Q: What was your position during the Ebola epidemic?

IK: I’m a senior matron, Ministry of Health and Sanitation, and I was coordinating the Ebola holding cell, holding unit, at Connaught Hospital. I’m a nurse by profession.

Q: What were you doing during the Ebola outbreak?

IK: In Freetown after the training, we decided to establish an isolation unit and found two rooms in the outpatient section of the hospital that we used to isolate patients. We started. Our first victim of Ebola was in May 29, 2014, an Egyptian who was a doctor working at one of the Arab clinics. At that time, the patient was brought to a facility and we isolated him. There was also rash, no hand-washing hygiene, and only a few of us had [prior] knowledge of what a hemorrhagic fever should look like.

Patients started coming. Suspected cases. The seven beds were not enough. We decided to extend it to twelve. Still it was not enough, because it was the first holding center for the Western Area. And we expanded it to twenty-one. One of the committed nurses came to my office and said, “Matron, you are our boss, we cannot sit down and allow you to go into that place doing all the work,” so some of them decided to join me. They were trained by King’s.

Since some of the patients were so weak that they were not able to walk, we organized a bucket system and trained hygienists. They would clean the patients and take the rubbish to the incinerator. We decided to have surveillance officers, advocates to look for symptoms and then we set up the criteria: fever above thirty-eight degrees centigrade, redness of the eyes, sore throat, cough, bleeding gums, vomiting of blood, cough, rash, diarrhea, and then difficulty breathing, and so forth.

We started treating some of these cases symptomatically: for fever we give analgesic, for diarrhea oral rehydration salts, and then antibiotics like ceftriaxone. Vitamins. Antimalarials. And encourage them to take fluids. We lost about twelve of our staff, four doctors, eight nurses, two hygienists, one of our maintenance officers. And a finance officer.

Q: Thank you. This is very powerful. Can you tell me a bit about becoming a nurse? How that began and how that led up to where you were at Connaught?

IK: I was born in a village called Malikenkambia district. My father was a courts messenger and my mother a farmer. I came from a polygamous family, twenty-five in number; my mother was my father’s first wife. In 1974, we came to Freetown, and I started school. I passed with flying colors. I entered the School of Nursing in 1983 and graduated in 1986 as a state-registered nurse. I have worked around the country. I have attended several courses in Africa, in Asia, in South America. I’m also an administrator. I entered University of Makeni in 2006 and graduated in 2010 with a BS in human resource management. Then I went to the school of public health in Ghana and earned a certificate in epidemiology and health system management. I did sexual and reproductive health and family planning. I have a certificate for that and as a trainer for Ebola. In 2017, I graduated with a master’s degree in public administration. I’ve been a nurse for the past thirty years.

Q: You shared a very vivid story about the period of time that you worked between April and November of 2014. And the lead-up of that, how you became a nurse. What kept you going? You talked a lot about stigma, about people dying, colleagues dying. What kept you going?

IK: Well, I had a passion for nursing. I think my greatest opportunity is here, because not all of us will leave the shores of Sierra Leone. Some of us have to serve, we are committed to serve our people. And I think one of the keys to success is hard work, humility, integrity, and a passion for people.

Q: Can you talk a little bit more about that passion for people?

IK: Well, since I was a little girl my father had a keen interest in nursing. He said that I should become a nurse. I decided to listen to the words of my late father. I decided to become a nurse because I have passion for people.

Q: Do you think he saw something in you, your father?

IK: Well, my father Muslim, so I think that humility stems from my father.

Q: At one point there was a lockdown? What did that include?

IK: Well, for the lockdown, community members were involved. They were told to go out and look within their communities for suspected cases. At the Ministry of Health, ambulances were dispatched. They saw a lot of suspected cases. Some of them tested positive and were transferred to treatment centers. During the lockdown, more holding centers and treatment centers were established.

Q: It sounds like that first period, April to September, was very different from September, October onwards. Those first few months were very different from those latter months.

IK: Yes, because the public health emergency issued a public notice that nobody should travel to the other regions. You should stay where you are. And for public transport, there should be no overcrowding. Because some were taking six per car. They reduced it to four. And for the bigger transports, they reduced the overcrowding. And then there should be no market days on Sundays.

Q: And when was that started?

IK: In August. At the peak of the epidemic, people were disallowed to eat bushmeat, and handwashing buckets were set up in all establishments: whenever you go to the bank, you go to the public value schools, you have to wash your hands when you enter; when you are coming out, you wash your hands. It was one of the protocols. And hand sanitizers were shared all over the place.

Q: Once people saw survivors, can you describe what then started to happen?

IK: Luckily some of the survivors were nurses, and they started working in the units, immediately they were much better, recovered. They joined the team. And so that was a sense of relief and hope to the other patients.

Q: You use the word hope. Can you talk about that a bit more? Amongst the nurses, what did you see when you said there became hope?

IK: Hope, because for me to be able to survive over eighteen months working with Ebola and not acquire the disease, it was a big hope for some of the nurses. Because you’re constantly telling them that whenever you enter the unit do the right thing. Handwashing. That is one of the keys to success. Wash your hands frequently. Don’t touch, wash your hands. Wherever you are, wash your hands. Use sanitizer. But handwashing I think is the best.

Q: You spoke a lot about your experiences right at the front line with patients, with your family, with community. Can you describe how you emerged as a leader?

IK: Well, I think one of my habits is to exert influence on my nurses.

Q: Influence?

IK: Yes. Because when you mentor you have followers. When you lead others will follow. And as an exemplar leader, you have integrity, they have faith in you. You are relying, you are responsible, and there is dignity and respect for your colleague. So you are able to lead. And then they appreciate the recognition. You recognize them for their good work. You encourage them.

Q: Where do you think that came from? Your leadership qualities. Where did that come from in you?

IK: I think a background in management helped me a lot. Because managing people in an organization, you have to look at their behavior, positive behavior, negative behavior. You have the good eggs and the bad eggs. You use the good nurses as change agents. You dialogue with them, you manipulate them, you give and take. And correction should be a last resort. I don’t think that correction should play a role in leadership. You encourage them, you listen, you have to be a good listener. You pick out the good things and use them, you see. Communication. Effective communication. Let them talk.

Q: Sometimes being a leader is lonely. Lonely. Who was around you supporting you?

IK: Well, I have my senior nurses. I’m not a perfectionist, I have my own weaknesses. Some of them would say I like to shout, but within a few minutes it’s all over. The next day, even if you don’t talk to me, I’ll go to you. I will meet you. Being a leader, you have to be submissive.

Q: Incredible. What is your proudest moment throughout this experience?

IK: I thank God for serving me through this ordeal, because I’m not better than my colleagues who died during the epidemic.

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

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