Winter 2014No 75

SAFE BIRTHS FOR REFUGEE MOTHERS 6-7

A FESTIVE SEASON IN THE FIELD 8-9

ON A MISSION TO MAP THE WORLD 10-11

INSIDE

The boy who survived Ebola

Patrick Poopel clutches the certificate that proves he survived Ebola at MSF’s treatment facility in Monrovia, Liberia Photograph: Morgana Wingard/MSF, 2014

Guinea

Liberia

iraq

JOrDan

SYria

Sierra LeOne

Dohuk

Damascus

For more on the Ebola crisis in West Africa, see pages 4-5 and page 12

Ramtha

S. SuDanCenTraL aFriCan rePubLiC

JubaBangui

SITUATION REPORT SITUATION REPORT2 3

The bombing of a crowded market on 9 October caused hundreds of casualties in Erbin, on the ouskirts of Damascus. At the MSF-supported hospital in Erbin, staff reported an influx of 250 wounded.

“After the bombing of the market last Thursday our emergency room was overflowing,” said one of the doctors in the hospital, who wished to remain anonymous. “I was working through my tears when we had to amputate the limbs of three children with severe wounds. We have used 95 percent of our stocks of drugs and medical supplies over the past days of non-stop emergency. With the bombs still falling, and another mass casualty influx this morning [16 October], we are very worried about the coming days and weeks. We are under siege

Hundreds wounded in bombing of market in besieged Damascus

SYriaand it is hard to get the supplies we need. So I am sad – and angry – that I cannot provide the high level of care we should be giving to all our patients.”

Some 50,000 people have been under siege here for more than two years, and bombing and shelling has intensified since early October. MSF supports more than 100 health facilities throughout the country including this hospital.

“This horrific bombing and carnage in Erbin is a clear example of the relentless violence in Syria’s besieged enclaves, and illustrates why these hospitals need massive support,” says Bart Janssens, MSF director of operations. “The conditions and stress for the Syrian medics, who live under direct threat every day, have reached unbearable levels. The doctors have been on call 24/7 for two years, always on standby to treat emergency cases. They never know when there will be power cuts or water shortages in the hospital, or whether there will be any fuel to run an ambulance. It is hard enough for them to keep routine medical services running when every box of medicine is difficult to get hold of, let alone responding to extreme medical emergencies.”

For more information, visit msf.org.uk/syria

look around and try to discern whether or not you should be alarmed. My colleagues were alert but calm. We continued with our work.

I heard from our staff that someone had hijacked a taxi, entered another group’s area, and then thrown grenades, killing and wounding a few. This man got caught, beaten, dragged on the streets for a few kilometres, then was beheaded and burnt. This morning’s confrontation occurred when some people from his community came to claim the body. The tension is real.

By early afternoon, the streets had calmed. Twenty of us huddled into two vehicles and drove through the streets. The main roads were deserted, except for military men and convoys, and a few lingering civilians. I am now home and, in between the sound of helicopters hovering above our heads, I will try to get some shut-eye. Good night, Bangui. Hope to see you in a good shape tomorrow.”

Follow Henriette’s blog at blogs.msf.org/henriette

Fourteen-year-old Malik plays chess with British anaesthetist Ben Gupta in Ramtha hospital, Jordan. Malik lost one leg and sustained severe injuries to his arm and other leg when a bomb fell on a wedding party at his family’s home in Syria Photograph: © Ton Koene, 2014

An MSF team travels by boat to run a mobile clinic in Jigmir, Upper Nile state, South Sudan.

More than 1.5 million people are currently displaced from their homes in South Sudan due to the conflict that broke out last December. Many families in remote areas have no access to healthcare, prompting MSF to operate mobile clinics.

MSF currently runs 26 projects in nine of South Sudan’s 10 states, with 3,800 staff on the ground.

Photograph: © Ton Koene, 2014

SOuTh SuDan

Bangui, capital of Central African Republic, has been extremely tense since violence broke out on 7 October. MSF’s team treated 13 wounded at the general hospital: one person died of his injuries.

Access to medical care has become increasingly perilous, with most of the city’s inhabitants taking refuge in their homes. Over three days, MSF teams treated 56 wounded people.

