Working in an Ebola Diagnostic Lab in Sierra Leone
Story appeared in the 2015 issue of QMS Connections Magazine.
BY LEANNE SCHULTZ, OPERATIONS & HR MANAGER
Wash your hands in bleach. Lift your shoes so that the bleach sprayer can spray the soles as you step over the threshold into the Ebola Treatment Centre (ETC). Have your temperature taken. Are you feeling well? Do you have any cuts or scrapes?
Diana Bate attended QMS for two years from 1989 to 1991. She currently lives with her family in London, England, where she works as a Senior Specialist Biomedical Scientist in Virology at the Royal London Hospital. In March 2015, she travelled to Sierra Leone, the centre of the world’s Ebola outbreak crisis as part of the International Medical Corps to use her expertise and help make a positive impact on those suffering from the disease.
Walk to the changing area via another bleach foot bath, and change into scrubs and Wellington boots. You are now scrubbed in and can walk towards the lab which straddles the red zone where the patients are.
Outside it is 45 degrees, inside the air conditioned lab it is a balmy 35. Don a pair of gloves, a coat, a second pair of gloves. You are now ready to work with samples from suspect and confirmed Ebola patients. And so begins another day at the Mataneh Ebola Treatment Centre outside Makeni, Bombali District, Sierra Leone.
In 2014, Public Health England was involved in setting up diagnostic labs in partnership with Ebola Treatment Units in Makeni, Kerrytown, and Port Loko. As the initial symptoms of Ebola are non-specific and could be attributed to many other things including malaria (very common in West Africa), it was important to be able to tell patients who had Ebola from those who did not early on to prevent further transmission and get them the right treatment. As the outbreak subsides, the labs are still important to confirm any new cases and to ensure quick contact tracing for any new positive case to prevent an outbreak rebound.
When the first call for lab staff came out in September, I was keen to go and help, but my husband, understand-ably, was much less keen on the idea of my going and leaving him in charge of our rambunctious but adorable two year old daughter. As time went on however, we both realised that I could be a big help as the work is essentially what I do everyday in my job as a Senior Specialist Biomedical Scientist in Virology at the Royal London Hospital, London, UK. My boss wanted to send one person a month, so I applied to be a part of the March team for a five week deployment to give us ample time to prepare the home front for my extended absence.
After the teary (on my part) good-byes, the cab ride to the airport, the realisation setting in that I was flying into a hot zone, and an all night flight via Casablanca, I was finally dropped off in a hotel, told that nobody else was staying there but they didn’t know where to put me, with no money, contact details, or any idea of where I was. But everything improves with a nap, and I was shortly united with my lab team, and getting ready for my first shift at the ETC the following day. And here is a good lesson for those interested in humanitarian work: be flexible, and go with the flow!
Using blood samples or swabs, we test for the Ebola virus by performing a diagnostic Polymerase Chain Reaction test to amplify part of the Ebola genome, so it can be detected even where there is a small viral load. We also perform a malaria antigen test. Safety is paramount, and once receiving the triple-contained samples and decontaminating the outer packaging, we transfer the samples into an isolator, which is a sealed box with sleeves and thick gloves to allow safe manipulation. When in the isolator we are working with small vol-umes under three pairs of gloves, the middle layer like a dishwashing glove. We inactivate the virus so that the sample is safe to open on the bench where we isolate the viral RNA and perform the PCR reaction and detec-tion. What may take an hour in a lab in the UK can take three with the limitations we have with the isolator plus our safety procedures.
The work is very demanding with a lot going on in the lab, working in the heat with very few breaks. But it is very rewarding, as our results enable the separation of Ebola positive and negative patients for treatment, and confirming recovery. Once a patient is confirmed Ebola positive, they are separated and treated appropriately. While Ebola Zaire (the subtype of the current epidemic) has a 70% mortality rate, if patients are identified quickly, their chances of survival increase dramatically. Once a patient has two consecutive negative results they are discharged. The discharge ceremony is very moving for survivors: they place their handprint on the survivors’ wall, then they proceed with dancing and music out to the psychosocial team (in colourful scrubs), which helps with re-assimilating the patient back into their village life. It is often very bittersweet, as many patients have lost spouses, children, parents, and other close family inside the ETC. But seeing one patient leave, due to the efforts of everybody working at the ETC, is very rewarding.
Two consecutive negative results is cause for celebration. Discharged patients place their handprint on the survivors’ wall, followed by dancing and music.
QMS Service Day
This year, on Earth Day (April 22, 2015), the School held its first QMS Service Day in recent years.
Students from Kindergarten to Grade 12 participated in service projects on campus and throughout the Cowichan Valley. The school’s younger students were well organized by Alexandra Johnston and Olivia Copeland as part of their Grade 9 Leadership Class duties. Split into different teams, they undertook campus clean-up and improvement projects like planting new grass, pulling ivy and other invasive species, and cleaning up in the Equestrian Centre. These students also participated in the creation of a mural to celebrate Earth Day. Students in the Senior School participated in service-based outreach pro-grams with five different community services: Cowichan Green Community, the MS Society, Clement’s Centre, the Raptor Centre and BC Forest Discovery Centre. Head of School, Mrs. Wilma Jamieson, notes that, “Service is such a fundamental part of our culture here at Queen Margaret’s School. Although our students and staff are generous in their service to others throughout the year, I can think of no better way to honour the school’s motto of “Servite Fortiter” by dedicating this one day to service. I am looking forward to continuing this new tradition for many years.”