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Nursing in the war of Ebola

Red Cross
Photo: Libby Bowell in Liberia. Image: Victor Lacken/IFRC
Libby Bowell was walking to the supermarket when a woman collapsed in front of her.

As a nurse of 30 years, normally Libby would stop and render assistance.

But, in Liberia at the moment, these are far from normal circumstances.

“As a nurse I couldn’t touch her - you just can’t break the rules, and I found that really hard,” she says.

“You have to keep that distance and try and get the ambulance to that person.”

The deadly Ebola virus is reported to have killed at least 2000 people in Liberia, and the World Health Organisation (WHO) estimates the death toll has risen to more than 4500 people from the 9000 infected in West Africa.

Libby returned from Liberia last week, where she worked as an emergency health coordinator for the International Federation of Red Cross (IFRC) and Red Crescent Society for five weeks.

Libby has previously worked for the Red Cross in deployments to South Sudan and Sierra Leone for cholera outbreaks, in the Philippines in the aftermath of the typhoon, Haiti following the earthquake, in Papua New Guinea and in the Solomon Islands, and in Aceh in the wake of the tsunami.

Now in isolation for 21 days at her home in Newcastle, New South Wales, Libby rates her experience in Liberia as one of the toughest deployments she’s encountered as an Australian Red Cross aid worker.

“It’s tough because it’s still escalating, it’s not going away and it’s catastrophic really,” she says.

“It’s a war of disease and it’s like cancer - it doesn’t discriminate.

“It’s not a poor person’s disease, I’ve seen experts die. It’s from the top to the bottom and everyone in between.”

Libby’s role in Liberia did not involve any direct patient care.

Instead, she worked to support the emergency response for the Liberian Red Cross.

Libby worked with the dead body management team and assisted in developing and introducing a new strategy to teach communities how to safely care for Ebola-infected family members unable to access one of the limited number of treatment beds.

“It meant changing tactic from the ‘no touch’ technique to the ‘touch with care’ technique,” she explains.

“That was teaching them about isolating the person immediately in the community and only having one caregiver because in Liberia it’s very culturally normal to have all of the family wanting to provide care for the sick family member.

“That was quite a big change for us but something that had to really be taken on.”

In communities battling Ebola, people’s lives have been put on hold.

Libby says children no longer attend school, public meetings and football matches have stopped, and people refrain from going to the gym, shopping or meeting friends.

She says fear of Ebola is rife, as is the stigma attached to those who contract the disease.

“One day, I saw a couple of kids immediately after their mother died,” she says.

“Their father had already died and then I saw their mother get taken out in a body bag.

“I just saw an eight-year-old boy holding his one-year-old sister and everybody in that community was several metres away from them.

“There’s a lot of Ebola orphans now and you’ve just got to hope that the community supports them and looks after them.”

While Libby was mostly involved in high level government and partnership meetings with stakeholders, there was no escape from the grim reality of Ebola.

“I was at a meeting at the Ministry of Health one day when I saw a dead body get rolled out of a taxi just because there were no beds,” she says.

“In the last two weeks I was there, I had to go into the Ministry of Health headquarters for meetings and two people - a chief medical officer and another person from the Ministry of Health - died from tables that I’ve been sitting at, and the floor that we met on was closed and quarantined.”

Libby says one of her Liberian colleagues, with a similar nursing background, had lost 16 friends, colleagues and mentors.

“She’s lost a medical director, she lost an anaesthetist, she lost several nurses, she lost physician assistants,” she says.

“Liberia only had 100 doctors, they are down to about 85 doctors now.

“What they are going through on a daily basis is very confronting and something that we couldn’t even imagine.

“They get up and go to work every single day because they believe that they have to make this horrible thing go away - they can’t hide from it at all.”

While WHO has now declared Senegal and Nigeria both free of Ebola, it’s also warned there could be as many as 10,000 new infections a week in West Africa before the end of the year.

Libby says more health professionals are desperately needed on the ground to help halt the spread of the disease.

“We need to help them. It’s a global emergency,” she says.

“If you’re seriously thinking about going, have the conversation with your family and think there is a risk involved, for sure, but the rules and the guidelines around it are very strict and you’re very well supported while you’re there.

“If you’re not going to go, then that’s fine as well, but find another way to support (the fight) because it takes a lot of money.”

Libby, who works as the director of education at CRANAplus, the peak body for remote health practitioners, says she’s exhausted from working 15-16 hour days, seven days a week, throughout her five week stint in Liberia.

Otherwise, she’s healthy and has no concerns that she will contract the infectious disease.

“It’s a risk but it’s a low risk because I followed very, very strict guidelines,” she says.

“I moved about in the community but you wash your hands in a chlorine-based solution at least 20 times a day, you have your temperature taken at least half a dozen times a day, you keep this distance between yourself and other people.

“I haven’t shaken a hand, I haven’t hugged a person, I haven’t kissed a person and I will keep a pretty low profile.”

Libby wants the mass hysteria surrounding the disease to stop.

“You’re not contagious unless you are symptomatic and if you’re symptomatic then you know you’re symptomatic,” she says.

“I don’t for one minute feel like I’ve got Ebola - I’m not sitting and worrying.

“I would be lying to say that I didn’t have at least one Ebola dream because you do, everybody does when you’re there and it’s usually after you’ve seen something that’s pretty confronting.

“It just gets in your head and then you get it out and keep going.”

For Libby, there’s been an element of “flatness” in coming home.

“It’s a reverse culture shock,” she says.

“You don’t want to leave these sort of places - there’s still so much to be done.

“I know that I helped - it’s about standing side by side with them and divvying up the work and taking some of the load off them really and that’s what’s important.

“Was it the right thing to do? For sure. Would I go again? Yeah, for sure.”

Donations to the Australian Red Cross Ebola Outbreak 2014 Appeal can be made here or by calling 1800 811 700.

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords