Ebola health workers in personal protective equipment entering the Island Clinic in Monrovia, Liberia, 2014. Photo courtesy of WHO/C. Black
The World Health Organization (WHO) is publishing a series, "Ebola Diaries," with first-person accounts of WHO staff and others deployed to the field for Ebola response since the first cases were reported in West Africa on March 23, 2014.
Ian Norton is an emergency physician who came to West Africa in 2014 to help find and coordinate foreign medical teams to treat people with Ebola virus disease. Under Norton’s guidance, WHO developed a registry of foreign medical teams around the world able to respond rapidly not only to Ebola but to other health emergencies.
“I’ve been to several major disasters in the past, particularly typhoon Haiyan in the Philippines, the Pakistan floods and other disease outbreaks. But this was almost like going into a warzone. The Ebola response was not able to function because of one key element, a lack of treatment capacity. Ebola would have overwhelmed any country in the world if it hit their capital and went through the streets like it did in Monrovia, Conakry and Freetown.
"What we found in Liberia was that people in Monrovia were being told to bring their loved ones forward to have care, to have a chance of survival and to decrease the risk of that loved one giving the disease to the rest of the family. They would arrive at the one or two facilities in the city and be told they were full and to take their loved one home.
"The messaging was contradictory: when they brought their loved ones – they had nowhere to go.
"So that was undermining our entire response. People were coming forward – all they could hear on the radio was how bad the disease was and how unsafe it was. Yet their friends and relatives were dying on a mattress next to them, in some cases in small, shantytown dwellings in the middle of a crowded city which was being flooded every day by massive rains.
"There is a long history of nongovernment organizations, government and military teams responding to sudden onset disasters. They have responded like this for decades, but the question was: could we bring foreign medical teams (FMTs) for Ebola? They had done outbreak response but never on this scale and never for Ebola.
"For two decades the only team that could manage this effectively, particularly Ebola, was MSF. But they, like us, couldn’t do it alone.
"We put out the call, and asked other teams to come forward. The most discouraging thing was to be sitting in Monrovia, asking teams to step forward and for the world to remain silent. To have nobody, I mean nobody, answering. That was truly awful.
"Then to have to go back to the ministry that afternoon and phone the ministry in Sierra Leone and say, 'I'm sorry, nobody wants to come, nobody is capable of coming forward.' I had to just stand back and say, what would it take to get these teams to come forward?
"We asked teams to be completely self-sufficient in the four S’s (staff, supplies, space and system), so I broke them down and said what is missing here? The first was the space; they didn’t know how to build Ebola treatment units. So we built treatment units for them, or got the UK and US to build them. The second was training. They had staff, but none of these staff were trained. So we put in place a training module.
"The first organization we asked specifically was the International Federation of Red Cross and Red Crescent societies (IFRC). International Medical Corps (IMC) also came early, along with a few other non- government organizations (NGOs) with no previous history with Ebola which bravely stepped forward.
"It’s just incredibly brave and inspirational that these teams took such a leap of faith. When we put in place the structures and the training and the supply chain, they would step forward and take on an Ebola treatment unit when it was not in their normal mandate or experience.
"Gradually, with a lot of coaxing from us, advocacy through governments and the very largest donors in the world advocating to government teams and NGOs, we saw an expansion of 58 foreign medical teams: an incredible response.
"Our real role with the foreign medical team unit was to increase the world’s capacity of medical teams that are able to not only come in and manage a public health outbreak, but actually deliver care to patients.
"Now we need to think about not just looking back on Ebola but to the future. Which of the teams could step forward for MERS, or for SARS, or for dengue? So we need a pre-registry and a registry of teams across the world with the capacity to be sent abroad, to their near neighbours first.
"WHO will coordinate the registry which means that the government affected can draw from effectively an à-la-carte menu of all the world’s teams. There are some that are good at trauma disaster response, some that are good at public health and outbreak response, some have specialty skills. It also allows surety for the country and the population accepting the team, that they meet the minimum standard.
"What have we learned from this? Now we have multiple organisations that have a history of response to outbreak, particularly to Ebola. We have a lot of teams that have learnt the lessons of that response and are more able to respond to Ebola in the future with less fear, more infection prevention control and an organizational capability. The really heart-warming thing is that, foreign medical teams aside, with support, logistics and monetary assistance it is the national teams that are leading the Ebola response now.”