“The security situation is preventing us from getting around the town,” says Claude Cafardy, MSF’s deputy head of mission in Bangui. “There is a real risk that the injured won’t come to hospital for treatment, either because they can’t find

Violence surges in capital of Central African Republic

Car

transport or because they are afraid of being attacked on the way.”

Henriette Huynh (above) is MSF’s deputy finance coordinator in Bangui

“Shootings here and there, grenades now and then... The mind is exceptional at adapting and, soon enough, your standards of what is normal shift. But when you hear explosions so close that it reverberates in your gut, your illusions of safety fall away.

What started as a normal day at the office quickly turned tense when the first grenade detonated. Then came the second and third one. Then the shootings. That’s when you

an injured man is brought into the hospital. Photograph © Aurelie Baumel/MSF

2 EBOLA OUTBREAk4

and I lean closer in my bulky space suit. What did he say?

– I said, can you get me a bicycle?Oh Patrick, where would you ride

your bicycle? You loved your mother and you

were near her while she was sick. Now you are surrounded by orange fences and you will never learn to ride a bike. Do you think this is just an upset stomach? Didn’t your older friends tell you about Ebola? Or did they turn down the volume when BBC Africa told you that soon you would be shitting your own blood?

I make my way out. I don’t want to start crying inside the goggles. I hate myself for having met this kid. Why do I never stay at home?

I take the rest of the day off. I promise myself I will get a normal job.

The next morning, something drives me back. I want to be there for Patrick’s father, no matter what he is going through. He looks tired, but he grins as soon as he sees me across the fence. And slumped in the chair next to him, someone is sending me a crooked, shy smile. We wave.

I can see that Patrick doesn’t have the energy to leave the chair, so I get dressed in my suit and go inside. In spite of seeing only a fraction of my face, Patrick recog nises me:

– I see my friend. I don’t see my bicycle!

I can’t tell him I didn’t think he would make it through the night. I try to find the right words. Can I say it slipped my mind? Patrick looks at me sternly.

– The lady forgets, but the man does not!

Oh Patrick, where do you pick this stuff up? Is this the kind of talk you hear from your entourage? Promise me you’ll start hanging out with kids your own age one day.

Crossing the fence

Patrick was discharged last Sunday with his father. They both looked worn out. I could hardly believe that Patrick had healed from Ebola before the bruise near his right eye had faded. He had become so skinny that we had to tie his trousers up with a piece of string.

Being discharged from the centre is a confusing affair. After weeks when people are afraid to go near you, suddenly they want to hug you and kiss you. It can bewilder anyone, even a worldly young man like Patrick.

On the rare occasions when somebody recovers, we provide them with a certificate of their negative status. Patrick Poopel, standing here on my side of the fence, smiling a shy smile and holding his Ebola graduation papers, ready to learn how to ride a bike.

Contrary to what you might think, Patrick, this is something the lady will never forget.

‘People on that side of the fence don’t return to this side’

‘Patrick had become so skinny we had to tie his trousers up with a piece of string’

Ane Bjøru Fjeldsæter, a psychologist from Trondheim, Norway, recently spent a month working at MSF’s Ebola treatment centre in the Liberian capital, Monrovia.

Liberia is divided by an orange double fence. We built it to keep the sickness at bay. We built it to separate us (the healthy, the privileged) from them (the sick, the needy). We built it to feel less mortal. We built it for the noble purpose of barrier nursing.

Patrick is on the inside, I am on the outside.

I see him every day, and we smile and wave at each other. Patrick is just a child, but he is hanging out with guys five times his age, as if trying to make up for the fact that he is much too young to die. They play checkers and poker when they have the energy for it, and they listen to BBC Africa on the radio I brought in one day in my space invader outfit. Patrick has a shy, crooked smile and a bruise near his right eye. He has just lost his mother, but his father is with him in this horrible place.

Dangerous to get close

Every day I tell myself: Ane, don’t lose your heart to this child who no longer belongs among the living. He is here for a week and then will be gone forever. How will you do your job once he has gone? Don’t you know what you are dealing with here? “This Ebola business”, as they say on the radio. Ninety percent mortality rate. People on that side of the fence don’t return to this side. You know that it is dangerous to get close.

