Who cares for the carers?

Natalie quit her nursing job at Basingtoke Hospital, in October 2014 and volunteered at the King’s Sierra Leone Partnership, an organisation backed by government money, that was sending clinical staff to Sierra Leone. Nat was one of over 150 NHS volunteers who responded to the threat of Ebola, the viral disease that by late 2014 had killed 1,400 in Sierra Leone.

Tens of thousands of people from Britain volunteer overseas each year and in some cases they can face extremely challenging conditions. Nat had been waiting for an aid opportunity, but there was nothing that could have prepared her for the stifling tropical heat of the hastily assembled hospital ward in Freetown, where the Ebola Holding Centre was located.

“It was much more harrowing than I had imagined,” she recalled. “Rats every-where, dead bodies everywhere. People were really ill and there was very little we could do. Death was just constant.” When the hospital was full, a tent was set up outside. Many people died in there, without treatment. The first confirmed Ebola cases were in March 2014 when patients started showing the tell-tale symptoms of fever, sickness, joint and muscle pain and weakness. The disease ultimately leads to bleeding, both internal and external. On average, half of those who catch Ebola will die.

On 29th July, the World Health Organisation reported 13,290 confirmed cases and 3,951 deaths from Ebola in Sierra Leone, an immense strain on a country which lacks the health services and infrastructure to cope with epidemics.

“It was unbelievably relentless,” said Nat. “The systems weren’t working. To get a blood result should take about four hours. It was taking about seven days... People were dead before they got their result. The burial teams were completely overrun... We had piles and piles of rotting bodies and nowhere to put them.”

“There were times it felt like the whole world’s going to die,” said Nat. But it was hard to talk to friends and family at home. That’s where the Ebola Psychological Support Service came in, initially a volunteer service that paired overseas workers from the United Kingdom with volunteer psychologists from the Maudsley Hospital in London. The aim was to provide a listening ear, or formal therapy, by telephone or Skype. The idea came from Katy Lowe, a mental health nurse working in Sierra Leone, who grasped that the risk of trauma among volunteers involved in confronting the Ebola outbreak was high.

Idit Albert and Elaine Hunter, clinical psychologists from the South London and Maudsley Mental Health Trust, took up the challenge to provide a team of qualified people for volunteers to talk to, with support from Al Beck, Head of Psychology and Psychotherapy. Nat was one of the first to use the service, and was paired with Idit. “I felt like I was OK, but if any more crazy things happened then I wouldn’t be able to cope,” said Nat. “I wasn’t able to get upset in the clinic. I couldn’t cry. The service… was a release.”

Idit explained some of the issues volunteers faced: “They didn’t have their normal routines and relationships, they didn’t have anything outside work. At work they were surrounded by death and worries about contracting the virus… They were feeling guilty when they weren’t working, and guilty over the care that they could offer.”

“It’s been a traumatising experience,” reflected Nat. “I feel like I’m coming through the other side.” When the Department for International Development heard about the service it wanted to offer it more widely, as not all volunteers had access. The Maudsley team now has government funding, and is liaising with UK-Med, which coordinates NHS volunteers abroad, to set up psychological support as a matter of routine. “Psychological support needs to be built in like physical health screens and immunisation,” said Idit. “Opting-in doesn’t work... aid workers are concerned about being perceived as weak and a burden.”

Ebola cases in Sierra Leone are now dropping, and a new vaccine is being trialled, but Nat remains there, improving infection control procedures. She doesn’t see the extremes of her experience as a bad thing: “If you look death and suffering in the face you are touched by that,” she says. “I do feel lucky.”