TORONTO – Paul Gully wanted to make a contribution. Eilish Cleary had worked before in West Africa and knew what it takes to work effectively there. And as West Africa’s Ebola epidemic continues to evade control, other Canadian health-care workers are assessing the overwhelming need and thinking about whether they too should step forward.
International response agencies have been desperately seeking volunteers for some time to help to contain this unprecedented outbreak. One person involved in the recruiting, Dr. Rob Fowler of Sunnybrook Health Sciences Centre in Toronto, estimates that by now dozens of Canadians have been deployed in various roles, through the World Health Organization and non-governmental response organizations.
Still, back in the late spring and summer when Medecins Sans Frontieres first warned it could not handle this outbreak alone, the initial response to the calls for help was muted at best.
“People were really afraid about it and still people are afraid about it,” said Christophe Lefebvre, manager of placements for MSF Canada, which is also known as Doctors Without Borders.
The group has had 28 people from Canada who have gone or are training to go to West Africa to work on the organization’s response efforts. MSF has been sending doctors, nurses, psychologists and psychiatrists and logisticians – people who can set up water systems for treatment centres and organize burial efforts as well.
The work is not for everyone, MSF and others stress. It is gruelling, dangerous and emotionally exhausting.
“On one project they had to bury quite a lot of people so they had to build a crematorium. And it’s very, very rare that we have to ask for people to do this,” Lefebvre offered as an example of how taxing the job is.
Still, people are coming forward.
Among them are 14 employees of the National Microbiology Laboratory in Winnipeg, who have gone in three- and two-person teams to operate a mobile diagnostic laboratory Canada has donated to the response effort.
There have been six rotations since the first team deployed in June, and three of these people have been to the Ebola zone twice.
This commitment is being juggled with the need of the Winnipeg lab to do critical research aimed at speeding up the availability of Ebola drugs, as well as doing the required testing whenever an illness in a person coming to Canada from the affected countries sends up a “maybe Ebola” flare.
“We are being very careful to ensure that we keep adequate resources at home,” the agency said in an email.
Gully worked with the Public Health Agency and Health Canada as well as with the WHO in a career in public health that spanned decades. When he retired two years ago, he was senior medical adviser to the federal deputy minister of health.
Now a public health consultant and professor at the University of British Columbia, Gully had been thinking over the summer about how he might help.
“As we have all seen the outbreak is not yet under control and the affected countries and international community are stretched to the limit,” he said in an email explaining why he volunteered.
When the timing of a teaching commitment changed, he was free to step forward. He arrived in Sierra Leone this week.
“My partner and I discussed this at length and both decided that given my flexibility, commitment to public health and past experience with WHO, that I should apply,” he said simply.
Cleary, New Brunswick’s chief medical officer of health, had worked in West Africa. She’d also had experience responding to Lassa fever, another hemorrhagic fever which causes outbreaks in that part of the continent. (Lassa is from a different virus family than Ebola and has a much lower fatality rate.)
Cleary knew her combination of experiences meant she had something to offer. Both she and Gully are in West Africa under the auspices of GOARN, the WHO’s Global Outbreak Alert and Response Network.
“You just have to get used to the idea that you’re working with something that’s very serious if you get this and you try not to get,” she said this week from Lagos, Nigeria, where she’s been helping public health officials in Africa’s most populous countries set up surveillance systems for Ebola detection.
“You just become accustomed to just being very, very careful.”
Cleary, who is half-way through an eight-week deployment, suggested people considering volunteering should spend some time coming up with an answer to the question: “Why do you want to go?”
Not everyone who wants to help should make the leap, she said.
“They should feel okay not going because it would be worse to have people going who are not a good fit…. That would be problematic,” she said. “It’s not for everybody.”
Lefebvre said MSF is only sending people who have been on previous MSF missions – no newbies this time. That doesn’t mean they are only taking people with Ebola outbreak experience; people who have done an emergency response or a regular project with MSF are considered.
“The stress they will have in the field is so high that we don’t want to add any of the stress from a first (time) missioner who discovers Africa, who discovers the MSF culture,” he explains, adding that while normal MSF project commitments last six months and emergency response missions are three, the maximum length of these Ebola deployments is five weeks.
Dr. Tim Jagatic, an MSF doctor from Windsor, Ont., has been out on two tours so far and may have another on the horizon. He was in Conakry, Guinea, in March and April – when the world first learned of the outbreak – and in Kailahun, Sierra Leone in July.
The low resource setting is tough on medical professionals who are trained to intervene and operate, but cannot do so safely because the risk is too high and the patient load too great, he said.
“A lot of people do say ‘I’m holding myself back. I’m fighting against my instincts here. Because when this particular thing is happening to a patient I want to get in there and intervene but I know I can’t.’ So that’s a very difficult thing for people.”
And wearing the layers of head-to-toe protective garb in the African heat is physically exhausting, he said.
“I was estimating I was losing a litre, a litre and a half of water every time I was going in (to the treatment centre),” Jagatic said.
“And then it’s very difficult to rehydrate simply because there’s only so much liquid, only so much salt-and-sugar water that your body can handle at a time…. And just over time your stamina just starts to go down, so it’s more difficult going in each subsequent time. You really start to feel that.”
Lefebvre said the duration and severity of the outbreak is inspiring more volunteers to step forward, but he acknowledges there isn’t an endless supply from which to draw.
“We’re not touching the end of the pool but we know that we don’t have a lot of possibilities to get more. So now we’re counting on people that will be able to go November-December. And then in January maybe we will have some people that already went in September-October going to (go back).”
Somewhere in there Jagatic may head back across the Atlantic for his third mission.
“There are some days where I’d prefer not to go back, and other days where I feel motivated to go back,” he admitted. “It acquires a sit-down discussion with everybody involved and I’ll make a final decision when the time comes.”