Ebola diaries: Doing whatever it takes
Christopher Lane, epidemiologist, Sierra Leone
Chris Lane, a water resource engineer and specialist in water pollution control, has worked for Public Health England since 1995, specializing in salmonella infections and response to outbreaks. In 2000, he was deployed through the Global Outbreak Alert and Response Network (GOARN) to Gulu, Northern Uganda, to work with WHO during the Ebola outbreak in Gulu, northern Uganda. It was an experience that gave him valuable insights into Ebola outbreaks so he was once again deployed by GOARN to work with WHO in Sierra Leone. But when he arrived in Kenema, Sierra Leone he found himself facing an outbreak so large and complicated he had to do much more than epidemiology and surveillance.
"The journey to Kenema was interesting. The roads were difficult and when I reached Kenema town, I was quite surprised at the large size of the hospital where the Ebola clinic and the Ebola patients were isolated. The newly constructed isolation facility was already in use, with around 20 patients. Kenema was seriously under-resourced for the problem at hand.
My first day at ‘the office’ was hectic. I spent it predominantly in meetings. I wanted to get first hand all the information I needed to assess where best to use my skills. I visited the district medical officer, the mayor, and met with the people working in the lab. I think I attended about 5 meetings that first day. My day started at 7.30 am and finished at around 11 pm. In the evening, I got a welcome call from Dr Zabulon Yoti, WHO coordinator and epidemiologist in Kailahun to our north, the first area affected by Ebola in Sierra Leone. His ‘welcome’ was actually a request for me to relocate to Kailahun to provide him with an additional epidemiologist. But my own risk assessment at Kenema, which had recently experienced its first healthcare worker death, led me to stay there instead.
Rumours, secrets and tragedy
The local population was not keen on being isolated. I soon became aware of rumours circulating in the community. “The disease was caused by the government to get rid of the opposition”; “the hospital are collecting blood and body parts to sell to Europe”; “being admitted to the isolation ward is a death sentence - you never see anyone released other than for burial”. All of these and many more rumours caused significant problems as the outbreak developed.
Within the first week we realized there was an issue with contact tracing. We only had 2 district surveillance officers and 5 contact tracing or monitoring staff to deal with a population of 150 000. The people who were doing that could not physically see that many people every day. I think it was on my third or fourth day that I went out with some of the surveillance colleagues to see what contact tracing teams were doing and give them some support.
Probably the most poignant moment was one evening when I was giving a helping hand to the chief staff nurse. She wanted to sit outside so I helped her, after she had been assisting the other medics. The next morning I discovered she had been Ebola positive and had died. At one point it became very difficult for me to live with the fact that a number of healthcare workers got infected and died.
I was the logistician, epidemiologist, and field coordinator
My job was to be an epidemiologist in the field, to assist with tracing people or suspect cases, actively find cases who were ill, establish what was causing the illness and put a stop to it. The reality was that it required much more than one person, more than one or two members of staff.
We were so short of human resources on the ground that there was a point in time where I was logistician, epidemiologist and field coordinator for WHO. So I only actually got out in the field about 8 or 9 times all together, which I should have done all the time. But if I had done that, we wouldn’t have had a good organization. Toward the end of my deployment it got better. I think for about 2 weeks before I left, we had a field coordinator, we had 2 logisticians at one point and we had 4 clinicians in the Ebola treatment unit compared to only 1 early in the outbreak - that is, 1 clinician working on the ward.
I was glad I did my deployment, I wasn’t 100 percent convinced my presence made that much difference although I was told the opposite. And the reason is that I felt too many people had died. But with time I got over that. I think probably the only way I felt I made a difference was in actually being there to provide help to other people who didn’t know exactly what they were doing, and giving everyone moral support.
I got the feeling that we actually had done some good."