We arrived on a Sunday night in Conakry in a three-quarters empty Air France flight from Paris. We were met immediately by a WHO [World Health Organisation] logistician and taken directly to a nearby hotel, and the next morning we attended briefings at the WHO office.
On the Tuesday, we and all our gear took a short flight to Kissidougou, a two-hour drive from Guéckédou, where we were to run the European Mobile Laboratory (EMLab) for testing patients’ samples for Ebola and malaria.
Coming in to land, the landscape below us was a vast patchwork quilt of bright green vegetation, with terracotta-coloured dirt paths, that we later discovered were the roads, weaving in and around these forested areas, linking small villages to each other and to the network of estuaries and rivers. It dawned on us only then that we really were just about to land in the middle of nowhere.
Settling in the lab
We unloaded the gear from the plane into the jeep that was waiting for us at the end of the runway, much to the interest of a local family who had gathered to watch the plane come in.
We were driven to Guéckédou, where we met the team we were replacing at the European mobile lab. It is in a small maternity-ward building within an old cholera hospital. Nearby, the Médecins Sans Frontières (MSF) tents sprawled out, meticulously divided into wards separating suspected and confirmed Ebola patients.
We were impressed by the decontamination procedures required for entering and leaving the isolation wards. In specific areas, hundreds of single white welly boots dried on wooden poles, and bleached washed scrubs hung on washing lines dotted around this clean area.
In a situation like this, communication is everything: we have to ensure that everyone involved is on the same page and is kept updated with changes and any developments. My team spent the first two days overlapping with the existing team and we ran through the assays, or tests, as well as the changes that had been made to protocols to streamline our procedures.
I spent most of the time with the outgoing team discussing the challenges they had faced and what we might expect, and meeting all of the MSF and WHO ground staff on the site who I would be liaising with several times a day.
Surge in Ebola cases My team happened to arrive just as the number of cases began to surge
, so from the outset we were extremely busy. For the first two weeks, we were working on average 16-hour days to ensure we got results back to the hands of the MSF ward doctors.
Having that information meant they could move suspect patients to the confirmed ward, or else make room for incoming cases by sending confirmed negative and convalescent patients home.
The one thing we all fear is sending someone positive home, or transferring someone negative to the confirmed positive ward. This is why communication between EMLab and the MSF doctors is so crucial, and why we test patients several times before they are released.
The system has proved effective and thorough, despite the pressures of new patients being brought in by MSF ambulances throughout the day. I am still in awe of the MSF ground staff and the professionalism and dedication they have to patient care in such inhospitable conditions.
Improving safety
The main challenge we found early on was the way in which some patient samples from the community were given to us; they could come in as tubes of blood wrapped in plastic bags, or wrapped in old noodle packets.
Given the hazardous nature of the contents, it has required a concerted effort to ensure that patient blood, or swabs from people who have died in the community, are packaged appropriately and safely.
This is vital to ensure that everyone along the chain – from taking the sample, transporting it and testing it – is put at as minimal a risk of exposure as possible.
The EMLab teams have worked closely with all involved to ensure this happens, and we have provided all the necessary secondary containment tubes to ensure we don’t get nasty surprises. It is really satisfying when you see these small but extremely important changes being implemented within a short timeframe.
The team (Claudia Köhl from the Robert Koch Institute in Berlin, Lisa Oestereich from the Bernard Nocht Institute in Hamburg and Joesph Akoi Borè and Raymond Koundouno, two local Guinean scientists working with EMLab) are great and I am very lucky to work with such hardworking and lovely individuals.
Keeping busy is the best recipe for maintaining morale, and busyness is something that has not been in short supply.
Last Sunday I gave the team a morning off; our first break in two weeks. It allowed us all to wake up to a sense of normality for a few hours, and it really gave the team a well-earned rest.
More frontline help needed
My opinion is that it seems as if everyone has underestimated the explosive nature of this Ebola outbreak, and that after having had some initial control of the outbreak, we are now at least one step behind it.
When you are on the ground, you see what is happening: you see the local situation and how a smouldering situation can easily burst into flames. West Africa needs help. From my perspective, it is clear there are not enough medical staff on the ground, nor enough people on the frontline to handle the numbers of cases as they continue to increase.
MSF is doing an amazing job juggling the resources at its disposal, but it is simply wrong that the people at the frontline do not have the actual “here-and-now” support they need.
European governments – including the Irish Government – need to provide more trained nurses, more doctors and more hygienists. They simply need to do more.
I understand that working with Ebola can be a big deterrent for many medical staff, but those who are willing and able to assist should be completely supported by their own governments to do so, and to do so now. Ebola is not simply going to go away.
In conversation with Claire O'Connell
Dr Christopher Logue is a senior virologist within the Novel and Dangerous Pathogens training group at Public Health England (PHE), Porton Down. He is in Guinea to work with the EU-funded European Mobile Laboratory (EMLab) project.
