‘I WENT TO SIERRA LEONE TO FIGHT EBOLA'
Would you volunteer to help fight an almost always fatal, gruesome disease in a country with a weak, failing health system? KATHRYN STINSON did – and it changed her life
T he reality of the Ebola epidemic is present as soon as we land in Freetown. We are ushered to a washing station before entering the arrival hall and instructed to wash our hands under a tap dispensing a water and chlorine solution. After completing health status questionnaires, we start making our way across the Sierra Leone River estuary to the mainland via water taxi. I had volunteered with Doctors without Borders/ Médecins Sans Frontières (MSF) to work as an epidemiologist, jutting myself out of my comfort zone at home. It’s becoming clear that I am very far from comfort indeed.
We slowly make our way across Sierra Leone, taking eight hours to drive the 400km from Freetown to Kailahun, where the MSF Ebola treatment centre is situated. We pass through rainforests interspersed with rice paddies and small villages. Poverty is everywhere. We drive through Kenema, where the market place is teeming with people, and I wonder why the fear of infection wasn’t keeping people away from circle, a man lies in the road, emaciated and with his face contorted in pain. With one arm he tries to shade his eyes. Far gone, too far gone. We drive on knowing no one will approach him – he will most likely die alone.
Kailahun, home to 30 000 people, looks like many of the other towns we passed. Dust roads are lined with trading stores and every so often evidence of the NGO presence is noticeable as a 4X4 vehicle parks Kailahun used to be a trading centre alive a standstill, with the police and army doing border patrols and manning checkpoints to help prevent the spread of Ebola.
The treatment centre was built from nothing by MSF on the fringe of the town in June 2014. Consisting of several rows of white tents, complete with treated water, generated electricity and kitted out with everything needed to support an Ebola patient, this is where I would be collecting data and interviewing patients. Inside, the centre is carefully organised into high and
low-risk zones. Hand-washing points, consisting of vats of chlorinated water, are strategically placed throughout. The paths through the zones are cordoned off with orange barrier fences and a carefully planned open-water drainage system.
On entering, we wash our hands and our shoes are sprayed with chlorine and water. We change into fresh scrubs and gumboots in a room where nothing is to touch the ground except the soles of our shoes. Strict safety protocols are in place: wash your hands as frequently as possible; don’t touch each other; touch as few objects as possible.
As an epidemiologist, it is my task to draw the links between the cases, to investigate what may have given rise to the infection, and to assist in prevention by informing the health promotion team where I work together closely, along with a streetwise team of local staff who are all else, brave.
Patients would arrive after travelling for most of the day, emerging from an ambulance six at a time. Some were too weak to climb down and nurses in full protective gear would slowly and carefully help them out. Some people don’t make it to the centre at all, dying en route.
I interview patients at about their potential source of infection – had they been in touch with a sick person; attended a traditional funeral and customarily touched the body of the deceased; or had they eaten bush meat ( the disease can jump from primate to human).
I also interview people in villages, trying to understand the chain of infection. Our arrival is often met with curiosity and we need to emphasise the ‘no touch’ policy. Speaking to a community about the reasons for my presence is highly sensitive, and I feel a huge responsibility to establish trust when the question, ‘ We’ve never had a white person visit us before, so why have you come now?’ is on everyone’s lips.
despite the long hours and omnipresent fear of contagion. For the health workers, personal protection and safety are key – without healthy health workers, these communities would have no one to help them. Continuous vigilance regarding this leads to obsessive hand-washing and we move around each other in a curious dance to ensure we don’t touch. The accidental brush of elbows would lead to two people quickly jumping apart and apologising.
By ensuring that data reaches the national and international reporting framework to update the world about the epidemic, I feel I’m making a small difference. Engaging with patients and their communities is a privilege, albeit a harsh one: I’ll never forget the image of a sick woman, whose daughter had just died, being gently led away to spare her from seeing her
child’s body. She was dazed and weak, wearing only a T-shirt and a diaper, I was struck by this tragic depiction of loss of life, control and identity that this disease so cruelly doles out. Little is known about the pathology of the virus. Death strikes suddenly at times – all in the context of extreme poverty and an already weak health system brought to its knees by Ebola.
After returning to South Africa, I had to observe a 21-day incubation period, monitoring my health for any signs of Ebola. Experiencing the stigma attached to the virus – even from friends and colleagues – was tough. I was asked to not go to a party in order to ‘protect the guests’ and to ‘maintain discreet social distancing’ from my colleagues, even though, to date, there has been no documented report of an asymptomatic person infected with Ebola passing on the virus. While we can rationalise human-to-human transmission occurs only fear of Ebola is to be expected, given the high fatality rate and that there is no vaccine or curative treatment currently available.
I have no regrets about volunteering in Sierra Leone. It gave me an opportunity to see life and death on the frontline and as a result, I appreciate my own circumstances so much more. Going to Sierra Leone will be with me forever.
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‘We drive on knowing no one will approach him – HE WILL DIE ALONE’
FAR RIGHT Medical teams working in a remote village
OPPOSITE A burial team removes a highly contagious body
RIGHT Kathryn Stinson