I tell myself this every day, and I never listen. It is impossible not to look out for his crooked smile once I arrive at work in the morning. It is impossible not to notice the small changes in his energy levels from day to day. I can’t resist waving at him, or scanning his face and his medical chart for any indication, anything that will allow me to hope that he is taking a turn for the better. Anything that will allow me to hope that we will play poker together one day, without all the bother of wearing a mask, goggles and double gloves.

The horrible morning arrives

Then the horrible morning comes. The one I had tried to prepare for. The morning when Patrick is not waving anymore. I look across the

My friend from across the fence

5

Cases and deaths since March 2014World Health Organization figures as of 31/10/14

Cases Deaths

Guinea 1,667 1,018Sierra Leone 5,338 1,510Liberia 6,535 2,413Total 13,540 4,941

What is MSF doing?The outbreak of ebola in West africa is the largest ebola epidemic ever recorded. The virus has already infected more than 13,000 people and the outbreak is far from over. MSF has been combatting the outbreak since the first cases were reported.

We are operating six treatment centres in affected areas, but more needs to be done. We are stretched to the limit of our capacity.

MSF has 3,481 staff on the ground and has brought in more than 1,019 tonnes of equipment and supplies to help fight the epidemic. it’s the finan-cial support of individuals like you that enables us to do this. Thank you.

For the latest news and information, visit msf.org.uk/ebola

The ebOLa OuTbreak

fence and he is lying on a mattress in the shade. His group of man-friends tiptoes around him, looking concerned. I suit up. I fear the worst. I make my way through the ward. His father tells me Patrick has complained of stomach pains all night. Patrick has parched lips,

feverish, shiny eyes, and none of his usual energy. He tries to smile when he sees me.

– Patrick, my friend, you don’t look so well. It worries me to see you like this. Is there any thing I can do for you?

He looks up, whispers something,

Left: ane bjøru Fjeldsæter with six-year-old Patrick Poopel after his discharge. above right: a week after being cured, Patrick got a surprise present from ane - a bicycle. below: ane talks to a survivor about life after ebola.Photographs: Morgana Wingard/MSF; Martin Zinggl/MSF, 2014

6 76 IRAQ

Thousands of Syrians fleeing the conflict in their home country have taken refuge in Iraqi Kurdistan, where they have been joined by almost one million Iraqis who have fled from areas under the control of Islamic State militants.

Most of the refugees are sheltering in schools, camps or unfinished buildings, where poor living conditions, overcrowding and a lack of sanitation pose a serious threat to their health.

MSF has scaled up its activities in Iraqi Kurdistan in order to provide more people with medical care.

In Domeez refugee camp, MSF has opened a maternity unit to provide for the estimated 2,100 babies born in the camp each year. MSF teams are also running three mobile clinics in the Dohuk region.

In the centre of Kirkuk, another MSF team is providing medical care in a mosque and a church. The team’s two doctors and two nurses carried out more than 600 consultations in October alone.

Despite the ongoing conflict and security risks, we are committed to continue providing medical care in this region.

Safe births for refugee mothers

above right: Yazidi families come for medical consultations soon after arriving at a refugee camp in northern iraq. below: Violence has forced some 1.8 million people to leave their homes in iraq in 2014, with almost half finding shelter in iraqi kurdistan.Photographs: Gabrielle Klein/MSF, 2014

below, left to right: ayla hamdo, the first baby to be born in MSF’s new maternity unit in Domeez refugee camp; MSF health workers meet local community members in Sharya; a Yazidi man talks to MSF staff in the tent where his family is sheltering. Photographs: Gabrielle Klein/MSF

‘With the new maternity unit up and running we only need to refer high-risk pregnancies to Dohuk, taking pressure off the hospital’

‘We employ Syrian staff, people who are themselves refugees’

right: Midwife Marguerite Sheriff poses with a mother and her baby – the first to be born at MSF’s new maternity unit in Domeez refugee camp. before the unit opened, many Syrian women in Domeez chose to give birth in their tents, which could be risky if they experienced complications during the delivery.

