Sierra Leone | Healthcare Workers Reflect on Ebola, 10 Years On
When the Ebola virus broke out in West Africa in 2014, it hit a vulnerable region still suffering the consequences of decades of conflict and widespread poverty. Less than three years later, the disease had resulted in nearly 30,000 infections and more than 11,300 deaths.
Half of all infections occurred in Sierra Leone, one of the poorest countries in the world, where the already-limited healthcare infrastructure and workforce had been devastated by a decade-long civil war that killed upwards of 70,000 people, maimed a further 20,000 and left two million displaced.
To treat the civilian victims of war, in 2001 EMERGENCY built a Surgical Centre in Goderich which quickly became the country’s main trauma centre, and soon expanded services to meet local needs, including a Paediatric Centre for treating children under 14. With the outbreak of Ebola, the NGO rapidly adapted its existing facilities and services to try and ensure that Sierra Leoneans continued to have access to healthcare of the quality and standard expected in wealthy countries, even in the midst of a deadly epidemic.
EMERGENCY worked closely with local health authorities to train frontline workers to triage cases in the Waterloo refugee camp, open an Ebola Treatment Centre in Lakka (later converted into a holding and isolation centre), and build a 100-bed Ebola Treatment Centre in Goderich equipped with a ventilated ICU – the only facility of its kind for Ebola patients in West Africa, and among the first concrete steps toward guaranteeing equal treatment of infected people, regardless of their country of origin.
“I worked exclusively with Ebola patients,” says Dr Gina Portella, EMERGENCY’s Medical Coordinator in Sierra Leone during the Ebola outbreak, and current Medical Director. “It was extremely challenging for clinicians, who had little or no curative options beyond organ support in intensive care. But many international health workers who contracted Ebola were evacuated and admitted to ICU: EMERGENCY was committed to providing that global standard of care within Sierra Leone itself.”
Medical staff were among the most vulnerable frontline workers, and health facilities across the country shut down over fear of contagion. The disease went on to kill almost 7% of the country’s health workforce.
Jacob H. Macauley, an EMERGENCY colleague since 2007, became a supervisor responsible for training national and international staff on entering the ‘red zone’: “It was frightening. Accepting a frontline role meant understanding that you could get Ebola at any moment. The dressing procedures were crucial for safety, and required full attention to every detail. I had to instruct everyone, even EMERGENCY’s founder Dr Gino Strada when he wanted to enter the tent in Lakka. We followed every step carefully: it was these strict protocols that meant we could continue providing care.”
Monjama Musa was among the patients admitted to EMERGENCY’s Ebola Treatment Centre in Lakka. “After showing symptoms, I spent time in the isolation tent. I was then transferred to Lakka for treatment. I lost relatives in the red zone, but I was lucky: I survived. Two months after my recovery, I applied for a job.” Monjama joined EMERGENCY as a cleaner while the epidemic was still ongoing. She continues to work at the Goderich Surgical Centre.
“As an Ebola survivor, I faced a lot of stigma. While I was still in hospital, we lost our home, our jobs. We survivors stay in touch; life has been hard for most of them. EMERGENCY accepted me when others would not, and I had hope again.”
Implementing these strict protective measures alongside the global standards of treatment for patients with haemorrhagic fever, EMERGENCY’s facilities guaranteed high-quality care in the midst of the deadliest Ebola outbreak in history – and its Surgical and Paediatric Centres were the only hospital complex in Sierra Leone to remain fully operational throughout the epidemic.
The facilities continued to treat infectious diseases and surgical emergencies no longer being dealt with by the public health network, with many patients presenting symptoms similar to Ebola. To increase the number of available beds, the patient accommodation block was converted into an additional ward.
“In Lakka, our main focus was treating Ebola cases, but we also managed other conditions such as malaria, typhoid, cholera, and trauma injuries. If a patient met the admission criteria, we accepted them,” says Freda M. Kangoma, an EMERGENCY Nurse. More than ten years later, she is now Nurse Team Leader in Goderich.
“It was extremely difficult and emotional, but I felt continuing to work was both a moral and professional duty to help my patients and my country. I believed in serving humanity: that’s our calling as healthcare workers. During Ebola, the normal healthcare system had collapsed, and public trust was lost. The EMERGENCY hospital had a major impact by continuing to offer care and by restoring hope in such a dark time.”
By November 2015, when the country was first declared Ebola-free, EMERGENCY’s Surgical and Paediatric Centres in Goderich had admitted over 6,100 non-Ebola patients – an average of almost 10 per day.
Meanwhile, its Ebola Treatment Centres had isolated around 670 suspected cases and admitted 227 patients for treatment, of whom around 50% survived. After two further cases emerged the following January, Sierra Leone became officially free from the virus on 17 March 2016.
“I was working in the red zone of the newly built Isolation and Treatment Centre. Patients who were infected with Ebola were scared and had many questions about the disease and what would happen next. That period of time was really tough, it is still difficult for me to think about even now,” says Abubakarr S. Kargbo, a nurse who joined EMERGENCY after the outbreak began and continues to work at the Goderich Surgical Centre. “But the hospital had a great impact: it saved lives, and provided opportunities for our people by hiring staff during such a difficult time. And today, we are still providing access to care for those who would otherwise have no options.”
Ten years on from the Ebola crisis, and nearly 25 since the opening of the Goderich Surgical Centre, EMERGENCY continues to provide high-quality care, completely free of charge, to the people of Sierra Leone, without discrimination. The Goderich hospital is the main trauma hospital for the entire country, and runs the only dedicated treatment programme for burns caused by accidental ingestion of caustic soda (lye), a major public health concern.
While the spectre of Ebola has mostly dissipated, the memories of those impacted by the virus will never fade. Concludes Dr Portella: “I’ll never forget a young woman who was about 18 years old. She arrived in extremely critical condition. She was the first patient on whom we performed invasive procedures. We took the risk, and she survived. Four years later, I met her again – she was healthy, and had a baby.”
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EMERGENCY has provided free, high-quality care in Sierra Leone since 2001. In addition to the Goderich Surgical Centre, EMERGENCY’s previous activities include a Paediatric Centre providing essential surgical care to children under 14 years old (2002-2020); Ebola Treatment Centres in Lakka and Goderich (2014-2015); and First Aid Posts and Primary Healthcare Centres in multiple locations (2014-2020).
The NGO’s Ebola response was supported by the United Kingdom’s Department for International Development (now Foreign, Commonwealth & Development Office), which co-funded the Ebola Treatment Centres in addition to constructing the Goderich facility.