Ebola diaries: Making things work in a desperate situation
Dr Olu Olushayo, technical coordinator
One year ago, when Dr Olushayo arrived to coordinate the WHO Ebola response in Sierra Leone, he found not only an outbreak on a scale beyond his worst imaginings but myriad problems that needed complex solutions. Even where funds were available, there were not enough ambulances in the country, not enough Ebola treatment beds, not enough nurses and other healthcare workers as fast as needed. Read his diary about what he did.
"I arrived in Freetown on the 2nd of August on a really rainy day with no luggage - just a shirt which I wore for the next 3 days. I came on short notice as part of one of the first teams to coordinate our operations. I thought I would have time to organize myself but the time was not there. I had to go straight into an Ebola operation centre meeting lasting many hours and looking at many issues.
The outbreak had really escalated and there was a lot of fear, even in the office, among the staff and in the Ebola operations centre. We got different calls from different places, bodies were lying on the street somewhere, we needed to check that and so on.
So the first few days were quite chaotic with huge and massive things to do. So that meant that we were working long hours to make sure that we put in place systems, the people who can do it, the materials we need. We needed to ensure that the field operations were beginning to take shape, all things like that.
An outbreak beyond my worst imaginings
This outbreak was massive. In my worst imagination, 2 to 3 years ago I would have never thought that we would have an outbreak that massive. It was also the first time that these countries, especially Sierra Leone, were experiencing this outbreak. So there was a lack of knowledge.
This was different from Uganda, where people know the disease, when it happens they know what to do. They understand the disease. In Sierra Leone that understanding was not there, so that was another major challenge.
The amount of logistics and the amount of work that was required was really massive. And it went beyond money. It was an issue of yes, we have the funds, but we just could not get enough ambulances in the country as quickly as we wanted, we just could not get enough beds as fast as we wanted, we just could not get enough nurses, healthcare workers as fast as we needed.
People were frightened
Another big thing, of course, was the number of partners. For me, being the coordinator, it was really a very big responsibility, because I was responsible for their safety and security. I had to ensure that the field staff got all necessary things as fast as possible.
Most of the people who initially came in were really scared, so we had to sit with them, counsel them, assist them and encourage them. They had not seen this kind of emergency before and they were really scared. For me, that was quite a big challenge. I had to ensure that WHO operations continue but also the new staff were doing well.
With external partners, it was also challenging. There were many partners and every partner has its own agenda. They have their own way of doing things. Everything that they saw, they said, ‘WHO should be able to do this for us, WHO should be able to look at this for us, they should be able to put this on the table.’ So that brought a lot of challenges, it brought a lot of stress. But I think at the end of the day, once we got a lot of support from partners it was quite easy.'
Two weeks after I got into the country, a colleague – a young epidemiologist, a very brilliant guy – who became a friend, he got infected. And that was the first WHO staff who got infected and the first medical evacuation we had. It was quite a tough operation. I talked to him every day to reassure him. I did not sleep for 3 days until his plane took off.
The second thing that moved me was, I joined the burial team one Sunday in Freetown, and we moved around town, picking up bodies, from 9:00 up till 5:00. We would have a number of bodies in the van and then drive to the cemetery. As a physician, I have never seen so many bodies in my life, at a go. At one point, I counted about 40 bodies. We are looking at teenage girls, pregnant women, a 20-year-old man, a grandmother. I thought to myself we need to do all that is possible for this outbreak.
Making sure this never happens again
For me looking back, this is an event that we should never have allowed to happen. And when I say we, it is not only WHO, but it is everybody. It is a collective responsibility that the world, Sierra Leone, Liberia, Guinea, the people, we should never have allowed this to happen.
We have learned a lot about this disease. There is still a lot that we need to know but what we have learned means I think we can actually, next time or before next time, put in place a robust system so that an Ebola outbreak will not become this major catastrophe. I think what needs to be different the next time is how we put those lessons that we have learned to use. I say that WHO has a large role to play in that capacity."