The staff have a close connection with their patients, as most are refugees from Syria. “We employ Syrian staff, people who are themselves refugees,” says Dr adrian Guadarrama. “Our team currently includes a gynaecologist, nine midwives and four nurses, who between them provide round-the-clock care.”

already there are five births each day in the new maternity unit. “So far we are coping,” says Dr Guadarrama, “but our limit is seven deliveries each day. Given the great demand, we are already studying the option of further expanding our operations.” Photographs: Gabrielle Klein/MSF

Midwife Marguerite Sheriff cares for a pregnant woman. Photographs: Gabrielle Klein/MSF

8

‘Not every life can be saved. Learning to find the good stuff in every day and enjoying the friendship of the local people helps overcome those difficult moments’

9WORkING OVERSEAS

This Christmas, more than 54 British volunteers will be working for MSF in the field, providing emergency medical care to people in war-torn countries, families who have been displaced from their homes and vulnerable people living without access to healthcare.

We asked three members of the team to tell us what it’s really like to work for MSF and how they will be spending Christmas this year. Jacob Goldberg, a hospital supervisor in Democratic Republic of Congo, Ann Thompson, a midwife working in Bangladesh, and Emma Pedley, a nurse currently in Central African Republic, tell all…

Christmas away from home

What made you want to work with MSF?

Jacob GoldbergI first heard about MSF around 10 years ago when I was at university and saw an MSF insert in a maga zine. The message really stuck. There’s a big, wide world out there full of people who need healthcare who aren’t getting any. MSF seemed to respond time and time again to every different emergency the planet threw at them. I decided I had to be part of that team.

Can you describe a typical day?

Emma PedleyOur hospital in Zemio, Central Africa Republic (CAR), is smallish, with a focus on HIV. The village is beautiful, surrounded by jungle, and we care for about 800 HIV patients in an area where there are no other treatment facilities.

Jacob I am working in a small town in South Kivu, Democratic Republic of Congo. We treat everything we possibly can, from HIV, TB, multidrug-resistant TB and malaria to malnutrition, maternal health and sexual violence. We are based in a big, busy hospital and run various outreach activities supporting health centres.

Emma The local roosters are the alarm clock at around 5:30 am – I usually make the most of the alone time by reading or doing yoga, then it’s breakfast with the team and off to the hospital at 7:30.

I try not to work too much past 6 pm, although that’s not always possible, and one night a week I’m on call so sleep with a VHF radio by my head in case of an emergency.

Jacob I am the hospital supervisor so my day normally starts with a round of the hospital. We have 160 beds but

Ann Thompson I am working in Kutupalong, Bangladesh, as a midwife. We’re busy, and sometimes see more than 100 women a day. About 700 babies a year are born at our birth unit, but many women choose to deliver at home, which can cause problems. It’s a challenge learning to accept that you can’t do everything. Not every life can be saved. Learning to find the good stuff in every day and enjoying the friendship of the local people helps overcome those difficult moments.

Jacob Soon after I started there was a young guy who had been bitten by a croco dile while washing his clothes in the river. He had open fractures

in both arms and wounds all over. He needed surgery and we weren’t sure if he’d lose both his arms.

Luckily, we were able to transfer him to the nearby surgical centre and I went with him for the four-hour journey. He was in a pretty bad way, having had a blood transfusion and showing signs of septicaemia. We had to stop every half hour so I could give him water and top up his pain meds. At that point I wasn’t sure if he’d make it. A month later, I went back to the hospital to see him and found him sitting up in bed smiling at me. Another happy customer; it was incredible to see.

Emma We had a beautiful Down’s syndrome toddler with severe

malaria – the son of one of our guards. On the day he was admitted, he was so ill he was practically unconscious, but after two days of treatment he was full of energy again. I got a big cuddle from him that was really special. His mother was given a mosquito net on discharge so I hope we don’t see him in the hospital again unless he is visiting his dad!

Are you enjoying your time away? Is there anything you miss?

Jacob It might sound odd, but I miss bacon.

Emma I love living here! The international team is small, only seven people altogether, but we

all get on really well and have gelled brilliantly, not only as colleagues but also as housemates and friends. We can’t leave the base after dark. We have a movie night once a week and play Bananagrams and Pictionary some evenings, but we mostly just chat and set the world to rights.

Ann Obviously I miss family most. Everything else you adapt to. It’s amazing what you can live without!

What can you not live without on a mission?

Emma Earplugs and sports bras. The nights are noisy and the roads are very bumpy!

