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Interview: Marjorie Lee, volunteer Ebola nurse

Travelling to the frontline of the Ebola epidemic is not for the faint-hearted, as one Red Cross volunteer explains

One of the worst things about Ebola is the loneliness,” claims British Red Cross volunteer Marjorie Lee. “You see a lot of patients who are dying and they are all alone. Your deathbed is the one time in your life where you should be surrounded by those you love but Ebola takes that away from you.” Lee, 56, spent four weeks in Sierra Leone working as an Ebola nurse caring for those who contracted the deadly virus which has ravaged its way through West Africa and threatens to spread more widely.

The spread of Ebola has been classified by the World Health Organisation as an “epidemic”, with the first case being discovered almost a year ago. To date, there have been 7,825 laboratory confirmed cases of the disease in Sierra Leone alone with 3,062 people in the area having died from the condition.

Worldwide there have been a total of 21,261 Ebola cases and 8,414 deaths as a direct result of the virus. It has spread to countries across Africa including Mali, Guinea and Liberia although Mali was declared “ebola-free” on 18 Jan.

Emotional highs and lows and a grueling schedules are something that Ebola nurses across Africa face on a daily basis.

Lee, from Ayrshire, Scotland, recounts one particularly poignant memory of a funeral she attended of a young boy who she had sat with while he died.

“They brought him out in a wee box which was followed by another and another and another. So many small bodies, so many grieving families, so many little wooden graves. That was really sad,” she says. Volunteering is a challenge - and not one for the faint-hearted.  Staff need to be available 24 hours a day to attend to patient needs and volunteers get one day respite a week.

Shifts are split into two. At the beginning of any shift, medical staff are briefed and are then divided into two teams; one to work on the confirmed Ebola cases, the other to work on the unconfirmed cases. Patients with confirmed cases of ebola are cared for within a quarantined ward and are quickly assessed by the nurses and their needs recorded. As staff can only spend an hour at a time in the ward - despite their protective suits - their data is then collected, passed over to a second team of medics who then administer any drugs they may need. In instances where morphine or fluids are required urgently, medication will be passed through the fence by a colleague from the pharmacy which is located outside of the quarantine zone.

For teams working on non-confirmed wards - the nursing staff will take a brief history of those with suspected cases of Ebola. Those displaying more severe symptoms will be prioritised and then tested.

The difficulty facing healthcare professions is that the ebola virus is passed by human contact with patients who are in the late stage of the disease, meaning that offering even the most basic levels of care becomes difficult. Staff have to go to extreme lengths to avoid coming into physical contact with patients. As well as being double gloved, they also wear scrubs, a boiler suit, wellington boots a hood and a mask to ensure that no part of their skin is exposed.

“It takes time to do even the most basic of things” says Lee.

“On the ward at home, changing IV fluids is quickly done, but here, you are wearing the suit and the patients are so weak and its so hot, that you're much slower.

“The safety aspect is really important. You can't be in a room without another member of staff there checking you at all times - to make sure you are physically protected. At one point my glasses misted up while I was seeing to a patient and I had to leave the room because I couldn't see. My colleague came with me so that she could check that I stayed safe."

Nurses only have a finite amount of time to spend with patients who are 'confirmed cases.' Housed in basic marquees, the temperatures inside the wards can reach 45 degrees. This is particularly dangerous for staff dressed in the thick biohazard-style clothing, who are allowed to spend no more than an hour at a time on the ward.This was one of the things Lee found the most emotionally difficult.

“You need to be quick and efficient on the wards, because of the time constraints, but when people are alone it's little things that count. Just letting them know you are there and that you care brings patients hope - and I think that's really important.”

Of course, it isn't only patients that benefit from knowing that people care. Throughout the course of the day staff constantly check one another's protective gear. They work, eat and socialise together to keep themselves motivated.

“The locals were so grateful for our help, so too were all of the other nursing staff. The amount of patients we had doubled during my time there from 20 to 40, but I did feel like we were part of a big family fighting Ebola together. When shift finished, the local nurses would be singing or dancing and we were always invited to take part which would help take your mind off things.”

Despite the challenges Lee will be returning to West Africa again in March. The reason is simple. As a bank nurse, she didn't have to worry about getting time off work and she believes that: “If we (the UK) were in the same situation, I would like to think that other countries would step in and save us.”

The news that she would be working with Ebola patients received a mixed reception from her family and friends in her hometown. While many people were incredibly encouraging of her decision, there were others who thought that she was “mad” for even considering it.

“ I think for a lot of people, they couldn't quite understand why I wanted to do it - particularly as Ebola is such a dangerous condition. When I originally signed up with the British Red Cross, an American health worker had just caught Ebola so I don't think that helped either. Ultimately though, every-one realised that it was my life. Even if they didn't agree with my decision - they did come to accept it.

“It was the same thing when I came back. Everyone was so glad I'd returned safely, but for a few weeks some people were very cautious about physically being around me, just in case."

“Being out there [in Sierra Leone] made me aware of how lucky we are to have an NHS that - for most of the time - actually works. At the Ebola hospital, the wards were made from tents, the pharmacy was on the floor and the kitchen consisted of two stoves, one to cook rice and another to cook beans, with three members of staff feeding 600 people.”

Despite her confidence in the safety procedures, Marjorie does admit that she was nervous when initially travelling. Things were even more nerve-wracking when the nurse she was due to travel with, cancelled last minute due to illness. She remembers arriving at the airport all alone and being collected by a Red Cross representative who just “sorted everything”, answering her questions and ensuring that she arrived safely at her destination.

In terms of recruitment, there is a wide range of opportunities available to work in Ebola nursing. Alongside the Red Cross, charities such as Save the Children, Oxfam and Medicin Sans Frontiers all provide nursing support to international areas with staff shortages and positions are advertised online. Lee advises anyone thinking about working abroad to, “talk to people who have been before and if it is something you are completely comfortable doing, go for it". Lee's parting memory is of another toddler who was separated from the healthy children in the hospital's kindergarten because of a fever.

“We were so terrified for him. On the day I was due to head to the UK he received the all-clear. All the children were so happy to see him that they ran up to him and hugged him. The joy on their faces - it was such a beautiful moment to be a part of. The best leaving present I could have had.”