Dr. Catherine Houlihan and Dr. Mauricio Ferri as they prepare to enter the isolation ward at Kenema hospital, Sierra Leone. Photo by T. Jasarevic/WHO
“It was great that Mauricio and I arrived the same day; we were able to share first, very shocking, impressions and to go through the process of adapting to difficult working conditions together,” says Dr. Catherine Houlihan, an infectious disease doctor from the United Kingdom deployed through the World Health Organization (WHO) to help respond to the Ebola outbreak in Sierra Leone.
For Houlihan this is her first deployment in an outbreak setting: “On my first day, I felt shocked by the enormity of the challenges. The day after, I started to adapt.”
Dr. Mauricio Ferri, a Brazilian intensive care specialist who has worked for seven years in various hospitals in Canada, laughs and say, “Before coming, I had to convince my wife to let me go.”
Both Ferri and Houlihan are mid-way through their three-week deployment to Kenema, one of the most affected areas of Sierra Leone since the outbreak was declared in late May. They are part of a team of four internationally-deployed doctors providing clinical care inside a newly established Ebola treatment centre located in the city hospital and managed by the Ministry of Health. They were deployed through the Global Outbreak Alert and Response Network (GOARN), a WHO-based network of experts and institutions that can assist with the international response to disease outbreaks. In Guinea, Liberia and Sierra Leone, WHO has currently 126 experts on deployment, sourced from staff, external recruitments and partners through the GOARN.
“I knew it was going to be hard but I did not expect this extent of challenges, in terms of lack of equipment and gaps in infection prevention and control measures,” says Ferri. “However, after the initial shock, I started to see those difficulties as opportunities for improvement.”
Ferri and Houlihan spend seven hours per day inside the treatment center, fully dressed in personal protective equipment (PPE), caring for between 40 and 50 patients a day. WHO has supplied PPE to health workers responding to this Ebola outbreak. Everybody – from security guards, ambulance drivers, cleaners and professional health workers – should be trained to properly use the PPE so that they can keep doing their job safely.
Some patients leave their mark. “On the first days I was seeing bodies being taken away; on my fourth day I saw the first patient discharged. It was my greatest moment so far,” recalls Houlihan. For Ferri, it is a story of a 4-year-old boy who survived Ebola, the only one in his family that was decimated by the disease.
The issue of personal safety is another concern for response teams, especially for medical workers in direct contact with patients. “Prior to my arrival to Kenema, I was scared about my own safety but I realized later that we can be in control of the risk,” says Ferri. “We need to strike the right balance between caring for patients and our own security.”
The infection and death of several local nurses who worked in the treatment center has had a profound impact on all the healthcare workers in the ward, especially national staff who had worked with them for a long time. “We need to lead by example on how to properly use the protection gear and to continue despite setbacks,” says Houlihan.
Would the doctors return to Sierra Leone or accept a deployment elsewhere if there is a need? “Absolutely”, both reply simultaneously. “Being part of such an operation is a unique experience. Not only can we contribute to the effort to stop Ebola transmission but it is also a good personal learning experience, allowing us to be better prepared for future deployments.”
Both Houlihan and Ferri applied immediately when they received the email that WHO sent out to various medical associations asking for volunteers to help with the Ebola outbreak in West Africa. “So far, no regrets,” says Houlihan. “I feel this is where I should be.”