Reflection on Ebola Outbreak

September 15, 2014

Reflection on Ebola outbreak by George Risi, MD, and Kate Hurley, RN

After landing in Freetown, Sierra Leone, we were driven to Kenema, in the eastern part of the country, by a World Health Organization (WHO) driver who we quickly grew to trust as he navigated through our first rough and tumble day in Western Africa. The country was already heading toward lockdown and isolation; we went through eight security checks between Freetown and Kenema, which is roughly a four hour drive. Shortly after arrival we learned that Air France, our ride out, cancelled all flights, so there were no carriers in or out of the country. 

We joined the rest of our team and had a brief introduction by the outgoing clinicians before starting our work in the wards. Our most important lessons included how to use our personal protective equipment, how to put it on and more importantly how to take it off correctly.

The busiest Ebola center in Sierra Leone

Kenema General Hospital is the busiest of the Ebola centers in the country. A month prior to our arrival their census was around 50 patients. By the time we got there it had increased to 90, and our peak was 95 patients of all ages (including small babies) and in all stages of illness. It is ironic that the very attributes of these people, attributes that have diminished in our country, have contributed to the explosion of disease. Specifically, the families are close knit, and multiple generations live under the same roof. Since the initial signs of disease are vague, and look much like other diseases (malaria, typhoid fever, dysentery, etc.) patients are frequently taken care of by their family members and by the time they realize what is going on they may themselves have become infected with the virus.

HurleyRisiMargaret cared for many orphans, with six children of her own at home

The same attributes of caring and selflessness were also apparent on the wards. The patients were diligent in caring for each other, with the less sick helping with the sick. Many children had lost their parents and were without any relatives on the ward; and we saw many instances of patients taking them on as one of their own. The most memorable, but not the only, example is that of Margaret McCauley, who came in from Freetown with her husband, Edwin (Eddie). They had six children at home who they had to leave when they got ill. Eddie was much more ill than his wife, and Margaret was in the bed next to him, nursing him as well as she could until he unfortunately died. After a day of grieving, and with much encouragement by Kate and others on the team, Margaret took on the care of several of the orphans. She carried them around in her arms, fed them, sang to them, put them to bed. Margaret went on to survive, and many of the kids she helped would not have survived without her. When we told her she was cured, there was much clapping and dancing and heartfelt expressions of “thank you, doctor.” All of her possessions had to be burned. She was sent home after a shower, given a clean set of clothes and went off to an uncertain future without her husband and worries of how she would support her six children without him. I think of her often.

Unsung Heroes

There are many unsung heroes of this battle such as Margaret. One of the nurses, Isaac, was not from Kenema but came to help when his mother, sister, brother and wife all came down with Ebola. We monitored him closely for signs of infection while he worked side by side with us on the wards. We had a scare when he got a fever, but it ended up being “only” malaria. Once we treated him he was back on the wards. His mother died, wife and sister and brother all survived. He and many other nurses kept up the grinding pace, with few days off, two and three shifts per day in the stifling heat, and are still at it while we are now back home.

Returning home

After two and a half weeks of a daily grind of 12 to 14 hour days, saving those we could, easing the pain of those we could not, we learned that WHO had arranged for a United Nations Humanitarian Assistance Service plane to fly us out from Freetown to Conakry, the capital of Guinea and from there we could fly to Paris. We had to leave on a Friday afternoon; saying goodbye to patients and coworkers was difficult, knowing that there was still so much left to do. We went through 12 armed checkpoints on the drive back, four of which forced us to get out of the vehicle and have our temperatures taken. Our temperatures were taken again before entering the airport, and again after getting off the plane and a final check in Conakry before boarding the plane to Paris.

And then home, but 21 days of self monitoring, taking our temperatures twice a day and reporting to health officials how we feel every day. We did not have any breaks in technique, and every day that passes with no illness is like peeling off one more layer of a 21-layer blanket of worry.

Would we go again? Absolutely. The people we met, patients, local staff and international staff from every corner of the globe were all focused on a single mission of controlling this disease. The commitment was awesome to see, and it was truly an honor to have been able to participate, to have played a small part in this massive endeavor.