Q: Who trained you?

MF: I was trained by WHO. We were the first set of nurses that were trained. Within the first week, we were trained before we were sent out. We started training in Freetown. So we went, and I trained them, crash training within two, three hours telling them what to do, the safe areas, how to handle the cases. We left and went back to look if the sister was getting a little bit better because she was having a drip and so forth. By the time we returned to that center, it was filled up. People were outside vomiting—you name it. We were so overwhelmed, I cried that morning—that afternoon when I stood out in front. It was now the soldiers, because we had some soldiers with us, who closed the doors so that people would stop bringing people because the whole compound was already full.

We went to Kono as well, Tonkolili, so we went. We are also doing some radio discussions in the night for people to understand. We went to the schools, we did some crash training again with the tutors who we had there and the students who we had there. So I came back to PCMH [Princess Christian Maternity Hospital]. Again, the Western Area, I was deep in the Western Area, Eastern. We had these people who were in the community that we are notifying, went from house to house.

Q: During the Ebola period, could you paint a picture of how things changed over time, how the nursing changed?

MF: When we heard about the Ebola—in fact, we were all scared, everybody. Because it started in Kailahun, the far east, with a case that came in from they said Guinea or so, and the nurse who was there died. So, we had this case, and we were all scared. We started reading about Ebola and so forth. So, what happened, some people really stopped coming to work. It became harder for us to sustain the nursing care to even those who were not Ebola cases. In fact, the nursing care was stopped. Some of us stopped coming to work unless they were very eager, you know? So, what happened when we started with that, the whole place, in fact some hospitals, they stopped working. So, there was no policy on Ebola. We never knew anything, no strategy, no nothing. So, for the reproductive health, we closed our office and worked together with WHO to develop a policy for Ebola and a strategy with WHO. So, every day, we spent some time with WHO before we went back to the office. So, we started with that development and then I think when expats came in, that was when they started training us on Ebola how to prevent and so forth. How to treat and so forth.

Q: And from the beginning from the first cases to becoming a stable situation where more health workers came back, how long did that take? How many?

MF: I think after the first month, because in the first month it was like chaos. After some time, they said the soldiers will be at the at the lead EOC [Emergency Operations Center]. Then we are now monitoring everything throughout the country. The district council chair people made rules and regulations like there was a barricade. If you are coming into this district they have to monitor you, you must answer some questions and so forth. And they have to know where you are going to stay so that they will make a follow-up for the first two, three days. So that was very good. Like for Pujehun district that was when we had only two cases in Pujehun district, you know, as soon as that was set up. And every road, the one from Liberia, the one from Freetown was blocked. They had people sitting there twenty-four hours, ensuring that whoever comes in is checked up.

Q: What kept you going?

MF: We learned that the nurses were looking up to us. If we leave, what happens? So we stayed. We stayed and we looked for opportunities. We went to meetings. And we started this policy book, and putting things together.

Q: Who’s training the doctors now?

MF: Everybody. They are training the doctors on surveillance. We have asked them that nurses can also be surveillance officers, and they will be the best surveillance officers. But most of the training is for doctors.

Q: Because nurses are primarily women?

MF: Yes. And women are considered third class, not even second. [laughs] No. Well women are second class, yes. But they forget that if the nurses don’t work, the doctors will not work. We can do some work that the doctors do, but they will not ever do the nursing. They don’t know how to do it.

Nurses are found everywhere wherever you go in Sierra Leone. Even if you go to the last village, you find a nurse there. So if you don’t train that nurse to pick up things from that area, when will the doctor in Freetown or Bo or Makeni get to it? So if we don’t train the nurses, the diseases will keep coming up. In fact, the time they come up they will now take us in the next few years—if we don’t stop doing that and showing that the nurses who are at the far end are aware of these things, and they can recognize it, and they can do something about it, then we’ll be ready for disasters all the time. Where the big doctors will be now to write the books and so forth. But the actual workers are right here in the field who are the nurses.

Q: What are those things that rise to the top of your mind that are the most important that World Health Organization needs to know?

MF: The knowledge of Ebola must be not only for health workers but for everybody. And not only Ebola, but all the hemorrhagic diseases and so forth. Nurses must have not only crash trainings but continued training, because your mind relaxes as time passes by. It can even become a degree, a course that nurses can go and do. The training needs to go on. It should not stop, because as we are seeing in Congo, Ebola comes day and night, in and out. We should be sure that every hospital, even once a year, goes through that Ebola training again.

We should also not forget about waste disposal. When you go to some facilities, the incinerators, are burnt out or broken, and then these infections can crop up again. We need to ensure the management of waste in the facilities, and even in the communities. Number three is surveillance. We don’t have to sit down to wait for disease to come and greet us. We have to go and look out for them. So to summarize: the trainings have to continue, we have to continue looking at our waste management, and we have to look at surveillance. They are training doctors, doctors, doctors. Well, who sees the cases first? The nurses. And we should ensure that nurses can now identify infection, they can sort them out and bring them to the doctors.

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Mary A.M. Fullah was interviewed for Frontline Nurses by Susan Michaels-Strasser on August 12, 2019 in Freetown, Sierra Leone.

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