Sierra Leone: Challenges and rewards of working on Ebola outbreak

July 2014

Dr Mauricio and Dr Catherine as they prepare to enter the isolation ward at Kenema hospital, Sierra Leone.
WHO/ T. Jasarevic

“It was great that Mauricio and I arrived the same day; we were able to share first, very shocking, impressions and to go through the process of adapting to difficult working conditions together,” says Dr Catherine Houlihan, an infectious disease doctor from the United Kingdom deployed through WHO to help respond to the Ebola outbreak in Sierra Leone.

For Catherine this is her first deployment in an outbreak setting; “On my first day, I felt shocked by the enormity of the challenges. The day after, I started to adapt.”

Dr Mauricio Ferri, a Brazilian intensive care specialist who has worked for 7 years in various hospitals in Canada, laughs: “Before coming, I had to convince my wife to let me go”.

Both Catherine and Mauricio are mid-way through their three-week deployment to Kenema, one of the most affected areas of Sierra Leone since the outbreak was declared in late May.

They are part of a team of four internationally-deployed doctors providing clinical care inside a newly established Ebola treatment centre located in the city hospital and managed by the Ministry of Health.

They were deployed through the Global Outbreak Alert and Response Network (GOARN), a WHO-based network of experts and institutions that can assist with the international response to disease outbreaks.

In Guinea, Liberia and Sierra Leone, WHO has currently 126 experts on deployment, sourced from staff, external recruitments and partners through the GOARN.

Personal safety and patient care

“I knew it was going to be hard but I did not expect this extent of challenges, in terms of lack of equipment and gaps in infection prevention and control measures,” says Mauricio. “However, after the initial shock, I started to see those difficulties as opportunities for improvement.”

Mauricio and Catherine spend 7 hours per day inside the treatment centre, fully dressed in personal protective equipment (PPE), caring for between 40 and 50 patients a day. WHO has supplied PPE to health workers responding to this Ebola outbreak. Everybody – from security guards, ambulance drivers, cleaners and professional health workers – should be trained to properly use the PPE so that they can keep doing their job safely.

Some patients leave their mark. “On the first days I was seeing bodies being taken away; on my fourth day I saw the first patient discharged. It was my greatest moment so far,” recalls Catherine. For Mauricio, it is a story of a 4-year old boy who survived Ebola, the only one in his family that was decimated by the disease.

The issue of personal safety is another concern for response teams, especially for medical workers in direct contact with patients. “Prior to my arrival to Kenema, I was scared about my own safety but I realized later that we can be in control of the risk,” says Mauricio. “We need to strike the right balance between caring for patients and our own security.”

The infection and death of several local nurses who worked in the treatment centre has had a profound impact on all the health workers in the ward, especially national staff who had worked with them for a long time. “We need to lead by example on how to properly use the protection gear and to continue despite setbacks,” says Catherine.

Unique experience

Would the doctors return to Sierra Leone or accept a deployment elsewhere if there is a need? “Absolutely”, both reply simultaneously. “Being part of such an operation is a unique experience. Not only can we contribute to the effort to stop Ebola transmission but it is also a good personal learning experience, allowing us to be better prepared for future deployments.”

Both Catherine and Mauricio applied immediately when they received the email that WHO sent out to various medical associations asking for volunteers to help with the Ebola outbreak in West Africa. “So far, no regrets,” concludes Catherine. “I feel this is where I should be.”