Abstract
BackgroundThe 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. Health workers play an important role during epidemics but there is limited research on how they cope during health epidemics in fragile states. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts – Bonthe, Kenema, Koinadugu and Western Area - of Sierra Leone.MethodsWe used a qualitative study design: key informant interviews (n = 19) with members of the District Health Management Teams and local councils, health facility managers and international partners; and in depth interviews with health workers (n = 25) working in public health facilities and international health workers involved with the treatment of Ebola patients.ResultsThere were several important coping strategies including those that drew upon existing mechanisms: being sustained by religion, a sense of serving their country and community, and peer and family support. Externally derived strategies included: training which built health worker confidence in providing care; provision of equipment to do their job safely; a social media platform which helped health workers deal with challenges; workshops that provided ways to deal with the stigma associated with being a health worker; and the risk allowance, which motivated staff to work in facilities and provided an additional income source.ConclusionsSupportive supervision, peer support networks and better use of communication technology should be pursued, alongside a programme for rebuilding trusting relations with community structures. The challenge is building these mechanisms into routine systems, pre-empting shocks, rather than waiting to respond belatedly to crises.
Highlights
The 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts
In this study we explore the challenges faced by healthcare staff working in government facilities, which took on the brunt of managing the Ebola Virus Disease (EVD) outbreak, and their coping strategies in four districts of Sierra Leone: Western Area, Kenema, Bonthe and Koinadugu
These reasons included: death, one from EVD; unwilling to participate in the study; health worker working in a different health facility that is not in the chosen four study districts; and health workers away from their work stations at the time of the study
Summary
The 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts – Bonthe, Kenema, Koinadugu and Western Area - of Sierra Leone. In Sierra Leone, the Ebola Virus Disease (EVD) outbreak, which started in 2014 and officially ended in 2016, evolved in alarming ways, spreading nationwide. The country struggled to control the escalating outbreak against a backdrop of a health system that was already over-burdened [1, 2]. Being a post-conflict country, the health system in Sierra Leone can be described as fragile and sub-optimal in the face of a disease outbreak as shown by its poor health outcomes. An unprecedented number of health workers were infected, with an estimated 221 deaths [4], which is an estimated 21% of the overall health work force in Sierra Leone [6]
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