by Dr Mo Yin, Infectious Diseases Senior Resident
During the height of the outbreak in September 2014, the Infectious Disease Head, Professor Dale Fisher, was planning for a third trip to West Africa with Global Outbreak Alert and Response Network (GOARN), which is one of the programmes in World Health Organisation (WHO).
Together with his and my programme director’s support, we took on the task of bringing my training to the field. After a few months of preparations, our team consisting of Professor Dale Fisher, Sharon Salmon, the infection control nursing director, and I, began our deployment in Liberia on 5 February 2015. We were thrown into action quickly after touchdown.
Focusing on Infection Control
There was a new cluster of cases in one of the most complicated sectors in the capital, Monrovia. A bloody gang fight just took place, involving two infected teenagers. We adopted a ’'Ring Fencing' infection control approach, and focused on triage, training and providing supplies in high priority health-care facilities in the sector.
The WHO team worked closely with the team from Centres for Disease Control and Prevention (CDC), and led forty-odd NGOs to bring the cluster under control. Having expertise from a wide range of backgrounds brought about strengths as well as challenges.
A seemingly straightforward issue of increasing case finding to maximise laboratory capacity took weeks for the various parties to come to an agreement. These situations called for experience in leadership and communication skills. I witnessed how important it was in picking the battles, easing into discussions, selecting and empowering a team to achieve common goals.
Our efforts were rewarded as this cluster of cases ended after four generations, with successively improving survival with each generation.
Strengthening Healthcare Capacity
The outbreak started in Foya, a border town in Liberia, and re-introduction of Ebola will most likely be at these fragile areas near the Guinea-Sierra Leone- Liberian borders as well. The task of carrying out in a limited period of time, effective training, providing supplies and ensuring the contents and the gravity of our messages were carried forth.
By then, infection prevention and control training had already been disseminated widely in the nation. We decided to adopt simulations to bridge the gap between classroom theoretical teaching and real-life practice.
Employing our drivers as the patients, we tested healthcare workers and their systems with a simulated suspected Ebola case. The experience was humbling for both the healthcare workers and us. They quickly identified the gaps for themselves and came up with improvement plans.
We also came to understand the harsh conditions they were working in. Almost all of them did not have electricity and running water. The staff from one particular clinic, which saw four Ebola patients, had not received any salaries for the past eight months!
Maximizing My Youth and Contribution
Aside from assisting in missions, I was given independent tasks. The team leader identified my youth as a strength, and engaged me to come up with creative solutions using information technology.
One of the roles we played was to aid the Liberian Ministry of Health in uniting the various NGOs and their efforts in infection prevention control to reduce redundancy and improve accountability. Fifty minimum standards in infection control were identified and emphasised upon for all health-care facilities across the country.
To complete the loop, I designed a web-based tool that made it possible to track output from each NGO and the progress of each facility with time. This helped us to identify, at a glance, the various needs, and improved the efficiency of prioritising resources.
Though my deployment in Liberia was relatively short, what I have learnt and contributed went far beyond what can be quantified by time. My posting evaluation was eventually based on my final presentation to the WHO Representative of Liberia.
Re-defining Apprenticeship in Medicine
The study of medicine is traditionally based heavily in hierarchy and learning in controlled environments. However, we are all aware and appreciate that medicine transcends textbook scientific knowledge. The art aspect requires innovation, leadership, communication and administration skills.
To move ahead with time, we need to re-define apprenticeship, and open up our minds to opportunities for teaching and learning. My experience in Liberia is an illustration of valuable training in the field.
It has proved that no task is too daunting with the right support and supervision.