Dorcas Sc

Compassion without borders: notes from an Ebola frontline

There is an old Swahili proverb that says: ‘War has no eyes’

I thought about this African proverb as I watched the Ebola crisis evolving in the last few months. The fear, sheer panic and deep sense of helplessness within the African Diaspora as the disease continues to wreak havoc across West Africa, the area most affected. A continent reduced to a single country, a single narrative summoned into a single virus.

Ebola has no eyes. Ebola knows no class, race, borders or tribe. An unwelcome visitor, it arrived second time round this time with a hasher strain, charging its way village to village, mercilessly killing people along with the health care professionals, the very core of any healthcare system. It stripped them bare, mattresses, clothes, shoes – all had to be thrown away and burned to rid them of the disease that few locals understood. Dorcas Gwata

Ebola challenged the very African cultural practises that we hold deep and sacred in our cultures. Touching and cleansing bodies before burial, praying, hugging, carrying babies on backs and eating. In most African cultures a greeting is not complete without touching. Equally, funerals and burials are held with deep honour and respect for the deceased. In Southern Africa, the body is cleansed by the women and is allowed to ‘sleep’ one last night in the house surrounded by grieving family who sing around the body all night. Cremation is almost certainly unheard of in most African cultures. Ebola changed all that.

Ebola

In a sense this is familiar terrain, Sub-Sahara Africa has been here before with the HIV crisis, the same fear of death, stigma, orphaned children, migration for better treatment, culture, inequalities and fragile health care systems, however Ebola has a different edge. HIV allowed us to touch our loved ones, wash them, kiss them goodbye, and we can still visit them in a marked grave, Ebola threw all those sentiments away.

“It feels like the whole country is under quarantine” wrote a Liberian journalist.

It feels like we are back in the war times again – but at least in the war, you knew who your enemy was. “With Ebola we are fighting an invisible war” wrote another Liberian journalist. This traumatised region, emerging from war and trauma into an Ebola crisis, didn’t get to catch its breath before the next wave of trauma immersed them. How do you begin to heal a nation, a region, a continent?

All this as we in the African Diaspora and around the world watched, debated agonised, send more money home, called, emailed and soldiered on with our daily lives, all the while aware of an unimaginable suffering back in the continent.

I battled with my own thoughts, scavenged the news and social media on updates. I attended many Diaspora events. There is a certain unsettling feeling of being an African clinician in the NHS, whilst being aware of fellow Africans suffering back in the continent that lives in many of us in the Diaspora. It is that same feeling that keeps many of us Africans in the Diaspora engaged with progress and challenges back in the continent.

I thought long and hard about fellow health care workers struggling with minimal resources, working in an unavoidable reality that they too could catch the virus and possibly die. I thought about their clinical practises, their safety, their patient’s safety, renewed ways of showing compassion with their patients. I wondered if they had enough gloves and aprons. I thought about the nurses and doctors who had been shunned by their own families for looking after Ebola patients – survivors stigmatised by communities. I agonised as I watched patients absconded from clinics in search of food.

Ebola 1

Africans have a common way of grieving, a burdened wailing, a loud weeping of desperate suffering and loss as women wrap themselves in traditional clothes. In crowds, yet alone in their suffering.

I wanted to help, I wanted to be part of the journey, the suffering.

I dug deep into my Global Health networks. I contacted Dr Julian Eaton, a colleague and a respected British Psychiatrist based in West Africa. He rolled the network ball until I was eventually put in touch with a professionals working in frontline in Liberia and Sierra Leone.

‘Thank you for thinking of us at this difficult time’ a Liberian nurse replied.

Martin, a Senior Mental Health Nurse working in frontline services in Sierra Leone and I agreed to share experiences of living and working in an Ebola frontline, whilst I share my experiences as an African working and living in the UK.

Sierra Leone has confirmed more than 5400 cases of Ebola, whilst in the UK we successfully treated one case of Ebola. Their experiences of working and living within an Ebola are vivid and moving.

‘If we do not do this job, who will?’ a nurse asked.

‘Our people are dying’ another wrote.

In Sierra Leone teenage pregnancies have increased, schools have been closed for nearly four months now, I read in papers.

Ebola survivors, particularly women are facing a huge degree of stigma from their communities, some are not able to go back to their homes, Martin wrote back.

Still, from this battered, exhausted and worn out region comes the stories of survivors, champions and carers who now taking part in the recovery of their nation. The psychological needs are extensive. I am touched and intrigued when Martin writes:

‘We are about to open a survivor’s clinic that provides psychological support for survivors’

Ebola 2

The clinic will address psychological needs within the local population. They are training traditional healers, community health workers, faith leaders, traditional birth attendance and health care workers in Psychological First Aid training.

Some young survivors are offering their help in community action research, village to village campaigns and with the help of local and international donors.

‘How is the UK managing with the Ebola crisis?’ A fellow nurse in Sierra Leone wondered.

I wrote back describing the media frenzy, the airport screening points, the London hospital designated to treat Ebola patients, the avid fundraisers, African Diaspora gatherings and the British healthcare workers making their way to West Africa. I did not write back about the British weather, It seemed too indulgent in these circumstances.

I read their notes over again; all the while reminded of the abundance that we have in the west, abundance we often fail to appreciate. Ebola could never thrive here, the NHS however squeezed it is, has ample capacity to contain an epidemic, our colleagues in Africa don’t. I am haunted by that.

Our exchanges carry on, a shared compassion, intrigued by each other’s health and cultural experiences. I am warmed by their sense of empathy and resilience, despite the challenges they soldier on. When patient care is your calling, that is what you do, you soldier on.

More positive stories continue to emerge, Nigeria, a vast socially and politically challenged nation got ahead of the crisis and managed to contain it before a national epidemic. Their health care professionals are now helping out in the region, important we acknowledge that progress.

‘The stakes were too high, we had no choice but to contain Ebola before it spread’ said my colleague Dr Kingsley Akinroye. ‘Had Ebola entered the country through the Boko Haram region, we would have been challenged ‘he added.

In the wake of this crisis, the WHO asked leaders of the African Diaspora Health groups in the UK to form a single, common platform of African Diaspora professionals to liaise and advice on public health issues in Africa. Better Health for Africa has recently been formed under the great leadership of Dr Titilola Banjoko and Dr Aliko Ahmed, and I am honoured to be part of a small group of Africans health care professionals contributing on public health issues in Africa, our continent.

Dorcas Gwata

Director: Tribal Sands

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