A nurse fights Ebola in Sierra Leone: ‘You do some crying’

Belinda Fish worked her way through the makeshift Ebola Treatment Unit, sweating in the African heat. Clad in protective gear and wearing three pairs of gloves, she slid in her rubber boots as she moved from bed to bed. The double-threat of heat exhaustion and dehydration clung to her like the fog that clouded her face shield.

Despite her discomfort, she was determined to deliver the tender care she considers standard, rubbing a patient’s feet, stroking another’s back.

Belinda Fish suits up before entering an Ebola treatment unit in Sierra Leone.

“The patients are scared and they feel terrible. They’re looking at you like you’re a monster, but they’ve gotten used to it for the most part,” said Fish, a chronic care nurse who recently completed a six-week stint with Partners in Health in the West African nation of Sierra Leone.

“I always made sure the patient knew I was there to help them, and I was sorry for their suffering,” said Fish, who earned a master’s degree in nursing last year at the University of Michigan. “The nationals would help with the language barrier, and I’d say, ‘I’m sorry I’m in this nasty outfit, and I can’t wait till we see each other in our regular clothes.’”

Seeing awful stuff

In January, Fish took an unpaid leave of absence from her work at the U-M Health System’s Chelsea Health Center to volunteer in Sierra Leone. She returned stateside in early March and recently completed the “forced vacation” of her 21-day quarantine in compliance with the Centers for Disease Control guidelines.

Although she had volunteered in Kenya, Haiti, and Honduras in the past, Fish had never experienced anything like the Ebola crisis. By traveling to Sierra Leone she was able to fulfill her own mission as a humanitarian – and take away practical lessons about global response and direct patient care under the most extreme resource constraints.

She hopes to share this experience and knowledge as a nursing professor one day, creating a curriculum for nurses in the U.S. and abroad to better deliver quality public health in resource-poor conditions.

“I couldn’t pass up the opportunity to engage with such a huge public health problem,” Fish said. “I knew that to be on the ground and see how this works was going to be incomparable – professionally and personally.”

Despite the extensive preparation and training Partners in Health provided, Fish was stunned by the basic conditions on the ground. Open-air units with tin or grass roofs, surrounded by plastic fencing, served as triage centers and treatment units.

Fish burns material from a treatment center.

Health care workers mixed their own medications. Buckets of chlorine lined the floor. Thin cloths served as minimal bed linens. Lizards, ants and other insects were everywhere.

“I knew I was going to see some awful stuff. Sierra Leone has some of the worst health outcomes in the world,” Fish said. “And yes, you do some crying, but most of the time you are so intent on just giving the best possible nursing care you can.”

Health care staff entering the treatment units worked in teams — at minimum, two clinicians and a “sprayer” who carried a tank of chlorine to disinfect patient areas. Direct contact with patients was restricted to shifts that maxed out at two hours, at which point conditions became dangerous for staff.

“The limitations on the care are defined by the tolerance and safety of the workers,” Fish said. “It is impossible to make a fabric that is breathable but also impermeable to germs. So basically you are hot, hot, hot. You come out and your scrubs are soaked. You take off your big rubber boots and just pour them out. I have never sweated like that in my life.”

Back home

Fish was encouraged to hear that during her time in Sierra Leone, a multidisciplinary charette of U-M students, faculty and staff from the Stamps School of Art & Design, School of Nursing, School of Public Health, College of Engineering and more convened to brainstorm new types of protective gear. Teams designed and executed innovative prototypes, keeping in mind occupational hazards and usability. Fish sees ways those lessons can be applied to many nursing scenarios, including administration of chemotherapy.

“That’s one of the terrific things research institutions like Michigan can do well,” Fish said. “We have brilliant designers, engineers and so much expertise here. Focusing on the health care workers’ safety is paramount. One of the greatest tragedies of this (Ebola) crisis is how many health care workers died at the onset. They jumped in because they had to.”

Addressing Ebola Through Design from UM Stamps School of Art & Design on Vimeo.

Fish was inspired by the collaboration she saw among multiple global public health care agencies, nongovernmental organizations and the Ministry of Health in Sierra Leone. Their work transcended the immediate crisis.

“It was great to see the organizations come together to fight this disease and also transform the health system, which really needs support,” she said. “I’m so grateful to have seen that happening in real time.”

Informal connections were just as valuable. Fish and about 70 health care workers lived in a tent city constructed by the Danish army. They enjoyed camp-style meals together and gathered around a large satellite TV in the evenings to decompress.

Although Fish was fortunate to receive a stipend from Partners in Health, which helped offset the financial loss during her unpaid leave, she met three nurses in her cohort of 15 who were not so lucky. Their employers did not even offer unpaid leave for the volunteer mission, so the nurses quit their jobs altogether. Health care organizations have a huge opportunity to develop policies that encourage and support volunteerism when public health crises strike, Fish said, because the benefits are far-reaching.

She added, “This land has now seen this response of their global neighbors saying, ‘We want this disease to go away for you. We want you to get better at taking care of yourselves. We’ll partner with you. We’re not going to take over.’”

A longer version of this story was published by Michigan Today.