Ambulance Training in Magburaka
By: Renée Zandvliet, Programme Quality Manager, October 2014
“OK, you have just received a call to pick up a suspected Ebola patient, an elderly woman who is vomiting and clearly very sick. What do you do?”
Angela Dunn, an Epidemic Intelligence Service (EIS) Officer with the Centre for Disease Control and Prevention (CDC), looks at her small audience of drivers and nurses, manning the four Ebola ambulances run by the District Health Management Team in Tonkolili District, Sierra Leone. Angela is facilitating a one-day training organised by Concern Worldwide with funding from DFID through the Ebola Response Consortium (ERC). The drivers and nurses learn how to use Personal Protective Equipment (PPE) and stay safe when they pick up and transport (suspected) Ebola patients. Although most of the information is new to the four nurses — Mariatu, Hellen, Kadiatu and Isata — some of the ambulance drivers have been doing this work for weeks already — and fortunately some have benefitted from previous trainings.
Idrissa Conteh (26 years old), for example, was asked a couple of months ago to work as an Ebola ambulance driver. Idrissa already had experience working as an ambulance driver and was keen to make his contribution to the fight against Ebola. Although his family begged him not to take the job he accepted. “I explained to them that this is my country and I want to fight for my country. I work for my nation” he says. He was trained for two days on the usage of the PPE before he was sent to pick up his first patient. Idrissa and his colleagues don’t only collect suspected patients from their homes to bring them to the holding facility at the Magburaka Government Hospital, they also take confirmed Ebola patients from the holding facility to any of the Ebola treatment units in the country. “I have been to the MSF treatment centre in Kailahun at least 10 times in the last couple of weeks” he says.
“I explained to them that this is my country and I want to fight for my country. I work for my nation”
Reactions in his community have been mixed, he says. “There are people in the community that respect me, but there are also those that are afraid to even talk to me.” His two young children, a boy and a girl, know about his work and often tell him to be careful.
“I put everything to God,” Idrissa says when asked if he often worries, “and I do everything I can to prevent infection. So I have confidence.”
Idrissa says he feels confident using the PPE and he says he knows how to talk to distressed patients: “Some patients resists and need a lot of encouragement. Some even think we are killing them. So I always take time to explain it is not like that.”
Until a few months ago Idrissa’s colleague and friend Abdul R. Kamara (34 years old), a father of two, was an ordinary mechanic and ambulance driver at Masanga hospital, not far from Magburaka. But then the first case of Ebola was reported in Sierra Leone and following a number of suspected cases the hospital was closed for three months and the expatriate staff evacuated. Today Abdul is still an ambulance driver, but he is also an Ebola survivor.
Shortly after the hospital in Masanga was closed, the Government Hospital in Magburaka, the district headquarter town, requested to use one of the ambulances of the Masanga hospital for the Ebola response. Abdul agreed to join the Government Hospital “because of the suffering of the nation.” There was no ambulance for picking up Ebola patients in Tonkolili and Abdul became the district’s first Ebola ambulance driver.
Like Idrissa, he received some days training, was provided with PPE and was sent to collect his first patient: “My first patient was an old man from Malal Mara chiefdom. He died in the Magburaka Government Hospital even before his positive Ebola test results came back.”
Surviving Ebola
A few weeks ago Abdul was sent to the MSF treatment facility in Kenema (an eight-hour drive) with 10 patients. “They were very sick,” he remembers, “they were vomiting and had diarrhoea.” Accidentally some of the bodily fluids entered the driver’s cabin of the ambulance. When Abdul later cleaned the driver’s cabin (not wearing PPE), he thought the dirty water was just water he’d used to wash his face.
A few days later Abdul started feeling unwell and though he didn’t think much of it then he alerted the doctor at the Magburaka Government Hospital. He was given treatment for malaria but soon started to feel weaker and weaker. He was then admitted, isolated and tested. “The results came back two days later, on Sunday. By then I had started vomiting too. The doctor was afraid to tell me that the test results came back positive as he didn’t want to discourage me. I was feeling very weak, but kept confidence. I was given pain treatment and something to stop the vomiting and diarrhoea, and on Monday I was taken to the treatment centre in Hastings, in Freetown. I spoke to my wife, my mother and my two children on the phone but at some point I had to switch off my phone because they were only crying.”
Abdul says he was treated well at the Hastings facility. He was fed four times a day and given intravenous therapy. “After six days I started to feel better and was walking again. They tested me again and the results came back negative. I was so happy; it was one of the happiest days in my life. I met so many people there who didn’t make it. Two other ambulance drivers died in there but thank God I recovered. I was moved to the ‘recovery ward’ and five days later to the ‘final recovery ward.” On a Sunday, Abdul and the other patients in his ward were informed they would be discharged on Tuesday. “We danced and sang all Monday night” Abdul says, as he smiles.
Abdul was provided with a towel, new clothes, flip-flops, soap, food items (rice, beans, oil and corn flour), soap and Le 50,000 (approx. EUR 8.55). He was told he is probably immune but should still use PPE to avoid re-contracting the virus and transmitting it to others. He was advised to abstain from sexual intercourse (without a condom) for a period of three months as the virus can persist in semen for weeks in Ebola survivors. Abdul was picked up by one of his colleague ambulance drivers at the Magburaka Hospital.
Today Abdul feels fine and is back driving an Ebola ambulance: “I had agreed to help the nation by driving the Ebola ambulance and that’s how I got the virus. But if God made me recover I need to go back to work, otherwise I would be ungrateful. So I came back to work, even though some people advised me not to.”
Spread the Message to End the Virus
So what does Abdul think needs to happen to end the Ebola outbreak in Sierra Leone? “The only thing is that we as Sierra Leoneans need to come together and help ourselves. So if someone is sick people need to report to the hospital. We should not touch or wash any dead bodies. We really need to stop that. Also, if there is any sensitisation, I think we need to be involved as survivors. I now tell people that I am an Ebola ambulance survivor. We need to go out and spread the message and I think people will listen to us.”
Abdul says there are still many fears and misconceptions. “Some people think they will be injected or poisoned with food at the health centre. Some patients think I come to kill them with the spray we use in the ambulance. I explain to them that that is a lie, that we just use it for cleaning after picking up different patients, some of whom may be positive, some of whom may be negative.” He thinks that as more discharged patients or negative suspected cases return to their communities, people become more likely to report suspected cases.
As more discharged patients or negative suspected cases return to their communities, people become more likely to report suspected cases.
Does Abdul have any final message for his fellow Sierra Leoneans?
“If anyone is sick, they need to report to the nearest hospital. It doesn’t mean that they have Ebola, but if it is Ebola you shouldn’t wait too long. If you wait until you start vomiting and have diarrhoea, it may be too late. If you report it early, it increases your chances of recovery.”
