Working collaboratively to support Ebola response efforts in Sierra Leone

CDC’s FETP partnerships with African nations continue to be leveraged beyond their national borders and for new and unexpected health threats. Dr. Bao-Ping’s blog posted originally on March 31 is being highlighted again as a reminder of how FETPs support global as well as individual nation’s health security.

In late November 2014, during the peak of the Ebola outbreak in West Africa, I was deployed to Sierra Leone to support CDC’s Ebola response efforts. Like many of my colleagues, I wasn’t sure what to expect or where to begin, but I knew that we faced immense challenges, and my skills and expertise in field epidemiology were critically needed to support the global Ebola response effort.

When I arrived in Sierra Leone, in the epicenter of the outbreak there, my first assignment was to assist in assessing contact tracing efforts in the Bo District. During the first couple of days in the Bo District, I visited the villages and towns where Ebola outbreaks were occurring. I observed a number of contact tracing efforts to assess the process, provide feedback, and then advocate for a more systematic approach to contact tracing efforts throughout the district to inform Ebola prevention and control efforts. By engaging in discussions with CDC, WHO, and Médecins Sans Frontières (MSF) colleagues, we were able to quickly develop a plan to systematically train contact tracers and in-country supervisors, and bridge some of the critical gaps by implementing a more systematic approach to contact tracing efforts and improve operations.

A couple of weeks into my deployment, I received a frantic call from a colleague informing me that in response to Sierra Leone’s Ministry of Health’s request for support, the African Union had sent more than a hundred health workers from Nigeria and Ethiopia into Sierra Leone’s districts. My colleague was concerned because many of these health workers were already in the districts, and they were requesting additional training around personal protective equipment (PPE), contact tracing methods, cross-cultural communication, all of which is critical information required for health workers to be effective and safe in the field. As an epidemiologist with extensive experience in outbreak investigation and response, I knew what I was up against and had to quickly assess the situation and come up with a plan.

Within 24 hours, we miraculously put together a training package that included training on the use of PPE, clinical and infection-control practices in an Ebola treatment unit, case investigation and contact tracing, as well as general occupational safety and health issues specific to working in Sierra Leone. Several partner organizations graciously provided unconditional and unreserved help to make this happen, including the Disaster Assistance Response Team (DART) of USAID, the International Organization for Migration (IOM), WHO, and the African Union’s Representative Office in Sierra Leone, to name just a few. The leadership of Dr. Sara Hersey, the Epidemiology Team Lead, was instrumental in making this happen.

As I reflect on my experience in Sierra Leone, one of the things that became extremely clear to me during the response is that during an outbreak response in a resource poor country, one needs to be flexible, draw on experiences, respect cultural differences without compromising life-saving measures, and work collaboratively to save lives. It was also clear to me that in Sierra Leone, Ebola was a disease of poverty and aided in its spread by a lack of health infrastructure and the absence of a clear process for early response and treatment of suspected cases. Data shows that Ebola was initially confined to a limited geographic area in Sierra Leone before it spread into the surrounding villages and districts. This process can be halted in future outbreaks by building the capacity for epidemiology and laboratory facilities before an outbreak.

This is a snapshot of what I and so many other CDC employees are called to do every day. In the face of seemingly insurmountable barriers, we figure out a way to make things work, and make sense out of what initially seems like chaos. Everyone’s contributions to the Ebola response has collectively made a huge difference and has potentially saved many lives.

In recent weeks, the case count in Bo District was reduced to zero. It is this kind of tangible impact that excites and motivates me and my fellow public health professionals here at CDC.

For more information, please contact, Dr. Bao-Ping Zhu, Resident Advisor, Uganda Field Epidemiology Training Program at (bxz3@cdc.gov).

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