It’s not all fashion and frivolities here on changmoh.com, you know! Meet Dr Jamie Whitehorn who is passing through Singapore today on his way back from fighting Ebola on the front line. I have known Jamie for about 15 years and, to be honest, he’s a bit of a hero. A doctor with a wife and three children, he has just returned from volunteering in Sierra Leone, where he was working in an Ebola treatment centre for the last two months. Having successfully cleared the required quarantine period, (he’s officially safe) I am sitting having breakfast with him today in Singapore as he awaits his connecting flight back to Vietnam, where he lives and works.
Jamie, over to you:
I am an infectious diseases doctor living in Vietnam doing research on dengue. West Africa seemed far away but like most people I was aware that the largest ever Ebola outbreak was on-going in Guinea, Liberia and Sierra Leone. A few months ago I received an email calling for volunteers to assist with the Ebola response in West Africa. Part of me thought I should go (I have worked in Africa before, I have done a masters in tropical medicine, this is what I specialise in…). Part of me thought I shouldn’t go (I am married with 3 small kids, Ebola is horrible and I really didn’t want to catch it…).
After a lot of discussion with family and friends I decided that going was the right thing to do.
I was seconded to Save the Children to work in their Ebola treatment centre in Kerry Town, Sierra Leone. A few weeks of online security training, psychological assessments and vaccinations followed and before I knew it I was on a plane to Casablanca to await my connecting flight to Freetown.
We worked in shifts, so the pattern of each day varied. Here’s an example:
6:30am I would typically start the day with a run on the beach. Sierra Leone is an amazingly beautiful country and without its tragic recent history would be a major tourist destination. Running while the sun rose was a great way to clear the head.
8:00am After a quick breakfast we would catch the shuttle bus that would take us from our accommodation to the Ebola treatment centre (ETC):
The ETC is an impressive facility built with funding from DFID and staffed by clinical teams from the NHS, Cuba, Save the Children and of course Sierra Leone. I was fortunate to work with an amazing group of people.
At 8am we would have a handover meeting with the night team to get an update on the clinical progress of the patients. Soon after this we would go into the “red zone” to do a ward round.
To work in the red zone we have to wear personal protective equipment (PPE).
This takes ages to put on (donning) and take off (doffing) and has the disadvantage of being really hot and sweaty which is not ideal when it’s over 30oC. Obviously as this protects us from Ebola its pretty essential, but when your gloves and goggles are filled with sweat you know its time to “doff”.
Patients are often terrified when they arrive at the centre, and this isn’t helped by the fact that we are wearing PPE suits. One of the most difficult things is when a young child is admitted with Ebola without their parents (who may have died from the disease). It is bewildering and scary for them. Sometimes when an adult is recovering from the disease they can act as a surrogate parent in this situation.
10:00am Soon after the first team goes in another team will be getting ready. There is only so much you can do in the limited time you have in there. In addition, throughout the day, hygiene teams go in to clean – they douse everything in strong chlorine. I will never be able to use a swimming pool again without being reminded of the ETC. Rehydration is vital after being in the red zone. I often drank oral rehydration salts while writing up the medical notes.
12.00pm I would get ready for another trip into the red zone. In addition to confirmed Ebola patients we would see patients who need to be assessed to see whether they have Ebola or something else. Unfortunately the epidemic has had a devastating impact on normal healthcare in the region. For example, we saw quite a lot of malaria. The PPE suits really hamper your ability to assess a patient and this time of day is the hottest.
Many days were filled with sadness when patients in the ETC died or patients arrived dead in the ambulance. The flipside of this would be the happy (discharge) showers after which Ebola survivors could be reunited with their families and friends. Seeing their joy at surviving and re-joining their family and friends again was amazing. Unfortunately many faced distrust and fear in their villages and our community teams were busy advocating for them.
1.00pm A lot of the international staff contributed to a lecture program that aimed to help develop the national clinical staff. I was glad to contribute to this. The national staff are the real heroes in this epidemic. Many of them have lost family members and colleagues and yet keep coming to work to carry on fighting the disease. After this outbreak has been controlled they will be the future of the Sierra Leone health system. Here are some of them, below, with me as I prepared to leave and head back to England with my leaving gift (a Bob Marley medallion in case you are wondering).
2.00pm It’s time for another handover meeting. The shifts are quite short (8am-2pm, 10am-6pm, 2pm-8pm and 8pm-8am) but wearing PPE really takes it out of you!
4.00pm Back at our accommodation…Often there would be additional meetings with colleagues about our clinical guidelines etc. Fortunately, however, there would usually be time for a beer while watching the sunset.