Ebola nursing: "one hell of a mission to cut your teeth on"

10 October 2014

Returning Red Cross nurse Donna Collins says the true heroes of fighting Ebola are the national nurses who have lost colleagues, faced eviction by landlords, and have been ostracised by their villages, but they keep turning up for work each day. Back safely from Sierra Leone, Donna talks to FIONA CASSSIE about the testing, sometimes fearful, but ultimately very satisfying mission to help the Ebola-stricken nation.

Donna1web"Initially, I was scared witless," says Red Cross nurse Donna Collins when asked about caring for her first Ebola patient in Sierra Leone.

"I looked at this gentleman, and I thought 'oh my God, you have the ability to kill me if either of us do the wrong thing or if I didn't have this PPE (personal protection equipment) on.

"It was one of those life moments when you stop and think 'far out – this is serious' and then I thought 'put your big girl pants on girl and get on with it'. So that's what I did.

"… that poor man was dying of Ebola, so he had more problems than I did."

It wasn't the only time that Donna told herself to "put her big girls pants on" or drew on her sense of compassion, strong practical streak, and Kiwi down-to-earthness to get her through her first ever Red Cross assignment.

"It was one hell of a mission to cut your teeth on," she acknowledges.

But rather than being intimidated, the Whangarei nurse and her fellow first-timer, Wellington nurse Sharon Mackie, requested for their initial three-week assignment in Sierra Leone to be extended. The pair ended up staying for nearly four and a half weeks as they weren’t prepared to leave before the Ebola treatment centre (built from scratch by their international Red Cross team) was open and caring for its first Ebola patients.  

Donna and Sharon returned home safely to family and friends in New Zealand at the start of October – after a three week quarantine period in Africa – and a week later, are back in their day jobs.

The pair initially arrived in Freetown, Sierra Leone's capital, in mid-August, and after initial orientation and training, they headed west to the 60-bed Medicine Sans Frontières (MSF) hospital in Kailahun, near the border with neighbouring Guinea, for three days of hands-on, literally life-saving training in how to don and doff the personal protection equipment (PPE) required to safely care for Ebola patients. (See Ebola nursing: how to safely get out of PPE).

After donning for the first time the multiple layers of personal protection equipment (PPE) – including 'duck bill' mask, all-in-one suit, hood, and apron all tied tightly around the head and neck area, with ski goggles on top – Donna says she initially felt claustrophobic.

Worse was the heat – temperatures constantly in the 30s and high humidity. She says her colleague Sharon Mackie’s description of it as like wearing a personal sauna "was a great analogy".  

Her first patient contact was having to certify a nine-year-old boy’s death – he'd died in the night.

"Then I was taken by an obstetrician (who heard I was a midwife) to see a 22-week pregnant woman who didn't look well … she was vomiting blood. Four hours later, she was dead."

"Ebola is a disgusting death – it’s a haemorrhagic disease, so there is a lot of body fluids."

"… people are vomiting, they have got raging diarrhoea, they are bleeding, pregnant woman are miscarrying – any body fluids you can think of, it's there, it's happening.”

She says because of the heat, the nurses and hygienists can only spend up to one hour at a time working in full PPE, "so you get down to it and do your work; you are giving medications, checking ID bands, washing the patients, or changing them."

Donna3webDonna says the time it took to don the PPE and to methodically take it off under careful supervision (ensuring skin did not come in contact with PPE contaminated by the deadly virus) meant most people could only squeeze three one-hour nursing sessions into a shift.

You also always work with a buddy nurse for support and safety, in case somebody passed out from the heat.

"A high percentage of Ebola patients experience confusion. One of our first patient's in the treatment centre was throwing rocks, so we were dodging rocks as well."

The base for their Red Cross team's assignment was Kenema,  the third biggest city in Sierra Leone, with an estimated population of around 190,000. There, they supported the government hospital that had early on been overwhelmed by Ebola, with the loss of nearly 30 staff to the viral haemorrhagic disease. The team's mission was to set up a two-stage triage tent outside the city hospital, and at the same time, build, equip, and staff from scratch the Red Cross's first ever Ebola treatment centre – a 60 bed unit being built on a cleared piece of jungle about 18 km outside the city.

Donna says they worked 12–14 hour days as they not only did a morning or afternoon shift at the hospital triage tents, but they were also "jack-of-all-trades" on setting up the new treatment centre, with jobs from interviewing new graduate nurses eager for work, to taking the "wheel barrows" of cash needed in inflation-hit Sierra Leone to buy centre supplies. They also had to train the new staff in PPE and infection control and be team leaders as the novice staff worked in the newly opened treatment centre.

"It was a big responsibility, but I loved it. I thrived on it."

Donna also developed huge affection and respect for the Sierra Leone nurses and hygienists she worked with.

"These are the true heroes of this whole Ebola response," she adds. "People keep saying 'oh you are amazing going' but it just embarrasses me as the true heroes were the national staff because they are ostracised within their own community for working with Ebola patients.

"They were brave, brave nurses that kept coming to work every day.”

Donna saw death and dying in Sierra Leone on a scale she had never seen before.

"It's a terrible way to die; it’s actually the fastest death I have ever seen."

However, about 30 per cent of patients did survive and walked out of the centre cured.

Donna says the medical team meetings each night were a chance to debrief with people who could understand.

"You would never do it at the whole team meeting because the builders would have looked horrified if we said what we'd seen."

But the medical team nurses and doctors were 'astounding', and she had the added good fortune to have the "fabulous Sharon Mackie” and it was "just fantastic to have each other to sound off at”.

"We’ll be lifelong mates."

Would she go back to West Africa to help the fight against Ebola?

"Absolutely, I would!" is the instant reply.

Ed. You can read more about Donna Collin's experience and her Red Cross team project in the next edition of Nursing Review.