Listen to Sarah reporting from west Africa for the BBC’s Health Check programme

Day four



At the jetty in Freetown, waiting for a boat to cross the wide estuary to the airport on the far side from the city, I encounter Professor Abdulsalami Nasidi, project director of the Nigerian Centres for Disease Control. He led the stunningly successful fight against Ebola in Nigeria. A catastrophe was predicted when Patrick Sawyer, a Liberian, flew into Lagos, a city of 21 million people, on 20 July straight from his sister’s funeral. He died from the disease, infecting nine doctors and nurses before anybody realised the lethal virus had arrived in their midst.

Yet within three months, Nigeria was declared free of Ebola. There had been just 19 cases and seven deaths.

Nasidi is off to Liberia for a high-level UN meeting. The white sands and lapping ocean by the jetty make you think you are on a paradise island for a moment, before you realise how much Sierra Leone has lost, thanks to Ebola as well as the earlier civil war. There are no umbrellas, no one on deckchairs and no tourist income at all. The only business in Sierra Leone is the Ebola industry, which offers the sorts of job that no one would have ever wished might be available – burying bodies and caring for the dying.

The jetty where passengers for the airport arrive by boat across the estuary from Freetown. Photograph: Sarah Boseley

Nasidi brings the lessons learned from quelling the Nigerian outbreak, and reinforcements, in the shape of 220 Nigerian healthcare staff who will work in the treatment centres across the region. They will be contracted for six months – far longer than most of the other international volunteers. Nigeria, terrified of allowing Ebola back in, has tough restrictions on people returning from Sierra Leone, Liberia and Guinea. But, says Nasidi, “we are hoping that in six months’ time there will be a vaccine”. Health workers will be the first to get it, he points out.

Most – 95% - of this batch of volunteers were involved in the public health crackdown that eradicated Ebola from Nigeria. It was a scary time, as it is now in Sierra Leone. “I felt danger had come,” said Nasidi. “We were frightened. We knew if Ebola takes root in Nigeria, all Africa will be on fire.” It didn’t happen, thanks to assiduous contact tracing and tough quarantining of suspect cases although, said Nasidi, they spent much more on public education, telling people how to avoid getting infected. They hit the outbreak hard and fast. By now there is consensus that the far less well-resourced countries now being ravaged by the disease did not – and on their own probably could not have done so.

They are not alone any more. Sierra Leone is now awash with foreign NGOs, UN organisations and volunteers, filling the roads with large white four-wheel drives. Even Welsh sheep are now playing a part in the global struggle against this killer virus. Genes from the Zaire strain in Nigeria, which arrived via Patrick Sawyer from Liberia, are being used to immunise sheep who are not susceptible to the virus and produce polyclonal antibodies against it. Those antibodies, it is hoped, could boost the human ability to fight off Ebola. It’s a collaboration between Nigerian scientists, a small British biotech company, Oxford University – and the Welsh sheep.

A second batch of NHS volunteers has just flown in and 18 of them are heading to the treatment centre in Makini, built by the British army, funded by the UK department for international development and to be run by the International Medical Corps. It is due to open any day now. With Port Loko, one of the current hotspots, less than an hour away, they may get busy.

Talking to two of them in Freetown, on their first day in Sierra Leone, I am struck by their sense of fulfilling their calling. One is a GP and the other a senior nurse. What they will be doing is very low-tech compared with the NHS. There are no drugs to cure Ebola, although painkillers and antibiotics are given to help the symptoms. Most of the treatment is getting fluids into the patients. Even intravenous fluids are not always an option. It’s very basic care. But they have come because, they hope, they can save lives.

“It was a no-brainer really,” says Rachel Duncombe Anderson, who works at the Royal London hospital in the largest trauma centre in Europe, where the 7/7 bombing victims were taken for emergency care. “I had skills I could do something with. Why did all of us come into medicine? It was to cure people, although on a Saturday night when people are drunk and annoying in A&E it’s not what you feel like [you’re] doing.”

With her husband’s backing, she signed up as soon as she saw the appeal for volunteers back in September. She does feel some nervousness. “I think it’s a healthy fear,” she said. “I do know something about Ebola but if we try to follow the rules as we have been trained to do, we should be safe. This country is on its knees and we have such an amazing resource back in the UK.”

Mike Barstow, a GP from coastal Suffolk, said he could not look his sons in the eyes if he did not go. “I couldn’t sit there and not do anything. I always tell my kids if you can do something to help, you should do it. I try to lead my kids by example.” His boys are seven and nine and not really aware of what Ebola is and does. “I just told them daddy has got to help some people,” he said. But he explained in much more detail to their school, the Scout group and the rugby clubs. All have offered their support for the boys and his wife, as have his partner GPs.

GP Dr Mike Barstow from Suffolk is having final training to help with the #EbolaResponse today #NHSvolunteers @rcgp pic.twitter.com/doOEUe3cvw — DH Media Centre (@DeptHealthPress) December 5, 2014

When he comes back, Barstow says he will not go back to the practice for three weeks, even though Public Health England’s advice is that it is safe for the volunteers to return to work straight away unless they have been in direct contact with the virus – and even then they should just take their temperature every day and not directly treat patients.

But he wants his patients to feel comfortable, says Barstow. “It’s entirely perceptual. I will be walking around doing the usual things.” He might meet a patient in a supermarket instead of in the surgery.

He thinks he is in for “a bit of a culture shock” putting on a protective suit in 30 degrees heat to give patients painkillers and fluids. “But it is the basis of why most of us went into medicine – treating people and giving comfort when they are in distress.”