Q: You were the principal of the National School of Midwifery in 2014, when did you first hear that there was Ebola in the country?

JS: We heard about Ebola in May. But we had started hearing about Ebola in other countries like Congo and then gradually in Guinea and then Zaire, and Liberia, of course.

Q: What role you did you play when you realized Ebola was in the country?

JS: Everybody was worried, but we were kind of taking things a bit lightly even though it was kind of scary. There were meetings organized by WHO and the ministry, but after a while we realized that Kenema started bearing the brunt of the disease, where we had colleagues, and we started hearing of people dying. It became very chaotic, and everybody was afraid. Everybody was worried about what would happen next. We were all obsessed with news about Ebola and what to do, how do we protect the students? We instituted hand washing measures. We also did awareness and sensitization, told the students to avoid touching, to be careful not to treat people at home, you know, even neighbors.

Q: And during that year and you were working with the students, and you started putting in measures to protect the students, did your role change over time, or did you remain the principal and that was your primary focus throughout 2014?

JS: No, my role changed. I was still the principal, but then all of a sudden when it comes to midwifery, and the maternity setting we had the announcement of a three day lockdown. The government and the ministry of health had teams of young people going house to house giving them hand soap to wash their hands, pamphlets, literature teaching people how to tackle Ebola.

I was invited to a meeting with the program manager of malaria control. I was there as a stakeholder in midwifery services. We started looking at different zones, who should be a supervisor, who should be manager, and to divide them, the different people, into different zones. I raised up a concern: “So three days lockdown. What would happen to women if they go into labor?” And I remember a colleague saying to me that we are not here to talk about labor. We’re not talking about women. Ebola is something that is very scary, so we would not be looking at that. And I said, but what if in the event, while the three-day lockdown, a woman goes into labor? And everybody sort of dismissed me. I didn’t push too much, but I left the meeting a bit worried.

Q: So what happened during those three days?

JS: The ministry put my phone number on a radio program. We started receiving calls from pregnant women to see maybe someone will say there is a woman in labor. We did a quick sort of training to say now we are going out to collect women who are in labor and maintain all infection prevention control measures. We had a thermometer, gloves, and delivery kits. The ambulance driver would lead us. But then some of the midwives would be in one vehicle, and then we also had another vehicle.

On one call for delivery the lady was a teenager in prima gravida. Her vaginal passage was very tight. There was no way she could push the baby out. I realize that, uh-uh, I will have to do an episiotomy. It was a very dark room. The nurses held onto the lamp and then I was able to see. I gave a quick cut, and the baby came out, and we were able to resuscitate the baby. Then we gave the woman antibiotic pain killer and taught her breastfeeding.

We had calls for about six women who were in labor. I started to realize that in a day’s time we might have maybe ten or twelve women in labor. You know, I said that I thought maybe one, two, three, but not as much as twelve. So we went around. Sometimes we had trouble locating their houses, but the ambulance driver was able to. It was a bit scary, like going to the unknown. The relatives are there. If a woman has a fever we do not deny her services. We just make sure that we take proper protection. Some of the women were not yet ready to deliver the baby. So we took them to the hospital, where they were triaged and screened.

We had to have meetings to teach people, to create awareness and sensitization. And then the other risk is that having have been out there for this you are thinking, okay, I’ve played my role. I’ve sensitized people how to protect themselves, but then you realize you are also putting yourself at risk. I worried that after all that when I went back home to the family. During those periods with my kids, no hugging or handshaking. It’s more hand washing. We instituted hand washing measures at home and also in the community where I live. In the hospital setting we had some midwives who were afraid to come to work. But the team that we were working with was more confident.

It was very traumatic period for us that we were living each day. Each day we lived on hope to be safe. And sometimes I would say to myself I haven’t touched anyone but what if I have sat on a surface that somebody has sat on? I said, no, I didn’t go to the hospital. I only went to the school. But then there are times when we thought the nurses are out. They are giving their best, so we need to be there to support them. I would say no, no, I think I need to be in the hospital. I made sure I put on a special shoe, and that shoe doesn’t go into the house unless I’ve washed it with chlorine. I would go to the maternity ward to check on the midwives, see how they were

Q: Well, this is an amazing story of your journey, and I just keep thinking how strong you were, how resilient, what kept you going? And from the beginning you said, well, what about the women who go into labor during the lock down? What do you think was driving you and that continued to drive you?

