Tropical Diseases

South London is incredibly proud to have Dr Ling Harrison as one of our post-CCT Emergency Medicine Doctors. Many know Ling – she has been featured on 24 hours in A&E (when it filmed at Kings), and has worked with many of us. Her experiences of working in Sierra Leone put the current “crisis” in UK emergency care into perspective, and we have a huge amount of respect for her, and fully support all of her work – Charlotte Davies

Whenever I hear the word Ebola it brings a lump to my throat and a slightly sickening feeling in the pit of my stomach. November 2014 I spent working with the King’s Sierra Leone Partnership, a global health charity affiliated to King’s Health Partners and King’s College London, at the Ebola isolation unit at the Connaught Hospital in Freetown, Sierra Leone. I have worked with the hospital for the past two years as an emergency physician developing emergency services, but based in the UK, I could not ignore the all-consuming pull that led me to travel out to the West African country last year.

It wasn’t a decision made lightly however. Yes, there were the logistical questions of how to pay the bills and cover the mortgage, but there was the much more serious, if not slightly hysterical one, of what if I die? In the end over 8000 people have died of this disease! But medical common sense and the support of my family prevailed, without which, I honestly don’t think I would have gone.

So, it was in November that I found myself, petrified, donning PPE (personal protective equipment) in 35 degree heat, trying to breath through the tiny gap at the top of my fogged mask, hoping that the fluid dripping down my body was sweat and not a breach in the protective clothing. The work was, as warned to me, physically and emotionally challenging. The patients we received would be in varying stages of the disease from mild vomiting and diarrhoea to bleeding from their mouths and faces with a total look of despair in their eyes, too weak even to hold water to their mouths. One patient, who had soiled himself, I thought was saying in a pleading voice ‘clean me, clean me’, it was only after he held his hand to his throat I realized he was actually saying ‘kill me, kill me’. The next day we were pouring chlorine over his corpse. The smell of chlorine never leaves you.

As a clinician it was extremely hard to accept the basic therapy of empirical antibiotics, anti-malarials and oral rehydration solution that we were administering due to the lack of specific treatment for Ebola. At that time only a few centres were able to trial convalescent blood (blood of survivors), to give platelet and blood transfusions, measure electrolytes or even to deliver intra-venous fluids at all. This is the subject of contention and ongoing debate due to the issues of risk from a bleeding IV line and of needle stick injury to the healthcare worker. I found that in actual fact most of my role was to provide nursing care, cleaning, washing and lifting patients, and even where a doctor should be useful in diagnosing and assessing patients it was a challenge because almost everyone who presents with a fever meets the case definition and has to be an Ebola suspect!

Despite these challenges there were moments that filled me with joy; the patients who were able to drink when encouraged, the hand holding through gloves, the words of support, the happiness expressed by those who tested negative especially once reunited with their families and the wonderful conscientious team of nurses who turned up for work every day even when many had lost their loved ones.

Some might think Ebola is over now. Well the data suggests it’s certainly improving with only 117 cases in the last week in Sierra Leone, compared with 748 per week at its peak, and new vaccines and therapies being trialed – better late than never. However, for the countries affected, the real impact of Ebola has only just begun. The death of 499 health care workers along with the understandable fear preventing many from going back to work has decimated the health system; livelihoods have been affected through unemployment and lack of farming creating soaring food prices; children have been orphaned and their education weakened by the closure of schools for eight months; survivors are suffering stigmatization from their communities and the ABC policy of Avoid Body Contact has taken the wind out of the sails in a country whose name was synonymous with celebrations and parties but who now are not allowed to congregate more than five people.

Amongst this, however, are rays of hope and opportunity; for example infection control measures are understood and practiced, there is an emergency number to call, an ambulance service- although extremely under resourced, and a malaria campaign that reached 2.5 million. Hopefully the funding received for Ebola will be used to rebuild the health system, as the World Health Organisation (WHO) suggests, without being locked into vertical programmes. I saw an incredible ability to work together and with efficiency, which demonstrated to me that a future, certainly in emergency medicine, is not without hope. Nonetheless, until Ebola is eradicated from West Africa, the way in which medicine is practiced will continue to be challenging; all patients will need to be screened and, without a point of care test to rule out Ebola, the fear of touching patients will continue and thus appropriate assessment and management of them too.

Despite the emotional and physical rollercoaster, in which for a period of time once back in the UK I couldn’t understand why I kept bursting into tears, I am currently on my way back out to Sierra Leone to continue the development of the emergency services. The task now seems unfathomably large and I can only hope that the world does not forget what there is left to do.

For more information please feel free to contact me at [email protected]

Ling Harrison