Aid workers preparing to enter Ebola treatment unit. Image via CDC Global
Dr. Theresa Jones, 26, a clinical psychologist from Bristol, England, has just spent a month working in Doctors Wiithout Borders's Ebola treatment center in Monrovia, Liberia. She was already living in Liberia when the Ebola outbreak began. While working for Doctors Without Borders, she managed a psychosocial team of three who were dedicated to looking after the organization's national and international staff members. She described her typical day at the center.
As you can imagine, working with Ebola and its victims is incredibly tough. As yet there is no cure for the virus, and around 70 percent of those who catch it will die. All MSF's medical team can do is provide supportive care to give people the best possible chance of beating the virus-the hard work is mostly done by a patient's own immune system.
It's so easy for incredibly skilled doctors and nurses, who are used to being able to perform miracles, to start seeing their work as futile. A big part of my job is to give people working on the outbreak positive reinforcement about their work. Doctors need to know that every time they do something that may seem small, like giving a patient a cup of water, a reassuring word, or taking the time to ask questions, it is valuable. I see my job as helping my colleagues-from HR staff to the burial team-to find what it is they need to keep on going.
Every day is full-on. We have a morning meeting at 7 AM, and I tend to wear the same type of clothes every day, as dictated by Doctors Without Borders's strict hygiene rules. I usually wear jeans, because you have to wear tight trousers that don't touch the floor of the site, and then long socks, because when you're wearing the regulation Wellingtons you can't let your socks roll down. If you work in the high-risk zone with patients who have Ebola, you have to wear personal protective equipment (PPE), including a "spaceman" suit, which makes it much more intense. You work in a buddy system, and have to watch each other dress and undress, and keep a constant eye on your partner to make sure nothing happens that could put him or her in danger.
Ebola aid workers gearing up to enter an Ebola isolation ward. Image via CDC Global
The team has breakfast during the meeting, and we talk about what happened in the center yesterday: how many people were discharged, how many died, how many beds we have today, and how many patients we will let in.
After the morning meeting, I take the minibus to the hospital site. The hospital is an outdoors complex, and the patients and activities are held in a series of tents. We're expanding the hospital all the time to let more people in, so the teams are constantly trying to build new tents and create more space.
The center is divided into high- and low-risk zones. There are different levels of hygiene as you go through each stage, and you have to regularly wash your hands and feet and clean your boots as you move around the site. I don't go into the high-risk zone, though my colleagues who provide psychological care to the patients do. I tend to walk around the low-risk zone as my workstation is on the edge of the site. I wash my hands in chlorine more than 30 times a day.
The psychosocial support team is based in a tent on the site so that people can easily drop in for a session. If there is a particularly difficult incident that day, we can have a group session afterwards. During the day there are always meetings with other supervisors where staff well-being issues are raised. We have found that many of our national staff are facing problems back home: Some have been evicted from their houses, some even outright rejected by their communities because they are health workers. So my team also runs workshops where we invite community and family members in to talk about the center and the safety procedures we have in place for our staff.
We all go back to our base for lunch. I make sure I keep eating, as I'm running around all day. Lunch is usually local-style fish and green vegetables. Usually I have meetings with HR and admin to make sure I'm addressing any issues with staff. My focus tends to be around anything that can increase optimism, hope, humanity, and dignity in the center.
The symptoms of Ebola include vomiting, diarrhea, and sometimes bleeding. It is a disease that can so easily take away a person's dignity, which is something our wider psychological team is always trying hard to reinstate.
As my job is pastoral, I have to be "on" all the time. At the end of the day, lots of people feel guilty about leaving the site, but in some way I can escape this by being available in the evening if people want to come and speak to me about anything that is bothering them.
I went from living in Liberia earlier this year, feeling very frustrated by the lack of action, to coming to the treatment center where there is such a dynamic atmosphere. People are working so hard-it's very inspiring to see. But the flipside of that is the incredible pressure of Doctors Without Borders being among the only organizations working on the outbreak. For some time this meant that we had to turn people who we suspected of having Ebola away from our treatment center. Although we were running our biggest-ever Ebola center, we simply didn't have enough space for everyone who needed it. We were and still are expanding as fast as possible, but we can't go any quicker without making the conditions inside dangerous for our staff.
To have to turn people, who are often unwell and desperate, away from the treatment center is terrible. The only thing we can give them is a family-protection and home-disinfection kit-which contains chlorine, soap, two buckets, gloves, a gown, and a sprayer-so at least their family can have some protection from also catching Ebola. But it is in no way a perfect solution and does not allow them to care for their family member at home. In total, we have 50,000 of these kits to give out to high-risk groups and communities in Monrovia.
Ebola virus budding from a cell. Image via the NIAID
There are around 60 international workers and 600 Liberian staff at the center. When I talk to the national staff, they say that they want to do something for their country. We have one young man who drives our survivors home. His shift starts at 2 PM because we don't tend to discharge anybody in the morning. Even so, he always comes in at 9 AM just to help out, even though he isn't being paid-he just wants to be a part of the response, to feel like he is helping.
To cope with situations that seem quite hopeless you need a voice of hope and humanity. Medics can be reminded that, in the face of a situation that looks hopeless, small acts of kindness mean a great deal. Remembering that a decent proportion of our patients do survive can also help our medics. To give patients and staff a visual reminder of this, we set up a white board where survivors can leave a colorful handprint as they leave the hospital. For me, handprints are amazing things, because in Liberia people are constantly being told to wash their hands or not to touch anyone, so it's a powerful symbol. Some of our teams, like the burial team, only deal with the victims of Ebola. They only see death and dying-not our victories and those who survive. They especially need to see that we are making an impact.
Shaking hands is of huge importance in Liberia. Friendships are formed between the doctors and patients, and when a patient whom they got on with particularly well is discharged, you see the medical staff running over to shake their hand. It really creates a wave of positive feelings when you see this.
There is definitely still a stigma around being a survivor. People who live often go home to an empty house because everybody else in their family has died. Communities are often suspicious of them and don't believe they have recovered from the virus.
We usually leave the site about 6:30 PM, and then we have a number of meetings that are usually finished by about 7:30 PM-not too late, but by then your day has been very full. Generally, people are very close. In the evening, we sit together, chatting to one another, having a beer, and eating. At the end of the day most people are so tired that they want a shower, to chat with a friend on Skype, and just go to bed.
I've been back in the UK for two weeks and it's been great seeing my friends and parents-they've been so supportive and though they're obviously worried, I believe they trust me to look after myself and that they're proud of me.
I wouldn't say I was brave. Or maybe it is bravery, but the most important thing in my mind is to look objectively at the risks and decide whether or not you think you could help. But going back to Liberia doesn't scare me-I hope I can make a difference. I definitely want to try.
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