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We took up the fight against Ebola

Following the Ebola outbreak in west Africa last year, UK military nurses joined the international response. Three military nurses who travelled to the crisis zone recall their experiences of working in treatment centres in Sierra Leone to help tackle the spread of the virus.

Workers in Freetown, Sierra Leone, carry the body of an infant who died after contracting Ebola

Picture credit: Getty

Sergeant Kay Ward was preparing to have a leisurely breakfast with her parents, who were visiting for the bank holiday weekend.

The telephone rang. Would she be able to fly to Sierra Leone to help retrieve a British patient with Ebola and escort them home?

‘I’ve been in the military for 13 years and knew of the high risks involved,’ says Sgt Ward, a senior flight nurse at RAF Brize Norton.

‘I also knew I was not compelled to go. But I had done the training, I was ready and I knew we had a job we needed to do.’

This mission was just a small part of the UK’s ongoing military nursing response to the crisis. Since last year, hundreds of nurses and other healthcare professionals have volunteered to work in treatment centres run by charities and non-governmental organisations, such as Save the Children and Médecins Sans Frontières.

When Sgt Ward got the call, the threat from the disease was at its height, with hundreds of cases reported each week (see box, page 22). Media coverage was being stepped up and Ebola was in the headlines.

Ebola facts

Ebola virus disease − previously known as Ebola haemorrhagic fever − is fatal in around 50% of cases. The virus is transmitted to people from wild animals and spreads through human-to-human transmission.

The recent Ebola outbreak primarily affected three west African countries: Guinea, Liberia and Sierra Leone.

In August, the World Health Organization reported there had been almost 28,000 cases of Ebola and more than 11,000 deaths from the disease globally.

Three healthcare workers with Ebola have been returned to the UK and successfully treated by the NHS.

The Sierra Leone outbreak began early in 2014, with a ‘burst’ of cases in May/June; numbers rose exponentially, with the most dramatic jump in November. By September, teams in Freetown were burying up to 30 bodies a day, and by the end of December the country had recorded more than 9,000 cases of Ebola. By May 2015 numbers had fallen to single figures per week, rising slightly in June.

The outbreak in Liberia was declared over on May 9, but the country has since had several new cases. It is waiting to be declared free of the virus again (no new cases after 42 days).

The WHO says outbreaks can be controlled through case management, surveillance and tracing of contacts, a good laboratory service, safe burials and social mobilisation.

No licensed treatments exist to neutralise the virus, but several blood, immunological and drug therapies are being developed.

There is no vaccine, but two potential candidates are being evaluated.

Find out more at tinyurl.com/ctos5wf

In her regular job, Sgt Ward organises missions around the world to repatriate seriously injured UK armed forces personnel, their families or others in need of medical care. The difference with this mission was the need for stringent processes to limit the risk to those looking after the patient.

Sgt Ward had been through Ebola training, including a briefing from the Royal Free Hospital in London, the UK’s prime treatment centre for people with the disease, which was about ‘making sure we were kitted appropriately and followed procedure’.

Having volunteered to undertake the training, she knew she might be called on to leave at any time – even on a bank holiday weekend with family visiting.

‘The flight was about eight hours, and we wanted to ensure we got some rest because we knew that when we got there, we’d have a job to do,’ she says. ‘When we arrived in Sierra Leone, we were on the ground for a couple of hours. We put our kit on and it was very humid.’

Back on board the aeroplane, the team worked a shift system, taking turns to monitor the patient, and drew a line on the aircraft to segregate each shift team.

They took nursing observations and monitored blood pressure, all of which took much longer than it would under normal circumstances, and also chatted to the patient and kept him fed and hydrated.

Sgt Ward says: ‘We just got on with it, but I did have to pinch myself to think I was on that very first mission. It is really reassuring that everyone – health workers, government and military personnel – has been prepared to do this. It has been an excellent and prompt response.’

The British response has involved on-the-ground efforts as well. Last November, ministers announced the opening of a treatment centre at Kerry Town, just outside the Sierra Leonean capital Freetown – the first of six Ebola treatment centres built by the UK in the country.

Treatment unit

Part of the Kerry Town complex is a 20-bed centre staffed by British Army medical and nursing personnel. On December 20 last year, Lieutenant Colonel Maggie Durrant arrived in Sierra Leone to take up a senior nursing officer post at the centre.

