Dec 01, 2014

MSF in West Africa

Médecins Sans Frontières/Doctors Without Borders (MSF)Donning personal protective gear in an MSF Ebola treatment centre. A mirror reminds workers to check for any holes or openings.

Médecins Sans Frontières/Doctors Without Borders (MSF) has about 3,400 international and locally hired staff working in Guinea, Liberia, Sierra Leone and Mali. It operates Ebola case management centres and provides approximately 600 beds in isolation units in these regions. Anne MacKinnon, RN, BN, an MSF Canada board member, describes the challenges of this mission.

Are colleagues asking you how they can help?

I get lots of questions about volunteering in the field. And it’s not just nurses who ask. About half of MSF’s field workers are non-medical staff — we call them “logisticians” — so I have also been approached by people who aren’t health-care providers, such as water/sanitation specialists, administrators and mechanics.

One really important way that nurses can help is by making sure that public perceptions about Ebola are accurate. I think many people are worried about what will happen if Ebola comes to Canada. Public education is a big part of what we need to do, so nurses need to be knowledgeable about the disease and the risks.

What is your assessment of the global response to the outbreak?

The response has been slow and remains inadequate. MSF is leading on the front line of medical response in this historic humanitarian challenge, but others have to step up. For months the organization has been asking governments and NGOs for additional financial resources and personnel. MSF Canada is receiving much-needed individual donations because of the level of public awareness of the situation, but more financial and human resources are needed on the ground now.

You were part of an MSF mission in Liberia in 2011. What are you hearing about the effects of the outbreak in that country?

Liberia’s health-care system is in crisis. Its health-care workers are forced to stop work when they fall ill. People are dying from illnesses like malaria and diarrhea as health centres close. Some avoid seeking care for fear of contracting the Ebola virus. Local economies are adversely affected because people aren’t leaving their homes. The travel and trade repercussions for the entire country are huge.

What’s different about this MSF mission compared to previous missions?

This is an unprecedented epidemic, so we are all learning and adapting along the way. This mission is a wholly different experience. The selection process for field workers and the training required for the demanding work and difficult conditions are quite rigorous.

You are in the field for only about four to six weeks; a typical MSF mission is anywhere from six to 12 months. When you’re wearing the protective gear, you can work an hour at a time at most. Temperatures reach 50 degrees inside the suit.

The actual care nurses are providing is basic, but it’s draining emotionally and physically. I’ve heard from some nurses who struggled because they had very limited physical contact with patients and with one another. Those personal connections are missing and that takes a toll.

And you’re seeing so much fear and death. Without treatment, there’s a 90 per cent chance a patient will die. With timely treatment, that only goes down to 50 per cent.

It seems to me that there’s more stigma attached to this mission. Volunteers are being asked why they are even going to West Africa, and afterwards family and friends are concerned about coming into contact with the virus themselves and aren’t as supportive as they would be normally be. Stigma is a major issue for our locally hired staff.

What psychological support is available to field workers?

The support starts before the volunteer leaves. MSF has peer support volunteers who connect with you before you go. It’s an excellent program. We have psychologists working in the field, and we also offer remote access to psychologists in major centres. Once you get back, those services continue. We’re certainly seeing many more calls for psychological services and support. Our missions have never been more challenging; of course, some of the other humanitarian crises in the world, like those in South Sudan and the Democratic Republic of Congo, aren’t in the headlines right now.

There have been stories in the news about volunteers being quarantined when they return…

We’re seeing people cut short the length of time they’re in the field because of the possibility of forced quarantine. I’m sure it’s keeping others from volunteering at all.

Evidence shows that quarantine isn’t indicated for our volunteers, but our protocols are designed to keep the public safe. Those returning from Ebola-affected countries are expected to carefully monitor their health, and we discourage them from going back to work during the 21-day incubation period. They have to check their temperature twice a day, finish their regular course of malaria prophylaxis, and stay within four hours of a hospital with isolation facilities.

What message do you have for those who might be thinking of volunteering?

As a field nurse, I had a lot of faith in MSF protocols, staff and operations. That confidence allowed me to focus and be able to do my nursing work. West Africa is in dire circumstances. The skills you have may be the skills MSF needs. For more information or to make a donation, go to

RN joins Red Cross team in Sierra Leone

Canadian Red Cross

Toronto-based RN Kirsty Robertson has worked in conflict zones in Syria, managed a team of 100 nurses at a cholera treatment centre in Haiti and learned to treat tropical diseases in the jungles of Ecuador.

That level of commitment to global health is the reason she felt compelled to take on her latest assignment. “If we were to triage global health at the moment,” she says, “West Africa is a glaring code one emergency, and I want to use my skills as a nurse to contribute however I can.”

Robertson arrived in Kenema, Sierra Leone, on Nov. 8 to begin work as a ward nurse at the Red Cross Ebola treatment centre. “Containing this epidemic should be a priority,” she says, “not just to help the people in West Africa, but also to help protect everyone else, including in Canada.”

Her two-month assignment started with intensive training, prior to deployment, on Ebola treatment and on the important safety precautions she would be taking while in West Africa. The experience helped boost her confidence: “Learning from people who succeeded at doing something really important, and who remained healthy themselves, was incredibly helpful and reassuring.”

Robertson encourages other nurses to consider responding to the Red Cross appeal for ward nurses, who are urgently needed to support the West Africa Ebola response.

Faces of Ebola response

Meet some of the nurses working on the front lines to contain the Ebola outbreak in West Africa.

“We appreciate the training because it helps the health workers. At first we were afraid, but now enough equipment is coming that we will not be afraid. I need to work for my country. I have the know-how, so I have to volunteer.” – Linda Harding, community health nurse, Sierra Leone

WHO/N. Alexander

“So many of them are not aware of Ebola. We have to teach them door-to-door, explain to them certain things so they know Ebola is real.” – Nurses Memuma Mansaray (right) and her daughter Huwanatu Caulker were part of the teams going door-to-door in their own neighbourhood in Freetown, Sierra Leone, explaining Ebola prevention information.

WHO/N. Alexander

“When I started to have symptoms and heard about the results of my blood test, it was a very difficult moment. I was really afraid for my life. There were some rumours about the origin of the disease, but once people saw that even health workers like myself were infected they trusted us more.”” – Mohammed Issa Cisse, nurse and Ebola survivor, Telimele, Guinea

WHO/C. Black

Courtesy of the World Health Organization

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