The West African Ebola outbreak has been the largest, most severe and most complex in human history. For more than a year, people from all over the world have answered the call to work with WHO to overcome this outbreak. Starting from the initial detection of the outbreak, to the arrival of the first responders, to the overwhelming spread of cases in West Africa, to the moment when cases began to decline, "The Ebola Diaries" is a series of first-person accounts describing what it has been like working on the front lines of a global health crisis of unprecedented proportions.
Dr Pierre Formenty recounts how he received word of a cluster of cases in Guinea thought to be caused by Lassa virus but with features that made him very concerned that this was Ebola virus disease, and how urgent testing revealed it was in fact the first ever outbreak of Ebola Zaire in West Africa.
Dr Stéphane Hugonnet, one of the first WHO experts sent to Guinea to investigate cases of Ebola reported in late March 2014, is a medical doctor who has spent the past 20 years working for WHO, MSF and others. He has managed outbreaks ranging from cholera to Ebola. Dr Hugonnet found a very different sort of outbreak when he arrived in Guinea.
Jose Rovira-Vilaplana, a WHO logistician, was in the first WHO response team to arrive in Guinea in March 2014. Logisticians are the “doers” – they make sure everything is in place so that a response can take hold. Their work includes overseeing construction of treatment centres, taking swabs from the deceased for laboratory testing, and garnering support for necessary outbreak activities.
When the Ebola outbreak was confirmed in late March 2014, Rob Fowler, a Canadian critical care physician from Toronto, was part of the first clinical response team to deploy to Guinea. In the months to follow, Rob worked at an Ebola treatment centre, focusing on treating dehydration, organ dysfunction and shock to drive down mortality rates.
Cristiana Salvi recounts the early community engagement challenges at the end of April 2014. In Guinea communities had begun to hide family members, fearing treatment centres, believing rumours Ebola response teams were there for sinister purposes. As a risk communications specialist from WHO’s European regional office, Cristiana was among the first to provide social mobilization support.
Dr Cota Vallenas talks about her experiences in the early days of the Ebola outbreak as an expert in infection prevention and control. She reminds us that health-care workers are among the most vulnerable and a cultural change is needed around self-protection to ensure these frontline workers don’t become infected.
As the WHO emergency focal point for West Africa, Dr Ngoy Nsenga is one of the first to be deployed to regional emergencies. Dr Nsenga went to Sierra Leone to help assess emergency response capacity. Originally from DRC, Dr Nsenga quickly realized that the few cases in Kailahun could quickly become a serious health emergency.
Aminata Kobie is a health promotion officer in WHO Sierra Leone Country Office. When the first Ebola cases began to appear in May 2014 in Sierra Leone, Aminata travelled the countryand spent months at a time educating health workers and the public about Ebola and visiting resistant communities where Ebola cases continued to occur.
Mikiko Senga, a WHO epidemiologist specializing in emerging diseases, was sent to Kenema, Sierra Leone in early June 2014 to gather data about the Ebola outbreak. She found herself trying to make sense of information presented in a variety of ways – from bits of paper to blood samples to incomplete hospital records. She soon realized this outbreak was about to catch fire.
Chris Lane, a water resource engineer and specialist in water pollution control, has worked for Public Health England since 1995. When the Ebola outbreak began, he was deployed through the Global Outbreak Alert and Response Network to work with WHO in Sierra Leone. In Kenema, he found an outbreak so complicated he had to do much more than epidemiology and surveillance.
Jim Strong and Allen Grolla, two Public Health Agency of Canada lab scientists, had worked in previous haemorrhagic fever outbreaks. They deployed through the Global Outbreak Alert and Response Network to work with WHO in Guinea and Sierra Leone. As they began testing specimens, they realized they were in the middle of something much bigger than any outbreak they had seen before.
Cheikh Ibrahima Niang, a professor of medical and social anthropology at the Cheikh Anta Diop University Senegal, has researched anthropological aspects of health issues. In July 2014, WHO asked him to investigate community attitudes to Ebola virus disease. He led a team of anthropologists to Sierra Leone just as the outbreak exploded in the eastern part of that country.
When Leticia Linn arrived in Monrovia, Liberia, in July 2014, most people were not taking Ebola seriously. Denial about the outbreak was widespread. A communications expert, Leticia worked with the Ministry of Health’s team to liaise with the media and inform the public about the disease. When Ebola cases tripled in Liberia, Ebola denial turned to fear.
When Dr Olushayo arrived to coordinate the WHO Ebola response in Sierra Leone one year ago, he found not only an outbreak on a scale beyond his worst imaginings, but myriad problems that needed complex solutions.
Erika Garcia, a WHO epidemiologist, deployed to Nigeria in August 2014. She recounts that the key to containing the Ebola outbreak in Nigeria was strong leadership, good coordination and availability of resources.
Marie Claire Mwanza is a social mobilization expert from the Democratic Republic of Congo. Prior to the outbreak in West Africa, she helped end 5 outbreaks of Ebola virus disease in her country. She and 60 colleagues went to Guinea to support the outbreak response there.
Dr Carmem Pessoa, an infection control specialist, was first deployed to Liberia in September 2014 when the Ebola outbreak was at its height. The number of people ill with Ebola greatly outnumbered the number of treatment beds. People needed help to safely care for their relatives and friends while waiting for an ambulance.
A WHO logistician Francis Mulemba was first deployed to West Africa in March 2014 to respond to the fifth Ebola outbreak in his career. Five months later, he was sent to Monrovia, Liberia, to support training of the national burial teams. He said that situation in Liberia was unlike any other Ebola outbreak he had experienced before.
Ian Norton is an emergency physician who came to West Africa in 2014 to help find and coordinate foreign medical teams to treat people with Ebola virus disease. Under Ian’s guidance, WHO developed a registry of foreign medical teams around the world able to respond rapidly not only to Ebola but to other health emergencies.