Twenty-nine-year-old doctor Hannah Spencer, from Surrey, recently arrived back in the UK after three weeks fighting the Ebola epidemic in West Africa with Médecins Sans Frontières/Doctors Without Borders (MSF).
“When I heard about the Ebola outbreak in West Africa, I contacted MSF and asked if I could help. I’d worked in Sierra Leone before, with Lassa fever, so I had some experience of haemorrhagic fevers – but of course Ebola is something else because the disease is so infectious and so severe.
When I told my mum, she said, ‘As if I could stop you from going!’ Naturally my family were concerned, but I explained that MSF has a long history of working with the disease.
Ebola is highly infectious, and while you can never say there’s no risk, if you follow all the procedures, the risk of catching it is low.
Flying to Guinea
I packed some saucisson and some coffee, to share with the rest of the team, and then I flew to Guinea, where the outbreak started, to get some experience working in an isolation ward.
I wouldn’t say I felt completely calm – obviously you have some anxieties before you go. But once you’ve done your first day in the isolation ward, when you’re wearing all the protective gear, you feel safe to work with the patients.
It’s difficult working in the protective clothing – it’s very hot, and you can’t spend more than an hour inside it.
So when you’ve got a large number of patients, it’s hard to feel that you are spending long enough with each one.
I also found that, with the mask and the goggles and the layers of protective clothing, it took much longer than normal to build a relationship with the patients.
Good management = Good outcomes
This strain of the disease can kill up to 90 percent of people infected, so I was surprised to find that, in Conakry, the capital of Guinea, we had a much higher percentage of people cured, at around 50 percent.
It shows that with good management – by giving fluids and by treating associated infections – we can get good outcomes.
One 15-year-old girl was inside the isolation ward for over a week, along with her seven-year-old sister and her mother, who was very unwell at first – I really thought she was going to die. But then they all started to get better.
When, finally, the girl’s test came back negative, she had a shower in chlorine to disinfect herself, changed into new clothes and was then discharged from the ward. Her family were all there to meet her at the gate and she was crying because she was so happy.
That was a wonderful moment – to see that and to know that her mother and sister would soon be well enough to join her.
"Liberia was a different story"
But across the border in Liberia, where I went next, it was a different story. I drove over the border with Sissele, a Norwegian nurse, to support the Liberian staff working at a 10-bed isolation unit that MSF had built in Foya.
It’s a very remote, forested area and the roads are pretty terrible, so it was a bumpy journey to get there.
When we arrived, we found there was no water for the patients or staff, as the pump had broken. There were seven patients there, but in the space of two days this went up to 22.
They all had to be crammed into a ten-bed ward, with many of them lying on mattresses on the floor.
Soon the Liberian Ministry of Health arrived with some extra beds from another health facility. And then an MSF team arrived from Guinea to build a tented extension ward.
But that’s only a short-term solution. There really needs to be a permanent MSF team in Foya, but with our ongoing projects in Guinea and Sierra Leone, for now we have no one to send.
Motivation
The local staff were all very motivated and very interested to learn more about Ebola. It’s the first time the disease has broken out in West Africa, so health staff have no experience of dealing with it.
Many told me they had lost friends because people were scared they would bring the disease into the community.
There’s a lot of fear around Ebola. One day four children, all aged around three and four, were brought to us from another health facility sick with fever.
They were from two different families but lived in the same house, where two adult family members had died of the disease.
The children arrived in the ambulance accompanied by a mother and an aunt, but the mother refused to let them out.
She didn’t believe the children had Ebola, or that their family members had died from it – she was convinced they had been poisoned by something. It took us over an hour to persuade her to even leave the ambulance.
Health promotion
It’s clear that, although there are charities doing health promotion in that region, a lot of the messages are not getting through.
These communities are all very remote, people are living in the forest, and it will take a big deployment of staff to get the health promotion messages to them.
We had at least three deaths while I was in Liberia. After the medical team has confirmed the death, the hygienist team comes to disinfect the corpse and the body bag, so that it is safe to be buried with the family present.
Burials are one of the riskiest times for spreading the disease. At traditional funerals, it’s common for the body to be displayed and for all of the mourners to touch it as they say their final goodbyes.
If someone has died from Ebola, the level of virus in their body is extremely high.
It’s frustrating that there is no specific cure for Ebola. I feel sure that if it affected people in the West, then a lot more would have been done to find a cure or a vaccine.
We need more staff
Not enough is being done to contain the outbreak in West Africa. The most frustrating thing for me was in the daily meetings, where we would hear about the numbers of cases of Ebola going up and up. That makes you feel quite powerless.
To treat the outbreak adequately, we really need an integrated approach between the governments in the region and other non-governmental organisations.
MSF has deployed a significant number of staff, around 300 local and international professionals.
But we need a lot more medical staff with experience with Ebola; and we need a lot more people spreading health promotion messages and tracing everyone who has come into contact with people with the disease.
This is the only thing that will really bring the outbreak under control.
I’m back in the UK now, and a bit tired. Working in an Ebola epidemic isn’t easy, but it’s exactly the kind of work MSF should be doing.
If asked, I would definitely work in an Ebola outbreak in the future.”