What will you do this Christmas?

Jacob I will probably spend Christmas morning in the hospital. There are always things to do there, especially as most of the staff will be on holiday. The afternoon I’ll spend with the international team. Hopefully someone will attempt some Christmas-style cooking and we’ll hang out in the shade and maybe play charades, if anyone will agree to play it with me.

Emma We will definitely try and make Christmas a bit special. We’ve already started planning games to play and we’re going to do a Secret Santa, although the choice of gifts to buy for each other around here is a bit limited! I’m luckily in the same time zone as my family in the UK, so we’ll try and Skype, although if I call and interrupt them watching the Doctor Who Christmas Special they probably won’t answer...

Ann On Christmas Day, I shall bake, as I do most weekends here.

Do you have any messages for our supporters?

Jacob We have a very dedicated team and that means we’re genuinely improving people’s lives in places where hope is scarce and suffering is common.

Emma A huge thanks to all MSF supporters. Not only are you the reason I can do a job that I love, but you are literally saving lives every day, in places where there is otherwise next to no healthcare on offer.

Clockwise from left: emma blows bubbles with children in Zemio; Jacob and colleagues in South kivu; emma feeds a baby in Zemio; Jacob at baraka hospital. Photographs © MSF, 2014

usually no fewer than 200 patients so it’s difficult to keep track of them all. I always follow the most serious cases just to make sure they’re headed the right way if possible.

I’m lucky to have an excellent Congolese counterpart, Philippe, who after showing me the ropes now trusts me enough to share the administrative tasks with me, which I take as a compliment. The afternoons have recently been spent in the newly opened emergency department helping the team there with triage and admissions. It’s a world away from the London A&E that I’m used to, but there’s a pang of familiarity about it which is a comfort.

Ann Thompson

Emma Pedley

Jacob Goldberg

‘We’re going to do a Secret Santa, although the choice of gifts to buy around here is a bit limited!’

If you would like to send a message of support to Jacob, Emma or Ann, visit msf.org.uk/ecards

11MISSING MAPS PROJECT10

Imagine this: cholera has broken out in a major UK city. The disease is spreading fast and people are succumbing to it in scores. What should be done?

John Snow, the founder of modern epidemiology, had the answer in 1854. Taking the addresses of patients during a cholera outbreak in London, Snow plotted them against a map and traced the source of the epidemic to a water pump in Soho. The contaminated pump was turned off, and the outbreak ended.

The volunteers on a mission to map the world

Bangladesh richard kinder Project coordinator; ann Thompson Midwife; Catherine McGarva Mental health specialist

Central African Republic emma Pedley Nurse; barbara Pawulska Pharmacist; robert Verrecchia Medical manager; eleanor hitchman Project coordinator; hayley Morgan Project coordinator; Stephen bober Gynaecologist; aileen ní Chaoilte Medical Referent

Chad Jonquil nicholl Midwife

Colombia Stephen hide Head of mission

Dem Rep Congo richard Delaney Logistician; Jacob Goldberg Nurse; Demetrio Martinez Logistician; Catherine Cormack Medical Manager; Mark blackford Finance coordinator; Louise roland-Gosselin Deputy head of mission; Laura McMeel Pharmacist

Ethiopia robert allen Logistician; elizabeth harding Deputy head of mission; Josie Gilday Nurse; Sean king Logistician; Geraldine Willcocks HR Manager; barbora Sollerova Midwife ; Peter roberts Logistician; Virginia Ponsford Doctor; Christopher hall Logistician

Haiti Dominique howard Logistician

India Luke arend Head of mission; Shobha Singh Mental health specialist; Melanie botting Nurse

Jordan Paul Foreman Head of mission; Tharwat al-attas Medical coordinator; Lucy Williams Nurse; Samuel Taylor Communications coordinator

Kenya beatrice Debut Communications manager

Kyrgyzstan rebecca Welfare Project coordinator

Lebanon Michiel hofman Head of mission

Myanmar Simon Tyler Deputy head of mission; Laura Smith HR coordinator; Jose hulsenbek Head of mission

Nigeria Judith robertson-Shersby harvie Medical referent; Philippa Tagart nurse

Papua New Guinea Jenny nicholson Mental health specialist

Russia Fay Whitfield Nurse

Sierra Leone William Turner Project coordinator; benjamin black Doctor

South Africa andrew Mews Head of mission; amir Shroufi Deputy medical coordinator

