Q: Can I ask you: when was the first time you heard of Ebola?

MLP: The first time I really heard of Ebola was the time when there was Ebola in Sierra Leone. I had never heard about it before. And as a matter of fact, when I was asked to go to Sierra Leone I was a bit scared, because I really didn’t know what it was all about, and the risks that one would take, that I was taking, to come into the country which had just gone through and was still going through that epidemic.

Q: Later, when you returned to Sierra Leone after your holiday trip to Malawi, were there nurses who had died from Ebola that you had known?

MLP: Most of them I didn’t know then, but one thing I learned was that actually most of them who died were really the frontline nurses, the second level, the enrolled nurses who really do provide bedside care. Those were the ones that died, in majority, and, of course, some of the doctors, too. And we had the opportunity to visit the hospital where the Ebola started, in Kenema, where they have a statue for all those who died, so you can read their names. They are there.

Q: Who did the statue? Who put up the statue?

MLP: I think it was put up by the government itself, Ministry of Health.

Q: There were that many nurses that had died.

MLP: Yes, the number was about 222, although some think that maybe some were not recorded. And most of those were recorded were the ones maybe who were officially employees of the Ministry. Very sad story. Sad. Sad in the sense that nursing lies in caring for people, and if you can’t care you’re not doing anything. And then if in the process of caring you become a victim yourself, then it’s really a different, tragic story. And it was, I think, because of that that one of the priorities during the—when the epidemic had just started, and even in the course of recovery, was how can we make sure that people, especially providers themselves, are protected. How do we do that? And that was one of the key interventions in the process of managing the Ebola itself.

Q: So then with Ebola, the outbreak and the rapid spread around, what was your sense of how communities saw nurses during Ebola time?

MLP: Communities saw nurses, on average, as their sources of hope, in the sense that you see you have this group, which you will call state-enrolled community health nurses, and that group works right in the communities, so they are really part of the entry-point into the normal or formal healthcare system. And that’s why most of them, it’s that category that died, because of their closeness, one, to the communities, and also really working as formal frontline health workers. I think the nurses did a great job in terms of providing the care and the information, the health education, community awareness-raising about the disease, as the group that is closest to them.

In addition to that, in Sierra Leone, nurses form more than seventy percent of the healthcare workers. They’re the majority, so every program you go through, they’re the people that are literally manning the interventions. What I’m trying to say here is that the community relied on the support from this group, right at an entry level point in terms of if they were sick or whatever, those were the people that actually provided the first line of care.

Q: In looking at what were the lessons learned and where to go forward, maybe you could talk about that a little more from the perspective of nursing. What were missed opportunities to not have nurses at leadership, or were there—in structuring a response and then going forward? What do you think, looking back at this? You said some things you think were really important changes.

MLP: Having appropriate knowledge and skills is key. So is putting in place communication systems for proper coordination. Thirdly, availability of the required resources: drugs, utensils, PPEs – appropriate ones, not ad hoc. And fourthly, really giving recognition to people when they’re doing such a great job, because it was a risk, a real risk for those who helped and still survived. I think they need to be thanked or recognized professionally, to say, “You made a difference in the lives of people.” The last is to promote working as a team, because no single professional group can solve all the problems, and I think the nurses dutifully recognized that. They didn’t think to say because we’re in charge then we can work just on our own. No, they did everything involving the communities, the patients themselves, telling a story to say, “You know what? We feel bad about the patients themselves, because of the restrictions of infection prevention.” These people still needed to be seen by their relatives, just to say hello. And they devised means on how they can still communicate, and allow them even to pray, which I thought was, wow, yes. Those were some of the things that give hope to patients, yes, that they still felt, oh, not all is lost. So putting in some of these human touches, things that may not be prescribed in the book, but that show, as people, what do you stand for?

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Margaret Loma Phiri was interviewed for Frontline Nurses by Jennifer Dohrn on August 14, 2019 in Freetown, Sierra Leone.

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