Grazia Caleo of Médecins Sans Frontières (MSF) UK describes her experiences as a medical epidemiologist during the Ebola outbreak in Kailhun, Sierra Leone.
In José Saramago’s book, Blindness, he describes an epidemic of an unknown infection that causes people to lose their sight; a single person remains uninfected to bear witness to the anger, chaos, violence and death generated by the spread of disease.
In the novel, humanity’s descent into blindness represents the loss of reason, and shows how fear can cause dramatic social breakdown; at the same time, the clear vision of one person represents the opportunity to restore light.
What I saw in Sierra Leone as a medical epidemiologist reminded me of Saramago’s book.
I saw ‘blindness’ circulating in villages and amongst local and international Ebola ‘experts’; I saw wisdom among the patients who survived and the doctors and nurses who cared for them.
I saw the under-estimation of the risk and consequences of Ebola in an area bordering three countries; the fear caused by rumours; the late communication with villagers about Ebola and its spread; the huge numbers of patients dying in front of us without our being able to provide them with treatment; the missed opportunity to trace contacts and to apply the simple rule of previous outbreaks: ‘time, place, person’. All of these contributed to a blind response.
As an epidemiologist, I was in charge of setting up the surveillance system in MSF’s Ebola treatment centre in Kailahun. This included investigating where, how and when our patients had become infected; visiting their homes and informing their communities about what had happened; and making sure that all infected people were isolated and that any new cases were rapidly detected.
Villagers told us who had been first to be infected with Ebola; how, at the beginning, people were helping each other but how, later on, infected people were hiding in the forest out of fear and to avoid the stigma. For months, villagers were left alone to fight Ebola; many villages experienced a huge number of uncounted deaths.
As a medical doctor, I was also supporting the medical team to treat patients and focus on the most vulnerable. As a doctor, I felt helpless in the face of so many deaths, and amazed at being able to assist in patients’ recoveries.
We knew each patient in the line list: their village; their family; how they became infected; and, for most of them, the date of their deaths. We were able to reconstruct their relationships and calculate their risk according to exposure.
Each of them gave us a bit of light, helped us to think about how best to respond and where we should focus our efforts, and allowed us to understand the main driver of infection in those places. During my four weeks in the field, we admitted 119 patients, with a case fatality rate of 79 percent, and 17 patients who recovered.
The reality is that there is much more that could be done – in terms of data, human relationships and reason – that until now seems to have been affected by the collective blindness generated by this disease.
MSF is looking for qualified epidemiologists and doctors to support the Ebola response. For more information, please see: www.msf.org.uk
Grazia Caleo is a medical doctor and epidemiologist based in the Manson Unit of Médecins Sans Frontières (MSF) UK. She has just returned from working in the Ebola outbreak in Kailahun, Sierra Leone.