Sierra Leone called for help, I couldn’t say no

I’ve lived in a tent in South Sudan for a year and spent hours at checkpoints in Iraq, but nothing prepared me for what ebola is doing in western Africa, writes Save the Children worker Sarah Murphy

Arriving in Sierra Leone in the midst of this Ebola crisis is a disconcerting experience. A veil of calm and silence sits, tensely, over the city.

Until you can put your finger on it, you struggle to identify what is different. As humanitarian workers, we’re used to natural disasters and conflict zones.

We’re used to visceral damage and widespread human suffering that leaves no-one in any doubt of what they’ve come to do.

Ebola is different. Ebola is a silent, stealthy killer.

It’s an equal opportunities virus that is creeping steadily through the populations of Liberia, Sierra Leone and Guinea.

Unlike the more common disasters, there are no obvious, commonplace signs of crisis in these startlingly beautiful countries. The difference was the conspicuous absence of destruction.

Anyone paying a modicum of attention knew it was going to escalate, but no-one, except perhaps MSF, was able to anticipate the spread of the disease to this level of severity.

It’s to the eternal regret and shame that the international community was so slow – the WHO, other UN agencies, INGOs, governments across the globe, none of us moved fast enough to monitor, analyse, react and deliver.

Sierra Leone called for help, I couldn’t say no

Save the Children worker Sarah Murphy is a native of Cork.

One morning, we all woke up, rubbed our eyes, and saw the potential of the epidemic getting out of control.

Then, everything happened concurrently. INGOs starting quickly assessing potential to respond, discussing immediate emergency funding with their relevant governments.

At this point, we started assessing our internal resources that were immediately available (staff, money, supplies) and preparing for the kick-off.

On an individual level, staffing Ebola is different to most typical emergencies in that people’s families are far more influential than usual. Now, I’ve been to my fair share of conflict zones and natural disasters.

I’ve spent a year living in a tent in South Sudan, and I’ve spent hours at checkpoints in northern Iraq. I like to think that I have a responsible grasp on my job and its risks.

And yet…. As the situation evolved, I was having a skype conversation with my sister in Cork, Maeve. I was writing about us scaling up for Ebola, and before I finished, I received a response ’NO!’. I said ‘what?’.

Maeve re-iterated ‘NO way. You’re not going to work on Ebola!’. At this point, I highlighted that I hadn’t actually asked her a question…

When I was requested by the organisation to go a few days later, she again, firmly objected. I called my sister in Dublin, Cliona, a consultant physician, who asked me a range of health and protocol questions before reluctantly accepting I knew what I was getting in to.

I urged my sisters to give nothing less than calm reassurance to my parents after I informed them. That evening and throughout that week I was meeting up with friends who were all concerned at the risk, and all urged me to reconsider.

But what would I do? My colleagues and I work almost exclusively on emergency crises. What would it say to the organisation and to the world if we collectively threw up our hands to say ‘ah, now.

This is a bit tough. I think I’ll stay home.’

So off I went.

Initially working within the vanguard team of 6, we began immediately focusing on the how and when we could get a 100-bed Ebola Treatment Centre complete and open.

To appreciate the urgency, you need to have some context. Before the outbreak, there were 50 doctors in the entire country; with the addition of Clinical Health officers, Nurses and nurses’ assistants, the ratio was 1 health-worker for 40,000 people.

An isolation treatment unit was established several months back at the Connaught Hospital in the capital, Freetown, with additional staff support from King’s College Partnership, in London. By the time we had arrived, 10% of the doctors throughout the country had died.

Both IFRC and MSF had opened their own Ebola Treatment centres, and were struggling massively with the demand. The Sierra Leonean Ministry of Health was, and still is, stretched beyond belief.

It was a fraction of what is needed to stem the flow – Sierra Leone is a few weeks behind Liberia on its trajectory. Without immediate, acute, strategic impact, then devastation lies ahead, and a possible shift from epidemic to pandemic.

In the meantime, local communities can’t wait for resources – both then, and now, they’re risking their lives to protect others.

Community health workers, and determined family members and neighbours, are taking it upon themselves to bury their dead, though without any protective kit.

Towns and villages have put themselves in self-quarantine. Others who are Ebola-free have instigated clear protection measures – no person can enter without getting temperatures checked and being chlorinated.

The Ministry of Health mobilised cash and resources, and started breaking ground for a 50-bed facility in a district called Kerry Town, 1 hour south of Freetown, in early September.

Whilst the contractors and engineers worked exhausting hours to deliver the project, we went in to full planning mode. The Ministry of Health requested our collaboration along with expertise and funding from the British government.

Working daily with all partners, we continuously adjusted the design and construction plan to consider the stringent and evolutionary infection control protocols.

The British MoD Royal Engineers came on board the same week, and worked closely with the contractor on site. By this stage, the clinic was up to 80 beds, and the British MoD started directly constructing another 20 beds on the same site.

Things were changing daily – this level of outbreak has never happened before. Indeed, the Director-General of the WHO, Margaret Chan, called the outbreak "the largest, most complex and most severe we've ever seen".

The WHO has since described it as “the most severe acute public health emergency seen in modern times." Up until now, there were no templates for this – no clear standard construction site, no patient/worker ratio, not even standard uniforms.

There still aren’t, but as this continues, and as we collaborate across the organisations, we’re beginning to identify ‘best practice’. Is it in time though?

We still don’t know. On the 5th November, a mere 2 months after breaking ground, we jointly opened the Ebola Treatment Centre, to be operated by Save the Children with resources from the national Ministry of Health, the British government, the Cuban Military Brigade, Public Health England and the local communities.

Opening this centre is a huge psychological boost that we’re finally, perhaps belatedly, putting our money where our mouth is. The British government is funding 5 additional Ebola Treatment Centres, at least one of which is to be run by an Irish NGO (GOAL Ireland) with whom we have been sharing our experiences and lessons learned. But let’s not get complacent.

This is still a frightening disease that is ravaging through West Africa, and if we’re going to contain it at all it can only be through tackling it at the source.

This is why we need a huge number of health, hygiene and operations expertise.

And this is why I will eagerly return.

Sarah Murphy works for the UK charity, Save the Children, and is from Ballincollig in Cork and a graduate of UCC.

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