Fighting Ebola: 'This is our job', say experts from Singapore who have been to Liberia twice

Two from NUH have been to Liberia twice as volunteers, hope to go again

Two infectious disease experts from Singapore have been to the heart of the Ebola epidemic in West Africa to help battle the disease.

Associate Professor Dale Fisher and Ms Sharon Salmon went to Liberia twice - in April and last month - the only people from here to do so. They joined thousands of international volunteers to help hospitals reopen safely, keep infections in check, set up centres to care for patients, train local health-care workers about how to cope, and teach people about staying safe.

Prof Fisher, head and senior consultant at the National University Hospital's Division of Infectious Diseases, told The Sunday Times: "This is our job. Our families understand it and, even if they're concerned, they trust us enough to know that we do not take silly risks."

Ms Salmon, NUH's assistant director of nursing, infection control, helped villagers to understand Ebola and protect themselves while caring for infected family members, among other things.

Both Australians, Prof Fisher, 54, has worked here for 10 years and is a permanent resident, while Ms Salmon, 37, has worked here for three years.

They went for two weeks each time as members of the World Health Organisation's (WHO) main outbreak response arm, the Global Outbreak Alert Response Network.

There, they found graphic posters lining city walls, showing people bleeding, vomiting or with bouts of diarrhoea, warning afflicted citizens to head straight to the nearest health-care facility.

But with terrified health-care workers abandoning hospitals, and treatment units overflowing, patients were often turned away and families had no choice but to care for them at home.

Ms Salmon said she taught villagers to tape plastic bags to their hands when tending to sick family members, since gloves were not available, and how much chlorine to mix with water for disinfection purposes, for instance.

Many live in large households of 10 to 25 people, on dirt floors with no electricity, said Ms Salmon. "So if there were bodily secretions to clean up, they would generally put mud on it and scoop it up with their bare hands," she said.

Ebola is spread through contact with fluids from infected people. But it is hard to overturn ingrained practices such as washing, touching and kissing the bodies of those who die. "It was not easy to tell them why they should not do it, and to wait for the burial team to take over," she said.

Prof Fisher helped to reopen hospitals and health-care facilities and make sure they were able to screen for Ebola patients while treating patients with other health issues. He also taught others how to set up additional care centres for those with Ebola.

He had been shocked to hear of people being turned away from Ebola treatment units, conventional facilities which house 50 to 100 patients. "But when another 1,000 patients appear, the outbreak runs ahead of the response," he said.

He noted that bodies of Ebola victims were not picked up for days because capacity was full. And when he called in at Foya Borma Hospital in Liberia's Lofa County, where two nurses had died, it was barely open. "The staff's instinct was to run," he said.

Liberia is the hardest hit among the West African nations battling Ebola, with over 2,300 confirmed and suspected deaths, according to the latest WHO figures.

Returning to Liberia last month, Prof Fisher and Ms Salmon found that little had changed except that there were a lot more infections. While supplies such as protective gear had arrived, they had yet to be unpacked, and there were massive coordination problems between various agencies.

"A lot of people aren't admitting they have Ebola. They would rather not seek treatment because they see so many people dying and don't trust the authorities, and the same is true for people who have had contact with patients," said Prof Fisher.

But he believes that infection control interventions will eventually catch up with the outbreak, and the numbers will start to fall. "There is an end point to this," he said.

The United States Centres for Disease Control and Prevention's worst-case scenariois that an estimated 1.4 million Ebola cases could emerge in Liberia and Sierra Leone alone, by January next year.

"If we can break the chain of transmission, so that everyone that gets infected infects less than one other person, that's when the outbreak numbers will start to decline," said Prof Fisher, who is chairman of the National Infection Prevention and Control Committee, the Health Ministry's technical advisory group for infection prevention and control issues here.

Prof Fisher and Ms Salmon were not in direct contact with any Ebola patients, but have been monitored closely since returning on Sept 18.

The incubation period - from the time of infection to when symptoms appear - is two to 21 days, according to WHO. People are not infectious until they develop symptoms, which include fever, rash, vomiting and diarrhoea.

Both are in the clear and keen to go back to Liberia again next year.

Said Ms Salmon: "For those of us working in infection control, Ebola, a virus known for its deadliness, is the highest calling."

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