Hard But Fulfilling Work in the Fight Against Ebola

The fruit bat dropped silently from the delivery room ceiling and quickly crawled away as the nurse explained how she mixed the 0.5% chlorine solution used to sterilize the medical instruments. It was a normal day of assessing the infection prevention and control (IPC) procedures of peripheral health units (PHUs) in the rural areas of Kambia district, Sierra Leone. Bats are very common in PHUs, creating challenges to IPC steps and standards.  Each of these facilities is small and basic but serves a large and rural area. Working with dedicated international and Sierra Leonean partners, the CDC Kambia IPC team routinely visited PHUs, border crossings, and the Kambia government hospital to ensure proper screening for Ebola symptoms as well as proper use of personal protective equipment (PPE) to protect against infection. Effective screening at these facilities is important to quickly isolate patients with Ebola both reducing the possibility that they would infect additional people, and allow them to get proper treatment. During these visits we would also discuss other issues with the medical staff, such as waste management, proper disposal of used needles, hand washing, and general infrastructure concerns, including the presence of bats.

My ability to assess the potential exposures of frontline workers in the fight against EVD Ebola was by my work experience at CDC’s National Institute for Occupational Safety and Health (NIOSH). At NIOSH, I regularly assess worker exposure to occupational hazards thus giving me a unique worker-oriented perspective for preventing the continued spread of this disease.

Although it was rewarding to be able to see first-hand the IPC improvements resulting from my work, there was little respite during my four weeks in Sierra Leone. I worked 12 hours a day, seven days a week, making the time fly by. Evenings mostly consisted of eating well-prepared local fare while sitting in the oppressive heat. Frequently, winged termites would swarm around our dinner table, adding “extra protein” to the stew and additional topics of conversation. Once this relaxing dinner was over I would crawl into my cement bed, through a grey mosquito net, rest my head on a blackened pillow and sweat myself to sleep, hoping not to bring the next horror story of bites or infestations to breakfast the next morning. In the morning, I would crawl out of bed bleary-eyed, pour a bucket of water down the non-flushing toilet and let the water drip from my shower, while I stood in the pool of water that had accumulated overnight on the bathroom floor. The morning meal consisted of a fried egg and delicious bread, as our group shared stories and laughter about the interesting creatures that kept us company in the night.

However, the positive experiences of my time in Kambia far outnumbered the hard bed and other challenges.  I will have lasting memories of our evening meals and of celebrating a hard day’s work with a beverage and colleagues from the international and local community at the nearby gas station.   Working and living within the community allowed me to interact closely with all our partners and gain some perspective on the challenges faced by the community in the fight against Ebola.

The living was hard but the work was fulfilling, and each day I saw subtle improvements that would make the people of Kambia better prepared to combat this disease. On one of my last days, I entered the hospital and saw nurses at the triage tent, in proper PPE, correctly taking temperatures, and cleaners mopping the hospital floor, a big step forward in the IPC world of Kambia government hospital. Thankfully I shared all these experiences with a committed local staff, my CDC colleagues, and NGO partners forming lifelong bonds and memories. With the help and dedication of all future responders, these improvements will help to bring Sierra Leone to zero cases of Ebola and enable a sustaining IPC framework within the public health system.