South Sudan Joanna kuper bruegel Humanitarian affairs officer; Sophie Sabatier Project coordinator; John Phillips Logistician; Lisa naylor-Vane Midwife; hilary Collins Nurse; Laura bridle Midwife; haydn Williams Project coordinator; Joshua Fairclough Logistician

Sudan alvaro Mellado Dominguez Deputy head of mission; Shaun Lummis Project coordinator

Syria helen Ottens-Patterson Medical coordinator; natalie roberts Medical coordinator

Tajikistan Sarah quinnell Medical coordinator

Uzbekistan nina kumari Mental health specialist; Cormac Donnelly Medical manager

Yemen Oliver ross Anaesthetist; Luke Chapman Medical manager

Zimbabwe rebecca harrison Epidemiologist

MSF’S uk VOLunTeerS

MSF uses maps every day… but the places MSF works are often in locations yet to be mapped, forcing our teams to rely on hand-drawn guides or word-of-mouth directions

communities and track the spread of disease. But the places where MSF works are often in locations yet to be mapped, forcing our teams to rely on hand-drawn guides or word-of-mouth directions.

The beauty of the Missing Mapsproject is that anyone can getinvolved. Using OpenStreetMap, an online, open-source map, anyone can access its base to make edits. Using satellite imagery, roads are traced, buildings are outlined and lakes are shadowed. The information is then verified on paper by communities in the areas mapped, adding in local names and information, which is then finalised by moderators online.

“I give a direct debit every month to MSF,” says Pete Masters, the Missing Maps project coordinator, “but it’s harder to contribute to MSF’s field work unless you have a medical or logistical background.

“But with the Missing Maps project, you can contribute directly, because you’re building the foundation for epidemiological studies. You’re helping to build the base so MSF can respond quicker and find the source of diseases – this is real operational stuff, and you can do it on your computer while sitting in your front room. It’s exciting.”

The information is then sent back to the volunteer mappers and is saved on the digital map. © OpenStreetMap

The traced areas are then sent to the local communities for information to be added. here (and top) students from the university of Lubumbashi in Democratic republic of Congo fill in the names of neighbourhoods, landmarks and businesses. © Humanitarian OpenStreetMap Team.

editing can be done by anyone from anywhere. Large sections of OpenStreetMap are edited at ‘mapathons’, where volunteer mappers get together for an evening or a weekend to attempt to map entire towns, cities or regions at once. © Adam Hinchliffe

Looking at satellite images, volunteer mappers trace features such as buildings, roads and trees into OpenStreetMap.

Despite Snow making his breakthrough 160 years ago, cholera and other diseases still run rampant in parts of the world. Part of the reason is a lack of basic maps. “I want the most crisis-prone parts of the developing world to be mapped within two to three years,” says Ivan Gayton, an MSF head of mission.

Ivan is also a co-founder of the Missing Maps project, an ambitious initiative led by MSF, the British and American Red Cross and a group called the Humanitarian OpenStreetMap Team.

“We aim to crowdsource digital maps of the entire globe, beginning with the most vulnerable places on earth. While free detailed online maps exist for most parts of the western world, vast swathes of the planet are still completely unmapped,” says Ivan.

MSF uses maps every day to find patients, assess the needs of crisis-hit

Visit missingmaps.org to find out more and get involved

By Nick Owen

About DispatchesDispatches is written by people working for MSF and sent out every three months to our supporters and to staff in the field. it is edited in London by Marcus Dunk. it costs 8p to produce, 17p to package and 27p to send, using Mailsort Three, the cheapest form of post. We send it to keep you informed about our activities and about how your money is spent. Dispatches gives our patients and staff a platform to speak

out about the conflicts, emergencies and epidemics in which MSF works. We welcome your feedback. Please con-tact us by the methods listed, or email: marcus.dunk@london.msf.org

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DEBRIEFING

What was your role at the treatment centre in Monrovia?My main task was to set up and maintain the ‘suspect tent’, which is where we send people who have symptoms that make us suspect they have Ebola.

