Health Care Workers in West Africa

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An Ebola survivor working at the child care center at the N'zérékoré, Guinea, ETU managed by the Alliance for International Medical Action (ALIMA). Photograph by Martine Perret, UNMEER

Before the Ebola outbreak, Guinea, Liberia, and Sierra Leone already had severe health care worker shortages. Early in the Ebola crisis, health care workers treating people with Ebola were some of the first to lose their lives. Responding to an urgent call at the peak of the outbreak, health care professionals from around the world volunteered to work in ETUs alongside local health care workers. Most international volunteers worked for six-week periods, while local staff were in the field for much longer periods of time, risking their lives to serve their communities.

Confronting Ebola was a relentless endeavor, physically exhausting and mentally demanding.  Workers treated patients in stiflingly hot conditions wearing PPE that could only be safely worn for an hour at a time. Many workers felt responsible for the deaths of patients, witnessed tremendous human suffering, and saw many of their co-workers die. Exhausted workers bravely and tirelessly stepped up and continued to tackle the outbreak each day, despite facing stigma and fear in their own communities. Local health care workers were the backbone of the effort to eliminate Ebola.

Those who recovered from Ebola were likely to be immune to the disease, although many were subject to intense stigmatization. Consequently, many survivors worked in treatment and healthcare centers. The Ministries of Health, with support from partners, headed up training of local healthcare workers assigned to ETUs. The Ministries also set up systems to train healthcare workers in non-ETU settings.

CDC’s Anniston Training

From September 22–24, 2014, CDC coordinated the first of several 3-day experiential courses for U.S. healthcare workers headed to West Africa. The U.S. Federal Emergency Management Agency (FEMA) Center for Domestic Preparedness in Anniston, Alabama, hosted Preparing Healthcare Workers to Work in ETUs in Africa. The CDC syllabus built upon information from courses already developed by MSF and WHO. CDC staff and clinicians from other agencies with on-the-ground experience taught the training, which covered critical areas of infection control, ETU patient flow, and the delivery of care in the safest possible manner.

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Preparing Healthcare Workers to Work in ETUs in Africa training, Anniston, AL, November, 2014. Photograph by Jim Gathany, CDC

Donning and Doffing the PPE: The “Buddy System”

The Anniston training was hands-on, including the experience of donning and doffing (putting on and taking off) PPE (personal protective equipment). To practice what to do and how to do it safely, participants performed patient care activities while wearing PPE. Training also focused on repeated practice using the buddy system: health care workers walked each other through each step of the donning and doffing process. The buddy system ensured that the procedure was done properly, and that the gear covered every part of the body from head to toe, helping to prevent the chance of inadvertent exposure to body fluids.

Meticulously donning and doffing the PPE was a sobering experience. In the field, PPE worn by health care workers almost certainly had fluids on it from infected patients. PPE removal is considered an extremely high-risk activity. Each protective item needs to be shed in order, following very specific procedures. A hot, tired clinician who just finished working a shift in an intense environment still needs to remove the PPE methodically and carefully. This part of the Anniston training provided a taste of the challenges and risks health care workers faced in the field, which gave trainees a huge appreciation for the seriousness of this type of preparation.

This video provides a brief demonstration of donning and doffing of Ebola PPE. Source: NHS Forth Valley, 2015. 

McCarthy, Helena

Helena McCarthy

Helena K. McCarthy community health nurse at Kenema Government Hospital, briefly recalls a part of her training that covered PPE. 

Alpren, Charles

Dr. Charles Alpren

In this audio clip Dr. Charles Alpren describes the intimacy of caring for someone while wearing PPE.