm calendar,” Cain said.

“Some people have the viewpoint that the hospital brought Ebola,” she said. “There’s such an epidemic of fear.”

Since she returned to the Twin Cities from Sierra Leone, Ebola has come to Kamakwie.

One person has died in the hospital she worked at and other cases are in nearby towns, Cain said.

Recent news reports say that more than 600 people have died of the disease in the country, including more than 80 health care workers.

But next year, Cain plans to return to the country full time with her husband, Geoff, and 7-year-old daughter, Rebecca.

Cain’s family, which also includes two college-aged kids, has been in the country before doing aid work. This time, they’ll be living there on a missionary’s schedule: In the country for three years at a time and coming back to the United States for six months to a year. Cain said they’ll be there until Rebecca is close to graduating from high school or in college.

Cain will be working as the director of nursing at the Kamakwie hospital, and her husband, a transportation specialist at the Chaska school district, will be working with the facilities staff at the hospital. Cain said Rebecca will be home-schooled.

She said she was hoping to be able to return to the country in early 2015, but the Wesleyan Church’s missionary board doesn’t want the family to be in the country until the Ebola outbreak is brought under control.

Cain believes that won’t be until late spring or summer of next year, although she said, “I think it will be years before Sierra Leone is Ebola free.”

She said she feels optimistic when she hears how the international community is lining up with aid to bring the crisis under control. But she is concerned about recent reports about how aid materials have been stuck in ports in Sierra Leone.

She said the approach being used in Liberia, where the U.S. military is handling transportation and logistics, is more effective.

Cain said she was surprised that the first Ebola case diagnosed in the U.S. occurred in Dallas instead of the Twin Cities because of a large population of people from Liberia and Sierra Leone here.

“I’m sure we’ll have a case here,” she said.

But she said the health care and public health system here is well-equipped to prevent an outbreak in the United States.

It’s different, she knows, in Sierra Leone. But it’s also something that she’s used to. As missionaries, her father contracted hepatitis, her mother had typhoid, and everyone in the family has had malaria at one time or another.

“We’ve lived through several coups. We’ve lived through political instability,” she said.

She considers herself bicultural as well as bilingual, with deep friendships in Sierra Leone. That’s why she wants to help.

“It’s not like I’m going to the unknown or I’m going to somewhere new,” she said. “My neighbor is in Sierra Leone and my neighbor is right across the street.”

“God is going to direct my steps,” she said.

___

Information from: St. Paul Pioneer Press, https://www.twincities.com

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