Australian nurse Brett Adamson had worked in Africa before, but he said nothing could prepare him for the “sheer brutality” of the Ebola virus.



As project coordinator of an Ebola management centre, the Médecins Sans Frontières (MSF) nurse’s role was far broader than he had ever imagined.



“I was shocked by the sheer hopelessness I saw when I first went inside the management centre, the inhumanity that the disease causes, and the sheer brutal horror of it all,” Adamson said of his visit to the Liberian capital Monrovia last year.



“Seeing what Ebola does to people individually is shocking. Seeing people dying outside full management centres, dying in cars or under trees, desperate for care and having to wait with no place for them to go is shocking on another level,” he said.



Melbourne-based Adamson is one of 42 Australians who have been or currently helping with the Ebola response in west Africa for MSF.



Thirty-two more Australian health workers are in Sierra Leone working at a British-built medical facility that was partially funded by the Australian government.



Australia’s total contribution to the Ebola crisis is $45m, but the government has been accused of acting too slowly in curbing the spread of the deadly haemorrhagic fever.



The outbreak has infected 20,000 people and killed nearly nearly 8,000, including more than 360 health workers. Most of them are from the chronically under-funded and understaffed healthcare systems of Liberia, Sierra Leone and Guinea.



Adamson listed some of his tasks as “getting bodies out of cars, caring for patients, confirming deaths, picking up rubbish, dealing with distraught families, moving and cleaning beds, moving bodies to the morgue and generally helping out an extraordinary team of people”.



An Ebola worker is cleaned up. Photograph: Medecins sans frontieres

Nurses and doctors working to tackle Ebola can spend only an hour at a time inside isolation wards to minimise the risk of exposure to the disease. They are required to wear full-body protective suits and masks which are heavy and uncomfortable in the heat.



“The physical demands of wearing the protective equipment, the ridiculous amount of sweat, means you can only go in twice or three times each day,” Adamson said.



He said the lack of physical and emotional contact with patients made their plight even harder to bear.



“[Patients] can barely see your eyes, they cannot see the smiles that you try to bring them. They are lying there, children, adults, watching others die around them, shunned by their communities, knowing that they are more likely to die than not and may never see their family again,” Adamson said.



“To not have been able to give the hug that the child that died so badly needed it, and see more the next day in just as much need is more than challenging, it’s completely devastating.



“We have no physical contact with anyone while we are in the country; no handshakes, hugs or anything. We are very strict with hand washing and personal behaviour like sharing food or drinks. Everything we do is about minimising risk, and avoiding making mistakes because the consequences are obviously so critical.”



Avoiding mistakes is critical for Leisha Nolen, too, who notes that the risk of infection, however low, is always present in her line of work.



The New Yorker is one of only 130 epidemic intelligence service officers, commonly known as disease detectives, in Atlanta’s Centers for Disease Control and Prevention (CDC).



The CDC has taken the global lead in tackling the Ebola outbreak, and Nolen was among the first group of just eight officers deployed to Sierra Leone in early 2014 to track the spread of the deadly Ebola virus.



The role is largely desk-based and involves working with local authorities to trace and contain the trajectory of the disease.



“If you try not to look hard, you probably won’t even notice it. You get off the plane, you go to your own little world, you might not notice it. But if you start going to neighbourhoods where there’s more crowding, more people who’ve been infected, you start to see that people aren’t quite doing the same thing they always were,” Nolen said of her first visit to Sierra Leone.



Leisha Nolen is an epidemic intelligence service officer from New York. Photograph: Leisha Nolen

She has just returned to the US after her second tour of the impoverished African nation.



“This is a place that is well-stretched beyond its ability,” Nolen said.



“Even in the best of times they don’t have anything like the health care system or the overall infrastructure that we have [in US]. Imagine taking that and dropping in an infectious disease that’s dramatic and contagious and deadly. As you can imagine, it’s total chaos,” she said.



Sierra Leone has just 0.01 doctors per thousand people, compared with 2.5 doctors per thousand people in the US, Nolen said.



“The resources there even in the best situations are extremely limited.”



“You may well see bodies on the road. That does happen. There are bodies that are lying in the road because they have not been picked up yet. This is part of the problem. There’s not enough ambulances, there are not enough burial teams.”



Nolen said busting local myths about Ebola was one of the most challenging aspects of her job.



“Many people still believe that [Ebola] is a curse. They don’t believe that this is something caused by an infection. To them the idea of an infection is something that’s completely foreign.”



Gaining authority in a patriarchal society also proved a challenge for the paediatrician and genetic physician.



“One of the people I was working with laughed and told me that locals were asking if I was a woman or a man,” she said. “I’m dressed in pants, I’m dressed in a T-shirt and I’m acting in a dominant role. So to them I’m a man.”



Despite the culture clashes, Nolen said she was welcomed by local health care workers.



“You see people who are amazingly dedicated who have already been dealing with this for five months, working seven days a week, and they continue at it… It’s just amazing to consider how hard it is for them to keep going and keep going,” she said.



Adamson said nothing in his training could have prepared him for the conditions he encountered.



“I was unprepared for the grace that patients accepted their state; their lack of panic. I was unprepared for the full extent of the distance created between the patients, population and us as caregivers as a result of the disease and the necessary precautions. I was unprepared for how overwhelmed we were and how truly horrible it was to feel so inadequate, to work so hard and for it to feel, ultimately, so little.



“As a nurse I can only hope to never face such barriers to care again. Seeing the continued failure of the world to respond fast enough to the current situation I can only assume I will see worse. And this I truly dread.”

