Helen Azzopardi, Microbiology Laboratory Manager based at St Mary’s Hospital, left the Island on 19th February to spend five weeks working at an Emergency Treatment Centre in Makeni. Working to very stringent health and safety protocols, Helen worked in a field laboratory designated as low risk. After Helen returned to the Isle of Wight, she had to wait three weeks before the infection risk of Ebola had passed and has been declared fit to return to her day job at St Mary’s.
Helen has written an article about her experience of what she calls a very cruel disease, in which she speaks first-hand about the emotional impact of caring for those affected by Ebola. She talks of how she was inspired by the resilience of the families she met, and reflects how we should value the resources available in this country.
“I am very grateful to the Trust for letting me volunteer in Sierra Leone. I’ve brought back so many skills which I hope will also be useful here. It really makes you think differently about the NHS, we are so lucky to get access to medical treatment as people there really have very little.”
In her own words, Helen’s recollection of her time at the Ebola Treatment Centre is below.
My name is Helen Azzopardi and I am the Head of the Microbiology Laboratory at St. Mary’s Hospital.
Like many people, I had been following the harrowing news of the outbreak of Ebola in West Africa in 2014 and was moved by the terrible images of people suffering from the virus. In October 2014, I decided I needed to do something to help these people as I had the skills and experience required to work in a field laboratory. I volunteered with UKMed and Public Health England (PHE) and was selected to work as a Team Leader in a PHE laboratory in Makeni, Sierra Leone. A week’s intensive training followed at Porton Down in January 2015 and I was ready to go. In February I was contacted by International Medical Corps (IMC), a charity funded by the UK Government’s Department for International Development (DFID), and informed I would be deployed from 19 February to 25 March 2015, so on 19 February I left the well-equipped Microbiology Laboratory at St. Mary’s Hospital and my Island home on the start of my journey.
On Friday 21 February, I worked my first shift at the Mateneh ETC in Makeni. This was the first time things felt real and the enormity of what I was doing hit home. I confess to feeling more than a little scared. At the entrance, I washed my hands with bleach, a guard sprayed the soles of my shoes with bleach, another guard took my temperature and I was asked how I was feeling. When all the checks had been completed, I was allowed through. My life at the ETC had begun.
The ETC is split into zones depending on the risk level: white zone (indeterminate risk), green zone (low risk) and the red zone (high risk). The red zone covers all patient areas and full personal protective equipment (PPE) must be worn at all times. Due to the heat, the time staff can spend in this area is restricted. The laboratory was situated in the green zone adjacent to the triage area where patients were admitted.
The laboratory was setup and run by PHE with volunteer staff from PHE laboratories, research laboratories and the NHS, and the team to which we had been assigned would be our family for the next five weeks.
After changing into scrubs and white wellington boots, I was escorted with my team to the laboratory and introduced to Team 3, who we were replacing, and who would be leaving in a few days. We changed from boots into clogs, and donned more layers of PPE (two pairs of gloves, eye protection and a surgical gown) and Team 3 showed us round the lab and gave us a quick induction. We then started work under supervision so we would be up to speed before Team 3 left. We were informed that it had been very quiet with only 11 patients in the ETC at the time……then it all changed.
Ambulances full of suspected cases started to queue outside the laboratory. One ambulance carried a lady in labour who had been refused admission to her local hospital, as all the maternity units were closed and staff were frightened she might be an Ebola risk. There was nowhere else for her to go so she was brought to the ETC. She delivered her baby boy in the ambulance containing four suspected Ebola patients, outside the laboratory. Not the best start in life.
The laboratory processed samples from Bombali and Koinadugu districts, and the ETC. Most samples from the community were swabs taken from the deceased to check whether they had Ebola. The rate of infant mortality was shocking with many samples from babies and young children. For ETC samples, a hard copy of the results was taken to the medics so there was no delay in the results being acted upon. Every step of the testing process involved a double checking system to ensure no errors had been made. Misdiagnosis of Ebola, whether positive or negative, was not an option.
The first shift I worked was due to finish at 22:00 when the laboratory closed, however, we were still there at 23:45. I was later to discover that this was the start of a spike of cases from a single village which was to be devastated by the disease. Team 4 were going to be very busy.
A young man had absconded from an Ebola holding centre in Freetown. He had been in contact with confirmed cases from the fishing region of Aberdeen, and had returned to his family home in the village of Rosanda near to the ETC in Makeni. As no medical facilities were open, his family called on the services of a traditional medicine man. Sadly the young man died.
Death is as important as life in Sierra Leone, and the rituals which prepare the deceased are elaborate and very alien to us. Part of the measures the Sierra Leone Government had implemented to halt the spread of Ebola was to prevent unsafe burials by sending burial teams to deal with every death. However, this goes against traditional beliefs and practices and unsafe burials were still going on when I left. The family did not notify the authorities that this man had died and performed a traditional burial. As he was a popular man, the entire village turned out for his funeral. Family and friends washed his body, and children played in this run off water, whilst other villagers drank this water. The resulting Ebola outbreak claimed the lives of 46 villagers including the medicine man and the young man’s parents. Over 80 villagers were admitted to the ETC which had so many confirmed positive cases that they had to move some into the convalescent ward. At the same time, a teenage boy had been taken ill in Kerry Town. His parents sent his 16-year-old brother to bring him home and he subsequently nursed his sick brother until he died. The brother, mother, father and other siblings were admitted to the ETC and only the 16-year-old survived. I was there when he was well enough to be discharged, but he had lost everyone he loved, so it was bittersweet.
The hardest thing to see was the children who were admitted to the centre. Until my forth week there, no child under 14 had survived. We would see the children playing or being fed or cuddled by survivors outside the suspect wards before they disappeared. One evening, I had to give the medics a positive result on a two-year-old girl from a local orphanage whose parents had already died at the ETC. On the way back to the laboratory, I saw this beautiful little girl I had just reported as positive being carried from the suspect to the confirmed ward and heard of her death a few days later.
It is a very cruel disease. Burials in Makeni were controlled by the District Commander and performed by the burial teams who collected the deceased from the ETC in full PPE. It was a sobering sight. To celebrate the release of survivors from the ETC, their hand prints were left on the ‘Wall of Hope’ and a big celebration involving all the staff would take place with singing and dancing. A local rapper who had been a patient at the ETC had written a song and it became the ETC survivor anthem. I think the celebrations were as much for the staff as the survivors, who were still very unwell.
So, what shall I take from my time in Sierra Leone? Mainly that the local people are incredible. They have so little and have been through so much, yet their resilience is an inspiration. Electricity and running water are resources many do not have, and we should value them and use them wisely. I now know what it feels like to be waved at like a celebrity everywhere I go, and have children running after me calling “Apato, I love you!” I also met some amazing people whose bravery is truly incredible. My team were fantastic and I hope we will keep in contact.