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Ebola: "The hardest job of all"
Ane Bjøru Fjeldsæter is a 31-year-old psychologist from Trondheim, Norway. For the past month, she has been working for Médecins Sans Frontières/Doctors Without Borders (MSF) in Kailahun, Sierra Leone, helping to fight an outbreak of Ebola that has already killed more than 500 people across three countries.
She provides support and counselling to patients and their families, as well as to the staff whose job it is to deal with the dead bodies.
Hardest job of all
"I was expecting the Ebola epidemic to be quite gruesome and unlike anything I had seen before. But I really didn’t expect its magnitude – this outbreak is enormous. In Sierra Leone, it killed off a lot of health workers before MSF even arrived.
Not surprisingly, medical staff were reluctant to work with us at first. They’d never come across Ebola before – but at least they had previous experience of people suffering and people dying. But for the non-medical staff, like the hygienists – our hospital cleaners – it’s been a new and disturbing experience, and a large part of my work involves providing them with counselling and support.
The hygienists have the hardest job of all, because they are the ones dealing with the dead bodies. Since our Ebola centre opened two weeks ago, we’ve had 37 deaths – an average of two or three a day. A lot of the cleaners are young, unskilled workers. In an area with an unemployment rate of 95 percent, they jumped at this opportunity to get a job.
They are the ones who mop up the vomit, the stools and the blood. And when there’s a death, they are the ones who retrieve the dead body from the isolation ward, put it in the morgue and disinfect it. In the final stages of the disease, the viral load increases massively, which means the dead bodies are extremely contagious and very dangerous to deal with.
While all our staff are well trained in protective measures, just knowing that you are potentially putting yourself at great risk of contracting the disease can be stressful.
Dealing with the dead bodies is disturbing; the hygienists experience feelings of sadness and fear, and also disgust. With Ebola, patients can die in a disgraceful manner – there’s bleeding, vomiting and diarrhoea. The cleaners tell me they experience flashbacks – of things they have seen and of things they have smelt. Even wearing a mask, you can’t shut out all the smells.
Traditionally, in Sierra Leone, dead bodies are taken care of by the tribal elders. A lot of the hygienists feel they are too young to be dealing with the dead – they feel they’re being disrespectful of their culture’s traditions. We make sure that on each shift there is always one man and one woman, so that when someone dies, there will always be someone of the same sex to tend to them.
The local staff also experience huge stigma from the community. The son of one of our workers recently died from malaria. People in his village immediately said he had caused his son’s death because he was working with Ebola. It was very distressing for him.
Lives turned upside down
The stigma also makes it hard for the hygienists to maintain their image of what they are doing. We tell them, “You are heroes, you’re doing a very important service for your community – it’s absolutely vital that someone is doing this job.” But although we see them as heroes, this isn’t always how they are perceived by their families, their friends or their villages.
When we discharge a patient who has survived Ebola, it makes an enormous difference to them. Yesterday, three people who had been cured were discharged from the isolation ward, and all the cleaners were dancing around the ward, deliriously happy and taking photographs.
They find ways to manage the stress: they take good care of each other; when someone is upset, they talk about it; and they are very open about voicing their concerns and difficulties.
But the fact is that the local staff have had their lives turned upside down. For this entire district, everything is upside down. Here in Kailahun, the banks are shut, the schools have been closed for more than a month – the students are very upset about the fact that they are missing their exams.
A lot of people are isolated out of fear that, if they go near other people, they will get the disease. People are really at a loss to understand what is happening to them.