As a reservist, Lt Col Durrant was not obliged to volunteer for this tour, but when she was asked as part of an initial telephone trawl to find people willing to go, she gave a qualified yes. ‘I said I would happily go, but I wanted to go in a role appropriate to my rank,’ she says. ‘I wanted my full skill set to be used, so that meant going in a command-type role. I was not sure whether that would make it more or less likely that I would be chosen,’ she laughs.

In the event, Lt Col Durrant left behind her permanent job as service improvement facilitator at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in Shropshire to run the 20-bed unit in Kerry Town, managing 76 nurses and medics (a term used for assistants).

The people were so grateful for every tiny thing you did

– Lt Col Maggie Durrant

‘I had been deployed to Iraq and Afghanistan but this is a different level of risk,’ she says. ‘It’s an unseen enemy; it requires a different sort of vigilance.

‘Even from a professional perspective I was thinking “this is big”. There was a real concern that it could get out of hand. If we didn’t do something about Ebola, then it could come to Europe.

‘Like everybody, I had a level of nervousness, but I think that’s a healthy approach. A level of anxiety keeps you on your toes and makes you vigilant.’

Lt Col Durrant’s role mainly focused on personnel management, she says. Most members of her team were from the UK, but some were from Canada.

Even with high-quality equipment, the environment was difficult. ‘It was hot, humid and tiring, so the shifts were relatively short – a maximum of seven hours,’ she says. ‘The protective clothing was the best we could get; we had disposable aprons and the visors were light and didn’t mist up. But it’s always going to be hot and you have to accept you’re going to sweat.’

Given that Ebola was endemic in Sierra Leone, staff at the centre had fairly restricted lives even when off duty. ‘We were allowed to go out for a run, but only in groups of three,’ she explains. ‘We had limited contact with local people.’

Tours of duty were limited to 60 days of operational work so that people did not fall into bad habits, but maintained the strict, life-saving infection-control procedures.

The timing of Lt Col Durrant’s deployment meant she was away for Christmas, something that her family, including her teenage son and daughter, took philosophically, she says. ‘We celebrated four weeks before – the whole works, with extended family and everything.’

Her children took their cue from her, she says, and did not appear to be unduly anxious about her safety while she was away. She found out afterwards, however, that her 14-year-old son did not tell anyone she had gone, and it was only after she came home that he would talk about it outside the family. ‘I think there was an element of pride there,’ she says.

The highlight for her was undoubtedly the Sierra Leoneans. ‘The warmth of the people was wonderful, and the welcome they gave us. They were so grateful and appreciative of every tiny thing you did; it was humbling.

Sgt Kay Ward was part of the first mission to bring a British patient with Ebola home

Picture credit: Crown Copyright

‘It was the first time I’d been to Africa. I’d seen it on TV and knew about the poverty but when you see it first hand, it really hits home.’

The military also organised back-up for the teams on the ground, in the form of emergency teams deployed by helicopter.

Leading Naval Nurse Gareth Bott, an emergency specialist nurse usually based at Derriford Hospital in Plymouth, was stationed off the coast of Sierra Leone on RFA Argus, a primary casualty receiving ship.

He was part of a three-person crew, comprising a doctor, nurse and assistant, that responded to emergencies.

‘We were there as insurance for the guys working in Sierra Leone,’ he says. ‘Some of the outposts were a six or seven-hour drive away, but in the helicopter we could get there within the golden hour to provide a critical care service.’

Family concerns

He spent six months away from his two sons, aged five and 11, between October last year and April this year.

‘I think my parents are always worried,’ he says. ‘But I’ve been in the navy for 21 years, so I’ve been away a lot. It’s just what I do.’

Nevertheless, the posting has had a lasting effect. ‘Since we left I have still been checking the numbers of Ebola virus cases every couple of days. I know it is not won yet, but at least we know the numbers are down from the hundreds we were seeing last year.

‘I have served in Afghanistan and Iraq, and you know what the dangers are. With Ebola it is completely different. The thought of it is quite scary, and it has to be in your mind.

‘But you have to trust in your training, and in the people you are working with. We visited Kerry Town and it was comforting to see how well it was run’.

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