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made valuable contributions towards.
The basic principles of treating Ebola
are to maintain electrolyte balances
and hydration, while warding off other
infections and hope that the patient's
immune system can overcome the virus.
Balanced against that are demands and
issues such as analgesics and antipsychotics
(necessary especially in the later stages
of the disease) or palliative care as well as
making decisions on other medications
-- should all patients receive malaria
prophylaxis? Should HIV patients continue
to receive ARVs? How should pregnant
patients be managed?
Contributing expert opinion to these and
countless other questions, the pharmacy
department became a strong pillar
of stability in the facility amongst the
near-constant turnover of clinical staff.
Later, Claire Liew -- another UK pharmacist
-- led research efforts in the ETC,
looking at patient safety and treatment
adherence with great effect. All of this
was done of course in one of the most
surreal environments any of the staff had
The work was intense -- in the course of a
day, a pharmacist might attend a morning
clinical ward handover meeting, go to
the daily logistics briefing, head into the
red zone to look at treatment charts and
patient safety issues and finish their day
with a few hours in a shipping container
moving boxes and counting stock. All of
that was completed under the spectre of
a scary, invisible and deadly virus.
Being able to see the infected patients
provided a good incentive to adhere to
the intense infection control protocols
in place, but even this was difficult when
everyone was required to wash their
hands up to 40 times a day or more.
All staff members had their temperature
taken a minimum of three times a day
and were expected to take their own
temperature at least twice more.
The nature of the work and the threat
of infection meant stress levels were
high for the entire time. It was fortunate
that the pharmacy also developed a
reputation as a haven for staff, where tea,
coffee and biscuits were available to all
who wanted to pause for a few minutes.
There was also the personal side of the
disease. Even the survivors often faced
terrible circumstances. One of the most
harrowing episodes I saw was that of a
young woman who lost first her husband
and then her unborn child (the survival
rate of unborn children in pregnant
patients is understood to still be 0%).
She survived but it is impossible to
comprehend the difficulty she faces
trying to rebuild her life.
There were also uplifting moments --
when an unaccompanied four year old
girl was admitted to the facility, there
were grave fears for both her health
(the survival rate of under-five-year-olds
at that time was perilously low) and her
welfare. Staff can remain on the ward for
only 30--45 minutes before the effect of
the PPE gear becomes overwhelming
and constant supervision of children is
simply not possible.
Another patient on the ward -- a middle
aged woman who had recovered and
could have been discharged -- refused to
leave, choosing instead to stay on
the ward to care for the girl for four
additional days. They both recovered
and walked out together. It brings tears
of joy to my eyes even writing about it
eight months later.
Pharmacists play a vital role in
emergencies. While we are unlikely to
see an outbreak of Ebola on this scale
again, when the next major disease
or crisis takes hold, pharmacists in
Ebola-infected countries once again
showed they should be on the first
From Sierra Leone, Claire Liew travelled
to Nepal in the wake of the earthquake
there, to apply her broad skills in a
Whilst the role of pharmacy is of course
only a single spoke in a large wheel,
it is a critical one. Without it however,
the wheel would be a wobbly one.
They did something right -- over the
course of the ETC's active life, the
survival rate improved from 30% to
well over 70%, even with the limited
resources and rudimentary facilities
available. From an active staff of over
500 -- including dozens of international
staff, only one staff member (UK nurse
Pauline Cafferky), was infected with
Ebola. One Cuban doctor tragically died
of malaria in early 2015. It was one of the
most difficult days in the ETC.
On a broader scale, the rate of Ebola
transmission was slowed and then
halted altogether. Today, Liberia has
eliminated the disease, whilst Sierra
Leone and Guinea are close to doing so.
It is an effort the pharmacy profession
should be proud of.
ˆ Michael Nunan with ETC staff
ˆ Michael Nunan in full kit
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