Perspectives from the field: Ebola response in Sierra Leone

On Christmas Day 2014, I started a 6-week placement at the Australian-flagged Ebola Treatment Centre, managed by Aspen Medical, in Freetown, Sierra Leone. I joined about 30 doctors, nurses, environmental health officers, and management and support staff from across Australia and New Zealand, working alongside 120 Sierra Leoneans.

A societal disaster

The West African Ebola virus disease (EVD) outbreak is a medical and societal disaster. Most patients die, leaving devastated families and communities. EVD spreads by interpersonal contact, so the community prevention message is “Avoid Body Contact” — ABC. However, body contact makes us human, and the ABC protocol is freakish in all cultures. Dramatic community-wide behaviour change is needed to control an EVD outbreak.

The EVD outbreak is occurring in West African countries already devastated by ecological, economic and governance crises. Access to food is limited; many people require food aid. Schools have closed, and a generation may never reach their potential. Health care services have collapsed — deaths from malaria, tuberculosis, HIV and diarrhoea will far exceed deaths from EVD.1

Challenges in the Ebola Treatment Centre

Outbreaks of EVD are brutal. The Ebola Treatment Centre assists in controlling the outbreak by isolating patients with EVD infection. A razor wire fence surrounds the treatment centre. Incinerators spew smoke as contaminated clothes, bedding, food and personal belongings are burnt. Controlled access to the treatment centre, and its white, green and red zones, prevents spread of the disease within the centre.

Survivors of Ebola virus disease leave their mark on this special wall at the Freetown Ebola Treatment Centre as they return home free of the disease. Image courtesy of Aspen Medical .

Clean gloves are part of the personal protective equipment (PPE) used every time anyone enters the red zone of an Ebola Treatment Centre. For tasks that do not require dexterity, thick gloves are used. All PPE is carefully removed on exiting the red zone, and the gloves are washed in chlorine and dried in the sun for reuse. Image courtesy of Aspen Medical.

Inside the Ebola Treatment Centre, personal protective equipment (PPE) is conspicuous. This equipment is required for entry to the red zone and is donned under supervision. Scrubs, boots, overalls, double gloves, an apron, an N95 mask, a hood and goggles must cover the entire body. The PPE soon becomes hot and goggles fog up, so time in the red zone is limited to 60 minutes. Patient care is restricted by these time limitations and by the PPE itself, which impairs communication and makes the stethoscope useless. Frequent chlorine spraying damages the available medical equipment.

Personal reflections

Despite the Ebola Treatment Centre’s restrictions and the lack of specific treatment for EVD, the work was satisfying. We offered symptom relief, particularly fluids and opiates, along with compassion, counselling and support. We witnessed life and death and celebrated each EVD survivor. The placement gave me insights into how health determinants can be so cruel, yet individuals so inspiring.