15 August 2014

Sierra Leone: British Doctor - Ebola 'Is a Terrifying Disease'

Sierra Leone is on lockdown after the president declared a state of emergency in response to the spread of the Ebola virus. Dr. Oliver Johnson tells DW what it's like on the front line of the fight against the disease.

DW: Several international organizations have withdrawn from Sierra Leone, while here in Germany the government has told its citizens to leave. You chose to stay - why?

Oliver Johnson: Part of it is because [at] King's Health Partners we don't consider ourselves an NGO; we consider ourselves a partnership. And so we consider Connaught Hospital to be a partner, the staff here to be our own colleagues. Many of us have been living in Sierra Leone for a while and see people across this city and this country as friends and family, really. We don't come with an agenda, so it was very natural when a new problem arose for us to say: All right, okay, we're in this together; what can we do to support your efforts?

The volunteers out here at the moment - when they signed up, this is not what they signed up for. So it's also been a personal decision from the volunteers that they wanted to stay. And I think it's shown an enormous commitment; it's been the volunteers fighting to ensure that they were allowed to stay, because these are our colleagues, and all of our instincts have been to stay as long as we can, and as long as it's safe.

You're talking about your colleagues and the volunteers making those decisions, but you've had to make those decisions for yourself as well. What's gone through your mind, and, given the deaths of some of your colleagues, have you since had second thoughts?

There are certainly moments when I've woken up and thought wow, this is a terrifying disease, and this is a terrifying situation. The risk is real. But one thing that makes this risk - the risk of Ebola - different to, say, the risk of working in a war zone is that this is a risk I can control.

I can't control where a bomb will be dropped if I'm right now in a conflict zone, but I can choose whether or not I am exposed to Ebola, because I've got to make sure that I wear the right gloves, the right mask, that I chlorinate things properly, I wash my hands - if I do those things, I will be safe. And I know that. And if I get sick, it'll be because I made a mistake. And actually that, psychologically, is a very different experience, because it means that it's something very much that you make a conscious decision about.

Paint us a picture of what a day looks likes now in the hospitals dealing with Ebola patients, in those isolation wards.

Dr. Oliver Johnson

As patients come into the hospital they're screened by a nurse. We've also got ambulances coming in quite a lot. And as patients go in, they move into an isolation unit, where we as health workers get dressed in these full suits. And it can be very dehumanizing, because they're suddenly there without their relatives, and it can be very scary for them.

So as a health worker and as a human you want to go and support them and encourage them and spend time with them, but you're dressed up in this mask and they can't see your face, and it's a real challenge to create those human moments of reassuring them. And as much as possible, you know, I'd hold their hands and sit with them and hear about their families and tell them a bit about me to try and make this extraordinary situation more personal and more human, so that they can be reassured.

But the work itself is hot, because it's hot anyway and you're in these suits, and you start to sweat, and as you sweat into the goggles they begin to steam up, there's a strong smell of chlorine; and it's tedious work sometimes because the infection control procedures are repetitive, going back again to change your gloves and again to wash your hands, and so everything takes a long time and is difficult. It's physically challenging and it's mentally challenging, but however hard it is for us it must be much harder for those patients.

What is the main issue that you're facing in fighting the spread of the virus?

One issue is just the spread itself. Someone could have got Ebola anywhere, and that makes it a much more challenging response. Some of the early challenges we had... People not believing in Ebola. That's actually shifted - I think there's a much better belief, and that's partly because of the huge government efforts to inform people. Some fantastic Red Cross volunteers - we had supply issues, but there's been a big international response, and now there are actually good stocks, certainly for us.

Health care workers have to wear special suits to protect themselves from the virus

One of the main other challenges has been that health workers are afraid, some of them, and I think that's a major challenge - alongside [the fact] that there are some heroic colleagues who have been coming in to work every day, despite the family pressure or the fear, and are enormously diligent. And they're role models really, for me, and for others: Sister Cecilia, the head of our A&E department, or Muhammad the security guard, Abdullai the cleaner - they're there every day, day in day out, working.

But more widely across the health workforce there are other staff who are afraid, and I think we've got an effort ahead of us to convince them that it's safe to come to work, and to convince patients that it's safe to come to hospital.

How has the Ebola outbreak changed daily life there? You've talked about things you think about in your professional work, but what about in daily life in Freetown?

It's really only been in the last six weeks or so, but particularly since the president declared a state of national emergency, that life has been transformed. People here are regularly comparing what it feels like now to how it felt in the civil war. Because there are curfews for motorbikes at night; there's a much stronger police and military presence at the checkpoints; the streets are quieter, and many of the foreign organizations have left.

And I think that there is a palpable sense of concern, and everyone's taking it seriously. So people on the streets are wearing medical gloves, outside every business or restaurant there are buckets of chlorine to wash your hands in. So life's a little bit harder; still in the range of normal, but it's certainly very different to what it was like before. And it feels a bit lonelier.

There has been talk this week of experimental drugs from the US and Canada. How much do you think that these could help?

It's very encouraging news that there are new drugs in the pipeline for Ebola, because prior to this there's been really nothing in our armory as a doctor that we could use. So generally, I think it's encouraging news.

Johnson: 'We need to strengthen our health systems in West Africa'

That said, I think there are two big unknowns at the moment that potentially mean it may or may not have an impact here on the ground. The first is: Are they effective; are they safe? The other thing is: Are we going to be able to mobilize the kind of volume of these drugs we would need, and get them into the hands of the patients here in West Africa? And are we willing to pay the cost, in the way we haven't for almost any other drug? Every day here we have patients dying because they can't access the drugs that we would have in our homes or readily available for us in our hospitals in the West.

The lesson has got to be: We need to strengthen our health systems in West Africa, and across sub-Saharan Africa, to have good disease surveillance, good infection control, good hand-washing, good soap, good gloves and aprons. If we'd had this, this outbreak would never have started. And if we implement this, we can not only stop Ebola but we can stop HIV and pneumonia and surgical wound infections and all sorts of other things that are a day-to-day problem - that hidden outbreak that has been happening every day in West Africa for decades. So I hope that's the message we take away.

Dr. Oliver Johnson is the program director of King's Health Partners, a partnership between British hospotals that works with hospitals across Sierra Leone, including Connaught Hospital in the capital, Freetown.

Editor Spencer Kimball

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