Our Ebola hospital waxes and wanes between storms of activity and lulls of calm. In the intensive phase the wards are full of PPE-clad worker bees swarming around the beds and corridors. Then suddenly all is quiet as the teams sit in small groups reflecting and adapting the routines.

We are still struggling with how to communicate information from our ward rounds. Such a simple task of taking notes on the ward round but unable to take anything out of the red zone. We need information on each patient from our clinical office white board to inform us on the round, and then documentation of any changes from the ward back to the office white board.

We consider walkie talkies, but these will corrode with repeated chlorine washes. A microphone under our PPE, but this will get drenched in sweat. Bluetooth or Wi-Fi, but too hi-tech for our low-tech environment and still the problems of chlorine.

The flimsy paper checklist used in Bo rapidly becomes damp from all our hand washing and disintegrates. We try small white boards, which we carry to the fence and get one of the nurses in the green zone to take photographs, but the distance is too great, even with a zoom lens, to distinguish the words.

In the end we laminate sheets of paper which we can soak in chlorine before we take out to the clinical office. It feels clunky, and we need to keep working on this.

Other problems this morning: our body bags leak fluids and so won’t be safe to use; our PPE overalls tear too easily and we will need more robust alternatives, however the Ebola emergency has now exhausted all the Chinese-manufactured supplies and there is now a global shortage. We will have to beg and borrow from other centres.

We have no kitchen equipment yet, so can’t cater for staff or patients; our staff toilets have become filthy after just a couple of days and the Norwegians are worried about infection risk; the toilets are flooding because the local contractor used cheap Chinese cisterns; we need to recruit phlebotomists and clinical officers urgently; security is poor at the hospital, particularly at night; we have no chlorine testing kits to test if the concentrations are correct; our goggles are misting up too easily. However, we have become accustomed to these sorts of challenges and all feel surmountable.

I am trying to improve my community integration with learning a bit of Mende. Before we left the UK we were given lessons in Krio, but Mende is the lingua franca in Moyamba, so I start again.

Just a few words of greeting and enquiry brings smiles of amazement to people’s faces. A white person who can say hello and how are you! Soon everyone is greeting me with a joyful cry of “Dr John!!” and while this is lovely and makes me feel wanted, it also has the downside of having to smile and say hello everywhere I go. No wonder the Queen looks glum most of the time.

Sky News come for a visit. I am pushed forward as the spokesperson. I find that when this happens it is usually because everyone is expecting a disaster and needs someone to be the fall guy.

They ask about how we are planning to avoid being another Kerrytown; have we built too many beds; why we have built the hospital in Moyamba (subtext: this godforsaken place); what it’s like working on an Ebola ward.

There’s lots of drills going on which provide good televisual images and we provide a positive picture of the UK’s aid effort to combat Ebola, the hospital on the cusp of opening.

Ola, the team leader for the Norwegians leaves today. He has been a rock in a stormy time, enthusiastic and wise. We will miss him until he returns in January with the next wave of Norwegian clinicians.

In town I pass a booming beatbox with a wonderful song about Ebola. It covers health promotion advice about the source (fruit bats and monkeys), the symptoms (shit and vomit, bleeding from your nose), no-touching, what to do when you fall sick, what will happen if you hide sick people (you’ll be arrested). And it’s a bit of an ear-worm.

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