My first priority was to make sure patients were rehydrated. The big killer for Ebola is dehydration. When patients come in, we greet them – although it is very hard to communicate with the mask on, and the goggles steam up so you can’t have eye contact. We give them a bed to lie on, we treat them for infections, give them pain relief and take their blood to be tested. And five or six hours later, we get their results back. That is a difficult time. Unfortunately, about 90 percent of the patients in the suspect tent test positive. When you’re faced with so many patients, you’re totally overwhelmed and it’s a bit like war trauma.

Were there any positive moments? One of the best moments was telling the negative patients they were negative. I remember two or three quite fit guys springing up and immediately starting to do star jumps. Then you have to get them out quickly, because you don’t want them to get contaminated. They strip naked, have a shower and then we give them new clothes. Everything that goes inside the high-risk zone stays inside the high-risk zone, except for staff and negative patients. Everything else gets burned in the incinerator.

Unfortunately, some patients are brought to the centre so late that they die soon after arrival. One day I had eight people die just during the day shift, and five of these guys seemed fit. When they first walked in, I thought they could sign up as rugby players. Over the next half hour or so they died.

That really shocked me.

The centre was so overwhelmed that MSF had to close it to new patients a number of times. Is it difficult turning people away? It’s very difficult. You know you’re basically turning people away to die. And you also know they’re going to infect other people. We had six members of one family come to the gate, but we couldn’t let them in. Each day the family came back with one fewer person, until the day the dad arrived with just one child. She was really sick and he said, “This is the last member of my family, can you please save her?” It’s horrific. Whole families and possibly whole villages are being wiped out.

But the morale of the teams is amazing. I have nothing but admiration for our Liberian staff. They’ve been working for four or five months in a row, and many of them have been ostracised by their families. The nurses and the guys doing the burials have a very difficult time with their families and friends – nobody wants to associate with them.

One of the tragedies of Ebola is that there’s nobody doing basic healthcare. If you break your leg, go into labour or get malaria, there’s nowhere for you to go. So a lot of the Liberian health staff are providing primary healthcare to their communities of an evening. People knock on their door asking for help. They’re running clinics at home, which puts them at risk, and some have died.

What is it like to wear the protective suit?It’s challenging and it’s hot. But you adapt. We managed to spend about 45 minutes in the protective suits during the peak sunshine hours, but on cooler days, when it was raining, we could spend longer. Afterwards, when you come out,

you have about two litres of sweat in your boots – you literally tip it out like in a cartoon.

When you’re not in the suit, Ebola is a non-touch mission. Everyone keeps their distance and, if you do brush against someone, you both jump. You work 12 to 14 hours, come home, have one beer and something to eat, have meetings and then crash.

You’ve been on plenty of MSF missions – have you ever experienced anything like this outbreak? I’ve worked with MSF for 14 years, on and off, in some quite horrific conflict areas, but this was something else. Probably it was because of the almost continuous suffering, and having to turn people away. This is a global issue and it’s a disaster. It’s an event that has totally overwhelmed three countries. It has the same catastrophic effects as an earthquake. It has the same economic effects. And where is everybody?

We need more boots on the ground. But we need appropriately-trained boots: health workers, logisticians, people to help with awareness raising, contact tracing, burial teams. The whole treatment of Ebola is simple if you get it right from the start. But we’re all playing catch-up.

It was a morale-boost when we were there and we began to hear pledges of boots on the ground. It will be even better when they actually get there.

Why did you first get involved with MSF? I travelled for two years through Africa in the mid 1990s and, wherever I was, the only relevant organisation I saw on the ground was MSF. So I came to the UK, did a tropical medicine course, applied to MSF and was accepted. To see people with real need and to be able to help them, it’s great. I always feel I get back more than I give.

1. I always take a small backpack for day-to-day stuff. Very useful.

2. A sun hat.

3. A map, so you know where you are and can place where people come from. I took one to Liberia, which was very hard to get – I spent six hours in Brussels tracking one down.

4. An open mind. In an emergency, you don’t always know what happened before you arrived. Don’t rush; watch what’s going on. Observe, critique and give feedback, but don’t jump to conclusions.

YOur SuPPOrT | www.msf.org.uk/support

DENNIS kERR

NURSE, LIBERIA

EXPAT ESSENTIAL KIT

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