In Sierra Leone, Doctors Without Borders/Médecins Sans Frontières (MSF) runs two Ebola Case Management Centers (CMCs)—one in Bo and another in Kailahun—with over 1,400 staff.
The Kailahun Ebola Case Management Center was opened on June 26, 2014. To date, MSF teams have admitted more than 600 patients with confirmed Ebola, of whom 292 have recovered. Here, staff members at the CMCs discuss their experiences.
Fatmata Swarray, Mental Health Officer: Listening and Comforting Patients
Fatmata Swarray has been working as a mental health officer at the MSF Ebola CMC in Kailahun, Sierra Leone since July 2014.
My role as a counselor is to be available for the patients—to comfort them, to talk to them, to listen to their fears and explain what being inside the treatment center will be like.
When patients arrive at the center, my colleague and I greet them and tell them that we are here for them. I ask who they have been in contact with and try to trace those people for testing.
Every day I keep an eye out for patients who are not leaving their beds and tents. I watch for signs that someone has given up or has started to believe that their end is near. When I see this, I go to talk to them; tell them that they must not give up; that they must eat, drink, stay hydrated; that they must try and sit up, go outside, and feel the sun on their faces.
It is more difficult when the patient is a child, because they are often too weak and it is not always possible to find a person inside the center willing to take care of them. There are children who have survived the virus, or have tested negative for it, but who have lost their families. While we try and locate a relative who can care for them, we send them to the interim care center, a house set up for children orphaned by the disease. I worry most about these children. What future will they have?
I also speak to people who are in the recovery phase, for whom the worst is over. They have a different set of fears to those who are still very sick. I listen to them, reassure them, and bolster their spirit. I tell them that now they have a future, friends, and families to look forward to.
Everyone is very emotional when a patient is finally discharged. We give the recovered patient a certificate, a few essential items, and a fresh set of clothes as they have to leave behind everything they came in with. Amidst smiles and handshakes, our health promotion team takes them home to their family and village.
Sometimes survivors are not welcomed back into their communities and their friends are still afraid to get close to them. In these cases, the survivors call me and I talk to them. I tell them to feel proud and unafraid, to disregard the whispers because now they are recovered.
It is very sad when a patient dies, to know that despite the efforts of the doctors and nurses, the disease won. It is my role to locate the family, inform them, and ask them if they would like be present for the burial. It is the most difficult part of my job.
Mohammed Leno, Hygienist: “Chlorine Is My Best Friend”
I am from across the border in Guinea. I came to Sierra Leone to learn English.
Before Ebola, I was able to go home. But now the borders are closed.
Before Ebola, I was a banker and a student. But now I live a different life.
I am part of the water and sanitation "task Force" at MSF’s Ebola CMC in Kailahun. I started here as a grass cutter, then a carpenter—I helped build this center. After this, I was a sprayer; I would sit by the doors with my chlorine sprayer and spray chlorine solution on the boots of everyone entering and leaving the center. Later, I moved inside the center. I helped in the undressing areas, guiding the people inside the yellow suits through each step of the long process of undressing and spraying their suits and boots.
Now I do infection control. It is my job to keep the virus contained. I disinfect the tents in the center, the toilets, the ambulances, and dead bodies. Chlorine is my best friend and I know that if I use it correctly I am making the center a safer place.
My job exposes me to the worst side of Ebola. When an ambulance comes in with patients, often there will be a dead body inside —you never know until the moment the doors are pulled open. I help patients out and into the triage tent, where they are given water and snacks and a moment to catch their breath after a long and hard trip.
If someone has died, then it’s my job to disinfect the body and ready it for the burial team. This is always hard because for some who die, my team and I are the last to see their faces. I always try to pay my respects to those whose lives were stolen by Ebola. We then disinfect the ambulance so that it can go and bring back more sick people in the coming days.
Sometimes, if there is a patient coming from a town or village that is close to the center, I go to the patient’s house to disinfect it. I spray the walls, the furniture, the toilets, and the floors. The community always looks at me with suspicion, but I keep my head down and do what I can to make the place safe.
When a patient dies inside our center there is always a mess, a pool of bodily fluids that show you that the person did fight against the disease, but the disease was stronger. When this happens, I go with pads and chlorine and I wipe away all traces of death.
I feel safe when I am wearing the yellow suit, gloves, and masks and have my sprayer with me. I take my job very seriously because as a hygienist I am exposed to risks. The work is labor-intensive: I clean and lift while wearing the protective clothing, which makes me sweat a lot. I am forced to pace myself, to follow the rules; if I make mistake, it could have serious consequences.
I know that the battle against Ebola is taking place in my country, Guinea, as well, but I am happy to be here and to be able to help. I am proud of my job because I know I am making a difference.
Dominic Pessima, MSF Health Promoter (Outreach): Breaking the Chain of Transmission Through Awareness
I am a health promoter at MSF’s Ebola CMC in Kailahun, Sierra Leone. I am working on the frontline of Ebola because this is my community and I must do what I can to convince them that Ebola is real.
As a health promoter, I stick by what I believe: prevention is better than cure. It’s been three months since I started talking to people about Ebola. I go out to the villages, to communities that are losing their family members and neighbors, and I educate them about the disease.
Every time I approach a village that has been affected, I am aware of the risk, but I am prepared. I drive in, past the quarantine barrier. I step out in my white rubber boots and my MSF jacket, ready to inform and entertain. I use flyers, radio spots, and my voice to clarify the confusion surrounding Ebola. Often, I am welcomed, and when I talk the communities listen. Sometimes, though, they mock me and turn their heads away because they don’t believe what I am telling them.
My job is convincing people to wash their hands; avoid bush meat; to eat from individual, rather than communal, dishes; and, above all else, not to touch.
Even though there is so much fear and so much death, there is still disbelief. I persevere; I try to engage, I tell them why they must not do all the things that bring people closer. They must try and keep their distance. They must not rush to help their neighbors and friends when they are ill. They must adjust their way of life until this awful disease is behind us.
I talk to them about the case management center. I tell them this is where the sick go to get better—though many also die there, because they have come so late and the illness has taken over their bodies. To the communities, the center is a place where people go to never return. It is where death happens. They ask, "If there is no cure, how can they make us better?"
There are many challenges, but they are forgotten when I get to bring a survivor home. The villagers gather with wide smiles. They sing, dance, and sometimes pray in celebration. For people who have lost loved ones, this provides hope. For me, this is proof that I have done a good job.
Unfortunately, often those who have been cured have no place in the community. They are shunned and considered dangerous. In those cases, I visit the survivor’s village. I try to convince them that this person is well and poses no threat. I explain this and reassure the community. I do this with words, and by simply touching the survivor to show they have nothing to fear.
I am a warrior going to battle Ebola. I am breaking the chain of transmission through awareness, and will continue until it is defeated. I believe I am on the winning side.