Wednesday, December 3, 2014

Heroes and villains

Alimamy Kamara- a cleaner in the Ebola isolation unit at Connaught hospital, Freetown
In humanitarian situations there are always heroes, they are usually local people who work hard and take risks to protect their community and country. They are rarely, if ever, ex-patriots. I have met a number of heroes in Freetown but the cleaners deserve a special mention. In the early days of the epidemic many worked unpaid to clean the high risk areas. This is a phenomenal sacrifice given that no-one was quite sure of the risks of infection and the mortality rate amongst healthcare workers was extremely high. Foreign healthcare workers like myself will be evacuated to a high resource intensive care unit if we become infected and that comes with a pretty good chance of survival. At that time the cleaners would have been placed on the ward like anyone else and suffered the same risk of dying, probably around 70%. Thankfully there is now a 12 bed unit in Freetown dedicated to treating healthcare workers and it has most of the trappings of a high resource unit. If this sounds like 2-tier healthcare then it is but it should not be criticised. There simply aren’t the resources to treat every patient with that level of care and it is vital for all concerned that healthcare workers feel as protected as possible so they continue to come to work.
Bilikisu is a nurse who survived Ebola infection and has returned to work in the isolation unit
The Stresses placed on local healthcare workers are also immense. All have seen colleagues die from Ebola but continue to enter the high risk zone, some have even survived infection themselves. Most disturbingly however, many face discrimination at home for their continued commitment to work with Ebola patients. A number have literally been barred from entering their own homes by their families and some have taken to sharing small rooms in the hospital as a place to sleep as they cannot go home. Compare this to the life of an foreigner like myself who gets almost daily affirmation from friends and family and you can see how truly heroic some of these people are. You can read some of their stories on the King’s Sierra Leone Partnership Facebook page-
Of course there are no villains here. What I have witnessed though is the lack of co-ordination between partner organisations that I’m told is typical of disaster response. There is duplication of effort in some areas and large gaps in others. Sitting in meetings with the ‘Great and the Good’ it is clear that there are 2 types of doctor here. There are those who look after patients and those who talk about it. The latter are a frustrating bunch to say the least; they have fanciful ideas of what is possible and can even be critical of those involved in direct patient care. For those wanting to discuss clinical management it is vital to spend some time at the coal face before offering opinions.There are a number workers engaged in non-clinical activities and in vital areas such as vaccine research and epidemiology who should never enter the high-risk zone but for others it is essential. 

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