As Ebola spreads across west Africa, we talk to the medical and humanitarian professionals scrambling to contain the spread of the disease
The outbreak of Ebola in West Africa is unrelenting: according to the World Health Organisation there have now been 888 cases and 539 deaths across Guinea, Sierra Leone and Liberia since the virus was first reported in March this year. The epidemic is unprecedented and the global health community has been left scrambling to contain the disease, for which there is no vaccine or cure.
In a bid to boost the response to the disease, the World Health Organisation (WHO) convened a special meeting on 2-3 July in Accra, Ghana, with health ministers from 11 West African countries and partners involved in tackling the disease.
Here, professionals involved in fighting the deadly virus share their experiences of what it’s like to be at the epicentre of the epidemic.
Dr Ibrahim Bah, medical supervisor at the isolation centre of Hôpital National de Donka, Conakry, Guinea
I work in the department for infectious and tropical diseases so I am used to working on epidemics but this is the first time I have dealt with Ebola. It is a new disease in Guinea. Before Médecins Sans Frontières arrived, we had no specific training on dealing with the virus. At the beginning, I was scared: I saw people haemorrhaging to death. The experience is traumatising for patients too: they know we don’t have a vaccine or a cure, and they think: “I have Ebola, my life is over.”
The earlier patients seek treatment however, the higher their chances of survival. We have had more recoveries than deaths on the ward. The first recovery was a real celebration – it gave us strength to continue working.
Safety is paramount but working with the protective clothing is exhausting in the heat. On very hot days, you sweat so much that you can’t keep the equipment on in the ward for more than 30 to 45 minutes.
It has been very hard for us: there is a lot of stigma attached to working with the virus and some people have been rejected by their families. But as people become more aware and realise Ebola need not be fatal, things will change.
Dr Jacob Mufunda, World Health Organisation representative, Freetown, Sierra Leone
One of the positive outcomes of the emergency ministerial meeting is that it aligned our actions. Until then, each country had been dealing with the disease individually. Yet the epicentre of the disease is the border area triangle between Sierra Leone, Liberia and Guinea. The people living in this region are the Kissi. They speak the same language in each country and they move across borders along traditional routes.
So WHO is very clear on this issue: closing borders would make no difference. What is crucial is that we keep focusing on surveillance and that we harmonise our approach across countries because if you use different languages and different practices to tackle the disease and approach these people, who should they believe?
We want to encourage countries in West Africa to send their medical staff to affected countries so that they get hands-on experience. That way, if the virus spreads, they’ll be better equipped to tackle the epidemic.
Mohamed Fofana, training manager with ActionAid, Kono District, Sierra Leone
We have just finished training 24 community outreach workers to raise awareness about Ebola. A key consideration in recruiting participants was that they are influential in their community so that when they go back, people listen to them.
The training focused on the origins of the disease, its transmission, the signs and symptoms and what to do if you suspect a case of Ebola. We heavily emphasised the fact that transmission can happen through a dead body because in Sierra Leone, it is customary to pay your respect to the dead, to wash the body, touch it or keep clothes or sheets of the deceased, but these practices do not conform with Ebola prevention.
If they suspect that someone is infected or has died from Ebola, outreach workers know that they should immediately notify the authorities. They must also refer the patient to the nearest health facility or make sure that no one comes into contact with the corpse if the person is dead. A specially-trained burial team will intervene instead.
Dr Bernice Dahn, deputy minister for health services, Monrovia,Liberia
Our biggest challenge is denial. People do not believe that Ebola is happening. There is a lot of fear and panic too and we’re struggling to get people to come into hospital when we suspect they are infected. The key for us is to align our traditional leaders with medical and health ministry officials: our society holds them in high esteem so if they are on board, they can educate their communities.
Dealing with Ebola is labour intensive. Case detection is a door-to-door process; once identified, patients have to be taken to isolation wards; and then we need to trace all the people they have been in contact with. We also need special burial teams to handle dead bodies. Sorting out the logistics for all these interventions has stretched us.
The difficulty is that the situation keeps evolving so we’ve had to modify our response needs: our initial strategy cost was $1.2 million but as the epidemic has progressed, we estimate we’ll now need $6.5 million. We’re still working within the constraints of the initial budget but the international community has been very supportive, so I am hopeful that we’ll be able to tackle this epidemic within the shortest possible timeframe.