Sierra Leone: On the Front Line of the Fight Against Ebola

Vincent van der Windt/MSF

Doctors Without Borders/Médecins Sans Frontières (MSF) hygienists in the Ebola case management center (CMC) in Bo, Sierra Leone are armed against the virus. Their weapon of choice? Chlorine.  

"Our hygienists are on the frontline against Ebola," says Daniel Baschiera, water and sanitation manager for MSF. "They see themselves as combatting an invisible enemy. Using their spray tanks filled with chlorine solution they keep the rest of the staff safe."

So what do hygienists in an Ebola case management center do? And why is their job so important? Team leader Alpha Koroma (25), from the nearby town of Gondama, explains. "Our job in the high-risk zone includes waste management, changing beds, cleaning floors and watching out for the medical staff. We give our patients a clean environment, and we make sure that the medical teams have nothing else to worry about but their medical duties."

Risk and Discipline

In the CMC, discipline is paramount. "It’s absolutely essential," says Koroma. "You have to stick to the rules, to the procedures. It’s the only way to protect yourself and the people you work with. That’s everyone’s responsibility. The medics count on us. We count on the staff helping us in and out of our personal protective equipment, or PPE. And, in the end, the patients count on everyone here doing their very best to care for them. That’s what it’s about. The case management center is a place where a lot of lives are saved."

But does Koroma ever worry about his own safety? "Never. I know I can rely on my co-workers. Even when I’m really exhausted after a long time in the high-risk zone, I know my sprayer will help me undress safely. Of course, sometimes there are risky situations. I remember this one patient, Ishmael. He was a big guy, but in real bad shape. He was very disoriented, and started pushing other patients. It could have been very dangerous for the staff. But we stayed calm, and managed to separate Ishmael from the others. Eventually, he calmed down too. And he was even cured some time later. I was very happy to hear about that."

Calm and Collected

Keeping a cool head can be difficult in full PPE, especially when confronted with the unexpected. Baschiera tells the story of the nurse and the Nairobi fly: "This insect doesn’t bite or sting," he says, "but it does cause very painful blisters if crushed against the skin. That’s why it’s also known as the acid-bug. One of the nurses had one on the inside of her goggles while in the high-risk zone. It must have been hiding right underneath the rim. She panicked, and wanted to take her goggles off right there and then. But the hygienist who was with her said 'No! Close your eyes!' He guided her to the undressing area, told her to stay cool and, together with the sprayer, made sure she undressed safely."

"Everyday Life Has Ceased"

"We watch each other’s backs," says Koroma. "You have to. You have to take care of each other. This is a bad time for Sierra Leone. Normal, everyday life has ceased. Kids don’t go to schools now. What happens if they can’t go to school for another year? For the next two years? That’s why it’s so important that we carry on working. We can’t stop. And we won’t. We have the faith, the strength, and the responsibility to keep on fighting this disease."

"It’s so important that we carry on working. We can’t stop. And we won’t. We have the faith, the strength, and the responsibility to keep on fighting this disease."

Alpha Koromo
A lot of boots are scrubbed and hung to dry every day at the MSF Ebola case management centre in Bo, Sierra Leone.
Vincent van der Windt/MSF