Ebola Health Care Workers Face Hard Choices

For Laura Duggan, going to Sierra Leone to care for patients with Ebola wasn’t so much a choice as a moral responsibility. “This is one of the biggest public-health emergencies of our time,” Duggan, a 34-year-old Irish nurse, told TIME as she prepares to leave London. “I’m trained to do this and there’s a great need. I couldn’t sit here and not go.”

Duggan had done her research, and knew the challenges: fatigue, long hot days spent working in sweltering biohazard suits, and the emotional toll of watching more than half her patients die no matter how heroic her efforts. But as for catching the disease itself, she wasn’t worried. Ebola is only spread through contact with infected bodily fluids. Duggan was confident that as long as she followed basic self-protection protocols, she would stay safe. But then, on Oct. 6, a nursing assistant in Madrid contracted Ebola from a priest who had recently returned from Sierra Leone. A week later, an American nurse treating a Liberian man in Dallas who died of Ebola also tested positive for the virus. Duggan’s partner, a Spaniard, pointed out that the Spanish nurse had been following the same rules, and still got sick. “He was getting a little nervous and saying, ‘Well, if she followed procedure and you’re saying you’ll follow procedure, then what happened? Why has she become infected?’” Duggan recalled. “That was my first little wobble and I kind of just went, Oh God.”

Despite pledges of support and widespread international concern, the Ebola epidemic in the West African nations of Liberia, Sierra Leone and Guinea is rapidly outpacing all efforts to contain it. As of Oct. 10, the number of cases had topped 8,399, with 4,033 deaths. With local populations of doctors and health care professionals cut down by disease and fear, and with those that remain overwhelmed, it is essential that their ranks be filled with international volunteers who can treat the ill and help prevent Ebola’s spread. But finding qualified doctors and nurses willing to face the risks, as well as repercussions back home, is “a challenge,” says Eric Talbert, the USA executive director for Emergency, an international medical organization that is setting up a 100-bed Ebola treatment center in Sierra Leone. “There is a significant fear factor. They are putting their lives on the line for people they have not met. It’s a courageous ask.”

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Never has the need been so great, and it looked like it might be exacerbated Monday when health care workers in Liberia signaled they would strike to protest conditions and pay — although many workers ended up defying the call to strike).

Calling the Ebola outbreak in West Africa a “tragedy not seen in modern times,” at the annual meeting of the International Monetary Fund and the World Bank on Oct. 9, Sierra Leone’s President Ernest Bai Koroma said, via video link, that his country would need 750 doctors and 3,000 nurses to treat the anticipated caseload.

As the numbers climb in West Africa, so too does the chance that more cases will be exported abroad, raising the likelihood that doctors and nurses around the world will find themselves faced with Ebola. “There is no doubt that we will see more cases of health workers getting sick” in West Africa, and those volunteers will have to go home for treatment, says Heather Etienne, a registered nurse from Texas who is on her way to Sierra Leone to work in an Emergency Ebola treatment center. So far, 416 health workers have been infected with Ebola in West Africa, and 233 have died, a sobering outcome. “You have to be comfortable with some amount of risk before doing something like this. You don’t have to be at peace with the idea of your death, but you shouldn’t be too uncomfortable with the concept either,” Etienne says.

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Having the wrong people could be just as bad as — if not worse than — not having enough, Talbert says. Ideally, volunteers would be willing to commit to a length of time that would make their training and airfare expenses worthwhile. They should have experience in the region, says Talbert, “so they know what they are getting into,” and experience working with highly infectious diseases, “because making mistakes can be lethal.” And because the risk of burnout is so high, there needs to be enough workers to fill a continuously rotating roster. Health care workers in Ebola treatment centers work under extreme duress, sweltering under layers of protective plastic to take care of patients who have a high chance of dying. “It takes a physical and emotional toll. Nobody can do that for too long,” Talbert says.

Umar Ahmad, a 29-year-old junior doctor at the Royal London Hospital in Whitechapel, who recently completed a three-month program at the London School of Hygiene and Tropical Medicine, is ready to take up the challenge, but he is finding it hard to take a few months away from a full time job. “There are plenty of doctors that would volunteer, but the issue is, what it actually means is that you take a financial hit, a career hit,” Ahmad says. “For lots of people, they’ve got responsibilities and they can’t justify it.”

For Etienne, the nurse from Texas, getting time off wasn’t an issue. Even though many of her colleagues told her she was “insane” for going to Sierra Leone, her superiors were supportive. Her main concern is about what happens when she comes back. As a nurse, she well understands the fear and stigma brought on by Ebola. Upon her return she intends to observe an informal self-quarantine, staying away from her hospital for 21 days, the incubation period for Ebola. “Given how jittery everyone is these days, they don’t really need me at the patient desk, only to have someone say, ‘Oh, you just got back from Sierra Leone. Get me out of here!’” she says.

Clare Parsons, a 28-year-old doctor who is leaving for a one-month stint with the King’s Sierra Leone Partnership, an initiative of King’s Centre for Global Health in London, shares those concerns. Even if she displays none of the symptoms of Ebola, she is planning to lay low at home for a few weeks, just in case. “Obviously I don’t want to go gallivanting around London and be known as the person that spread [Ebola] all over the London Underground,” she says.

Duggan, the Irish nurse, finally decided to go through with her mission despite her concerns, and left on Oct. 13 to work with Doctors Without Borders for six weeks. She is still afraid, she said, but she keeps reminding herself to go back to the facts and follow the procedures. In the end, she said, nursing, wherever it is, “is my job, and something that I’ve been trained to do.” Experience in other international aid missions has taught her that international health workers can sometimes be a breed apart. “You have a very high concentration of people who are willing to make a sacrifice and put themselves at risk for the need of others,” she said.

If Ebola is to be defeated, she, and several thousand more like her, will have to join their ranks.

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