That fact was driven home over the weekend with the announcement that a British nurse and a Senegalese epidemiologist have contracted Ebola while working in Sierra Leone, one of three countries battling the disease.
Dr. Rob Fowler knows the scenario all too well.
critical care specialist at Toronto's Sunnybrook Health Sciences
Centre, Fowler has done a pair of month-long stints in West Africa since
the outbreak appeared on the world's radar in March.
of Toronto's 2003 SARS outbreak, Fowler has practised his profession in
difficult and dangerous circumstances. But the Ebola work, well, that's a
whole other level of demanding, he said in a recent interview.
is the hardest thing I've ever done, I would say, in any of my clinical
experiences,” Fowler, a quiet man, says in a matter-of-fact tone.
“That's not to say that SARS wasn't difficult ... for everyone involved. However this is a different order of magnitude.”
describes working in Kenema, Sierra Leone's third largest city. Located
in the east of the country, near its junction with the other affected
countries – Liberia and Guinea – Kenema has been a hot spot for Ebola
A fourth country, Nigeria, has reported about 16
cases, all linked to a man who brought the virus from Liberia. The hope
is that Nigeria can stop transmission before it spreads out of control. A
fifth, the Democratic Republic of Congo, says it has diagnosed cases
too, but they are unrelated to the West African outbreak and are caused
by a different strain of the virus.
For more than a decade, the
international aid group Medecins Sans Frontieres (Doctors Without
Borders) has operated treatment centres when Ebola outbreaks occur. They
have the most experience delivering this dangerous care, and the world
has been happy to rely on their expertise.
MSF, however, has said it cannot open another treatment centre at Kenema because it is already stretched beyond its limits.
has spent the past year at the World Health Organization as a
US$1-a-year volunteer. He is helping the organization draw up standard
research protocols that could be rapidly put into use during disease
When Ebola hit, he was deployed to West Africa through
the WHO's global outbreak alert and response network, known as GOARN.
On his second mission, he found himself at Kenema, trying to treat an
ever growing number of Ebola patients.
Fowler was there when
Sheik Umar Khan, Sierra Leone's leading Ebola expert, contracted the
disease. Khan was his country's only virologist, and also the only
doctor working at the Kenema Ebola unit.
“And with his sickness
and death, you have zero pre-existing doctors there. And so the only
doctors that are there are the ones that have gone under WHO GOARN
contracts ... and you have very, very few nurses that remain ... a
relatively small number of very dedicated nurses,” Fowler explains.
have 60, 70, 80, 90 patients. And so, if you're one of two or three
doctors and 90 patients, of whom many are sick, you can imagine that
would be unthinkable in Toronto.”
“The sky would fall in. And in Kenema, that's just the daily reality.”
daily routine was challenging and long. Fowler says days started with a
morning meeting at 7:45 a.m. where the team learned who had died and
who had tested positive. Then the meticulous process of getting into the
all-important PPE – personal protective equipment – would begin.
would spend four to five hours in the stifling, spacesuit-like outfit,
hanging bags of intravenous fluids, doling out medicine, delivering food
and water to patients who couldn't get out of bed, and providing
whatever care he could.
At a point, he says, he would hit his
limit and have to leave, shedding the equipment carefully so as not to
become infected through contact with the exterior of a soiled suit.
After rehydrating and getting a bite to eat, it was time to climb back
into the gear and go in for another stint.
Eat. Sleep. Repeat. Seven days a week, typically for three or four weeks at a stretch.
found, and I think most people would find this, that with the schedule
we've kept anything more than four weeks is probably just pushing your
limits,” he says.
“It's not an environment where it's good for
people to be tired and not on their game. Because you really have to be
so careful and so vigilant at really every moment that you're inside the
facility in order to prevent risk to yourself.
The WHO says
there have been more than 2,600 cases so far in this outbreak – more
than all previous known cases of Ebola combined. Of those, 225 have been
health-care workers, and at least 130 of them have died.
week MSF put out a call for doctors, nurses and water and sanitation
experts, as well as people trained in tracing contacts of cases.
have 1,086 staff operating in these countries and we have just opened a
120-bed treatment centre in Liberia's capital, Monrovia, making it by
far the largest Ebola centre in history,” Dr. Joanne Liu, MSF's
international president wrote in a commentary published in Time
“But it is already overwhelmed with patients and we
simply do not have additional response capacity. Others must enter the
MSF pays its volunteers around $1,907 a month, depending
on experience. The rate is set, it says, to “reflect the humanitarian
spirit of volunteerism.”
The organizations GOARN draws on for
response assistance – institutions like the Public Health Agency of
Canada – agree to pay the salaries of volunteering staff when they are
in the field. Both MSF and GOARN cover travel and living expenses.
too is looking for extra health-care workers to send to the region.
Fowler, who recently finished his second mission, is currently screening
applications and putting out the word.
The WHO has had hundreds
of responses to its call for help, he says. But the agency is being
selective, looking for people who have the right mix of expertise,
interpersonal skills and maturity. Fowler says it's a very tough
environment for people who aren't used to being there.
“It is a
challenge in finding not just bodies, but more specifically, skilled and
appropriate and available personnel – all organizations are still
actively soliciting people to contribute,” he says, warning “this
outbreak will not be fading anytime soon.”
More health-care workers needed for Ebola response: aid groups
The conditions are gruelling, there may be a pay cut and the personal risks are all too real. The need for international health-care workers to help in the response to West Africa's Ebola outbreak is enormous and pressing. But make no mistake – this is tough, tough work that people are being asked to volunteer for – and dangerous.
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