Ebola in Liberia: Frightened patients infected their carers

May 2015

Barbara Bono began working at Elwa hospital in Monrovia, Liberia just as word began to spread about Ebola. Although staff did their best to learn about the new disease and how to protect themselves, reality was very different from the theory. One by one staff fell sick but Barbara continued to come to work, until she, too was infected with Ebola while caring for a man who denied his symptoms for fear of being sent to an Ebola treatment unit.

Barbara Bono, Elwa hospital in Monrovia, Liberia
WHO/M. Winkler

“I started working at Elwa hospital as an emergency room nurse in March 2014, just as word began to spread about Ebola,” recalled Barbara Bono. “The virus was unknown to us. The only thing we heard at the time was that there is no cure and almost everyone who comes down with it dies.”

A month later, Barbara learned much more about the Ebola virus. She and other staff at the facility took part in a training session that covered health worker protection, care of patients and how to put on and take off personal protective equipment known as PPE. When the hospital began to receive suspected Ebola patients, she had learned enough about the contagious virus and its symptoms to understand that she and her colleagues were at serious risk.

Overwhelmed by the outbreak

"In the training, we used proper protective gear, but at the hospital we only had basic gowns and aprons," Barbara says. "We doubled our gloves when in contact with suspected cases. But we had no rubber boots, no goggles, none of the heavy zipped PPE that would help protect us."

The situation at the hospital was growing increasingly chaotic and frightening. Health centres in the area were collapsing like dominoes and few Ebola treatment centres were going up. Patients were flooding Elwa hospital, including many suspected Ebola cases, yet there was no triage set up, no system to isolate and screen suspected cases.

"Sick patients were everywhere and we were highly exposed," Barbara says, her face tensing at the memory. "It was a terrible time. We knew that any of us could be infected at any moment and I was so afraid. But I came to work every day, out of concern, even though my relatives and my community were shying away from me."

"One day a man came in for diabetes treatment and made no mention of other symptoms," she recalls. "While waiting to be seen, he went to the bathroom and was there for a long time. We checked on him and he was in crisis. He was weak and couldn’t walk. I was one of the ones who carried him out and as he held on to me, his nails went right through my plastic gown and pricked my skin. His brother later told us that he thought he was infected with Ebola, but was too afraid to go to an Ebola treatment centre because "that’s where you go to die."

Barbara Bono, nurse, Liberia. Also an Ebola survivor
WHO/M. Winkler

Early treatment was key

Several days later, Barbara had a fever and couldn’t keep food down. She felt certain that she was infected so took medication to lower her temperature, increased her fluid intake and sought treatment. "I got help very fast and that’s what saved me, but the weeks when I was sick are just too terrible to talk about," said Barbara. "It was terrible being at the Ebola treatment centre. All the sickness and death, the depression and fear. It was so terrible."

Outside the Ebola treatment centre, her family was suffering. They were anxious about her condition and worried about their own health. They self-quarantined for 21 days but stayed home long after this to avoid contact with anyone. "Neighbours and even relatives were unkind, wouldn’t speak to them and encouraged people not to go near the house," Barbara says. "Praise God they were all okay. None of them got sick."

Barbara describes feeling overwhelmed when she learned that she was free of Ebola. "My life had been saved," she said, "but I couldn’t shake off the depression. I just cried and cried every day. I was in a kind of paralysis for many months, until I decided that for my own recovery, I needed to get back to work. I needed to be busy and back with my colleagues."

Well accepted when back at work

Barbara returned to her old job at Elwa Hospital in October 2014. Staff were outfitted in proper PPE and rubber boots and a triage system was in place to isolate, screen and refer suspected Ebola patients to a nearby Ebola treatment centre. "Everyone was far more alert, knowledgeable and cautious at this point," she says, "and they accepted me back without hesitation. They understood that a person who had recovered from Ebola was no longer infectious."

Barbara says she hopes there will be an investment in training health workers to respond to future outbreaks. "Empower us," she urged, "so that the next time there is a health crisis we are prepared and have the skills needed to beat it much faster."