Northland DHB Doctor Returns From Midst of Ebola

Northland DHB Doctor Returns From Midst of Ebola

After spending three months helping in a country overwhelmed by the largest Ebola outbreak ever known, Northland DHB’s Dr Clair Mills says there’s much more she could’ve stayed and got on with.

But the medical officer of health’s three-month commitment in Sierra Leone, West Africa, had come to an end and, with the number of cases of Ebola declining significantly, a tired, yet energised Dr Mills returned to her home country to reunite with friends and family.

“I had about one day off the whole time. It was busy and very challenging - but overall very satisfying and energising too.”

Dressing area of Kailahun Ebola management centre. Two hygienists are getting ready to enter the high-risk zone

Dr Mills left for Sierra Leone in November to take on the job of medical co-ordinator for Médecins Sans Frontières (MSF or ‘Doctors without Borders’, a medical humanitarian organisation), for three months. MSF ran three Ebola treatment centres in different districts, as well as a training project to upskill staff from other organisations, and surveillance and health promotion teams in the capital Freetown and a fourth district.

Ebola is a viral infectious disease with a high mortality rate and no specific treatment, marked by fever, vomiting and diarrhoea and bleeding. It is spread through contact with infected body fluids, so looking after sick family members or carrying out traditional funeral rites place people at high risk of infection.

Last year West Africa suffered the largest and most wide-spread epidemic of the disease in history, with reported case fatality rates of up to 70 per cent. Since the first case reported in Guinea in March 2014, the virus has infected over 25,000 people across the region. Over 10,000 deaths have been reported. At its peak (September-November 2014) in Sierra Leone there were 450-600 reported cases a week with patients travelling from far and wide to seek treatment. To date, there have been over 12,000 confirmed and suspected cases in Sierra Leone and 3831 people have died from the disease. However, this data is likely to significantly under-represent the true number of cases and deaths.

Before leaving, Dr Mills, who has worked for Médecins Sans Frontières (MSF) and other humanitarian organisations for over ten years, said: “This is a major public health crisis and Sierra Leone is a very poor country with few resources to deal with it. They need support from us.

“It’s a country that’s come out of a decade of civil conflict. It’s got a life expectancy of about 50. A lot of the population lives on less than $1 a day and certainly this (the Ebola outbreak) has had a huge impact on the health system.”

Arriving in Freetown, Sierra Leone at the end of the rainy season, Dr Mills describes it as ‘hot and wet’.

“You sweated bucket loads when you got into PPE (personal, protective equipment) and went into the high-risk tents.

“For my colleagues working shifts in the Ebola treatment centres, it was very physically and emotionally exhausting. The high death rate, the overwhelming numbers of patients, the lack of effective treatment - and obviously the personal risks of being infected yourself - made it extremely challenging.”

By December 2014, the number of cases began to drop and by the end of February 2015, the make-shift clinics could begin to close. Dr Mills says the reduction was due to a combination of reasons.

“From mid-December there were, finally – if not too late - plenty of treatment centres available with reasonable quality treatment. There was also a lot of public health work with basic contact-tracing, community engagement and other interventions imposed by the government, such as travel bans and quarantine of contacts. People were also mostly following safe burial practices, rather than the traditional rituals of washing and touching the body.

“There has been a lot of energy put into improving co-ordination in the last few months and, as cases fall, everything works better. There is less stress and demand. As soon as a new case is identified, health workers can get on top of it straight away.”

However, despite the country having a better handle on Ebola now, the repercussions will be long-lasting, says Dr Mills.

“Managing the transition back to some kind of normal is the next challenge. Sierra Leone had only just over 100 doctors and has lost ten per cent of them to Ebola, plus hundreds of nurses. Some health centres have closed because health staff have died, so it’s a very difficult situation. Most health facilities have no running water, less than 20 per cent of health facilities we visited had working vaccine fridges, and waste management is appalling, so infection control is a major issue. Even now, health staff are continuing to get infected.

“Plus, of course, there are big health problems. There is very high maternal and infant mortality, endemic malaria, there has been a major measles outbreak as vaccination has been very low for months, lots of unplanned teenage pregnancies as all the schools were closed, and malaria, lassa fever cholera etc.”

Upon returning, Dr Mills monitored her temperature for three weeks and remained well. She says being back home has taken some adjustment, although it has been ‘great to catch up with friends and enjoy the lovely weather’.

“It’s reinforced for me how privileged we are in New Zealand. We have a fantastic health system but we too could have been born in West Africa. I feel the only way to stop these epidemics is to go there and stop it. Had international organisations like WHO and CDC reacted more quickly, many deaths could have been prevented and the outcome would have been much better.

“I was a bit sad to leave. There are still many things to do.”

ENDS

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