JS: So those of us who were leaders in the nursing field thought that if we break down this is going to be disastrous. We thought we couldn’t allow this to happen. There was a saying that when you have war it’s the military, and when you have disease outbreak it’s the nurses.

So we say that we are now the soldiers. I am a nurse, and this is the only way. I’m not necessarily putting myself at risk since I am more knowledgeable about how to protect myself. But what about the drivers who don’t know much about IPC? They’re also out there giving their best. And it gives you hope to say that if I go out there to reach out to others, to create awareness; if I sensitize them, then I will be able to save more lives. And then you get this inner—I mean, when you realize that the next day, oh, I’m alive, then you get this push to say then I need to be out there to assist. And the next day when you keep on doing the same thing. At first it’s scary to start, but the hope is that I’m doing all that I’m supposed to do. You say, okay, now we have just checked the temperature. She’s fine. I have my gloves. I have my decontaminant. I avoid unnecessary vaginal examination. I avoid unnecessary exposure of fluids.

Q: During that time you talked about how you educated your children to prevent infection, and you talked about not being able to hug your children. How long was it that you didn’t hug your children?

JS: It was months. I was not able to count because it’s strange. It’s like you are even afraid of your student, your children, and your children are afraid. I couldn’t even count. I was just praying for the day that they would say this is the last case. All we were waiting for was that they should say that we are freed of Ebola. I couldn’t count days. I couldn’t count months. I was so involved in terms of saying that all of us should stay alive that I was not even counting. For me, hugging and handing of things, you know, without washing the hands was, it’s a moment we have to survive. It was a moment of living. We lived through each day, each week, each month, not counting. I never had time to sit down and count. Mentally I was engaged, and I was like a mother hen trying to see that how to protect the family. And being on the frontline, my thinking was that I should not be the one who should bring an infection into the house. So when I’m out there, I make sure that I adhere to the universal precautional measures.

So being a mom, they understood. We used to tease each other, I mean to make light of the situation. When I came home my boys would ask me have you washed your hands? And I said, ah, now it’s the opposite. Instead of me asking you whether you’ve washed your hands, and then when I’m going out they say, “Mommy, be careful. Don’t touch people. We know you. You want to go.” But I think we used the moment—we didn’t touch, but we used the moment to sit as a family, and we would watch the TV. It gave us time to even reflect now, ooh.

Q: How do you feel we can best address complacency, and you know what to do if by definition universal precautions, you’ve said that this transcends everything? If we do that we’re saving people. How do you feel we can best combat complacency?

JS: I think, one, we have to strengthen existing structures. Presently, the Ministry of Health has put in place IPC focal persons, and I think IPC should be inbuilt, inbuilt. I think that it should become—IPC should be everybody’s responsibility. In terms of complacency I think we should have in place disciplinary measures, you know. And we should have in place refreshers. It should be inbuilt that anybody, any new worker, any new person that’s coming in, because you have nurses who are just beginners. I think we should have refresher training. We should have orientation where workers are inducted. We should also have infrastructural support. Compliance also has to do also with leadership issues. You have to have a leader who believes in IPC, a leader who promotes that at various levels. If you go to the laboratory, you go to the theater, IPC should be embedded in all of our activities, even the gate man, even from the gate, the gate man, the porter, everybody who’s a healthcare worker.

I think people should be audited sometimes – I don’t like to use the word audited, but I think people should be called to book. We should have committees where if something goes wrong there should be a committee where we could look at what went wrong. We need to support people out there, constant support. The reason why the complacency is also creeping in is that the structures do not hold over time. It has to be permanent. It has to be integrated at part of the services that we offer. IPC should not be just a unit. IPC should be all over, wherever you go.

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Dr. Joan Shepherd was interviewed for Frontline Nurses by Susan Michaels-Strasser on August 12, 2019 in Freetown, Sierra Leone.

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