Sierra Leone’s health care workers have been confronting Ebola for more than a year – a relentless, shattering endeavour. 11 of the country’s 123 medical doctors have perished. The World Health Organization estimates that, across the region, over 500 health care workers have fallen victim to the virus. Most international volunteers undertook six week stints in emergency treatment centres. Local staff have been in the field almost nine times as long.
Médicins Sans Frontières (MSF) described their feat as “extraordinary” and “parallel to none”. When asked why she had returned to West Africa, Ella Watson-Stryker, a public health expert from New York and MSF volunteer, remarked:
“…most of all I came back for our Guinean, Sierra Leonean and Liberian staff who are fighting the long fight with a level of courage and compassion that exceeds anything I have ever seen. If they can keep going for months on end, then I can come back to help them.”
At the coalface
The speed at which the Ebola virus spreads, its devastating effect on victims and the number of medical personnel infected combined to present Sierra Leone with an unprecedented health care crisis. Physical conditions have been particularly challenging: treating patients in stiflingly hot conditions meant that protective suits could only be safely worn for an hour at a time. However, the spread of the virus was not matched by the distribution of protective materials – an inexcusable failure resulting from governmental neglect of duty and petty corruption. “When facilities run by NGOs began to open we had staff moving to these centres because at least they had the protective equipment”, a doctor who worked in Ebola treatment centres in Kenema and Freetown told ARI.
The task of providing care was as mentally demanding as it was physically exhausting. Psycho-social support for health care workers and others affected by the epidemic will be vitally important. Professor Yuval Neria argues that “a more pro-active, research-informed mental health response is desperately needed to mitigate the magnitude of the mental health consequences [of Ebola]”. Dr Bintu Mansaray, who works at Connaught Hospital in Freetown, described to ARI how colleagues who worked in the treatment centres have told her: “you feel responsible for the death of patients, you see colleagues die. Being in that environment again will be mentally challenging”.
In September 2014, the government initiated an incentives scheme to pay medical staff working in treatment centres a weekly bonus of 500,000 Leones (Le). The sum almost matched their monthly salaries prior to Ebola. This sizeable commitment has subsequently become one of the clearest failures of the response.
Corruption was a blight, at least initially, with the auditor general’s report finding that Le26 billion of incentive payments was dispersed without proper documentation. Health worker strikes over non-payments of this allowance have been frequent. Noticeable improvements have been observed since UNDP began administering payments using an electronic system in December 2014; but their claims that more than 90% of health workers are being paid on time are exaggerated. Even today, many health workers have only been paid in part, if at all.
The problem with payments was exacerbated by the fact that data was not readily available to compile a list of health workers. With hundreds of millions of dollars being donated to tackle the virus, funds should have been made available to draw up and verify such a list independently. The decision to end payments in March 2015, before the virus was even eradicated, indicates enduring insensitivity and failure to appreciate the risks endured by local health workers.
Recognition and reward
Local health workers were – and remain – the backbone of the effort to eliminate Ebola in Sierra Leone. At the peak of the virus international agencies were desperate for human resources above all else. Yet only 2% of all funds donated during the crisis went to the local nurses, doctors and burial teams.
Looking ahead, President Koroma has promised jobs for those who stepped up to play a role in countering the Ebola threat, but there is no clear plan for providing this employment. If the government really is well-intentioned, it could perhaps start by paying its health care workers better salaries.
Jamie Hitchen is a Policy Researcher at the Africa Research Institute.