Back from Ebola's front lines, a doctor shares her experience

A person in protective gear is hosed down with chlorinated water at the Ebola treatment center run by Médecins Sans Frontières in Liberia. How was it like volunteering to help with the Ebola response in one of the worst-hit countries in West Africa? Photo by: Simon Ruf / UNMEER / CC BY-ND

Yesterday’s high-level Ebola conference in Brussels talked a lot about the need to get to zero cases and move toward recovery in three of the most affected countries in West Africa. National development plans were presented, and pledges of support were made.

But on the same day, 17 new cases were confirmed in Sierra Leone, according to the latest report by the National Ebola Response Center, raising the total to more than 8,000. The country’s vice president has been put into quarantine after one of his security personnel died of the virus.

“The number of new cases in Sierra Leone is still a cause for alarm, and the coming weeks are going to be crucial,” Dana Krause, Medecins Sans Frontieres emergency coordinator in Sierra Leone, said in an update.

It’s unclear what this would mean in terms of the deployment of doctors and other volunteers. But in January, Monica Rull, who was then a volunteer medical coordinator, told Devex that several returning volunteers continue to arrive, some on their third or fourth deployment.

“We [found] people willing to come, and people willing to come over and over again,” she said, but with the caveat that this can change at any given moment.

Rull found their commitment rewarding, despite the clear danger the virus poses to front-line responders. Ebola has taken the lives of more than 200 health care workers, doctors and nurses included. Toward the end of last year, Sierra Leone lost its fifth doctor to the virus.

Basic protocol

The virus is not airborne, and dealing with it is not rocket science, but there are very strict protocols that doctors and nurses had to follow daily to guarantee safety. Rull said every one essentially had to wash their hands with chlorinated water “every two seconds.”

But it’s the basic protocol for everyone, even nonmedical staff. Inside the treatment centers, the procedure gets stricter. The first rule of thumb when entering or leaving the center is to hose down with chlorinated water, down to the soles of their shoes.

“We try to avoid as much as possible [anything] that has been inside the treatment center — even in the low-risk areas — to go out. So you change to your scrubs, rubber boots, and then from there you can move inside the low-risk area,” she explained.

Low-risk areas are part of the treatment centers where staff stays, away from the patients. But staying inside these low-risk areas doesn’t mean less vigilance. In fact, staff resting there needs to pay special attention to those coming and going, making sure they’ve washed hands, changed clothes and removed their hazmat suits or protective gear before being allowed to enter, especially those who’ve just finished checking suspected and confirmed cases in the high-risk areas.

Rull’s experience

When she first arrived, Rull went through the entire process under the supervision of a more experienced staff member, who made sure she wore the protective gear properly and that her whole body is protected. Somebody else was there to inform her of the time — so she’d be aware of how long she can remain inside.

“You may feel like you’ve been there for 5 minutes, but it’s already been 20,” she shared.

Her first stop was to patients who were suspected of having Ebola. These people are held in separate rooms with available washing facilities to avoid cross-infection. After that, she moved to another part of the room — “double reared,” she said, to remind people it’s a high-risk zone — where patients with confirmed cases are being observed and whose conditions are being monitored and managed by medical staff. This room includes an intensive care unit.

Before going out, she remembered soaking her boots in chlorinated water and washing hands, removing the hazmat suit — which for an experienced person would take 8 minutes — and then washing hands again with water and soap. Finally, she had to rehydrate.

“Because you have lost a lot of liquid during your stay in the high-risk area,” she said. The most a person can stay inside with full gear on is an hour and a half.

The protocol outside is a bit relaxed, but still needed to be strictly followed: keep alcohol or chlorinated water close, keep a safe distance away from people, no touching, no sharing of utensils. At hotels, people’s temperatures were first taken, and some are even asked to wash both hands and feet, before being allowed to enter.

No pressure to stay

Some endured these — and survived — for two months, which is the minimum length of time MSF asks of its volunteers. Allowing them to stay beyond that is approved on a case-by-case basis.

Those who couldn’t, meanwhile, are allowed to leave.

“It’s OK for them to leave the day after if they don’t feel comfortable; we don’t judge people. And there [are not that] many Ebola-experienced physicians in the world, so if you’re committed and you think you can handle it, you come here, but maybe you cannot. And you were never exposed before so you don’t know how you’re going to react. So for an organization such as MSF, we take care of the patient as well as people who take care of the patient,” Rull explained.

Even at the height of the outbreak, MSF could not ask anyone — whether doctor, nurse or logistician — to stay longer than they’re comfortable with.

Despite this being her first time handling Ebola cases, Rull wasn’t fearful. She felt fully prepared, having gone through theoretical and practical training with experienced people in Geneva, and an on-the-spot introduction at the center. She’s also been following the outbreak from the point of operations and as a medical doctor at MSF headquarters.

“They sent me here [as medical coordinator], because even if I don’t have firsthand field experience, I have been discussing with other people and I have been briefed — and you have to start somewhere. The best way to be able to support the teams in later, maybe future outbreaks, is to have firsthand experience,” she concluded.

Have you or known anyone who has volunteered to help with the Ebola response on the ground? Share your experience by leaving a comment below.

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About the author

  • Ravelo jennylei

    Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.