Medical aid workers working in west Africa spoke to the Guardian about the risks of working in the pressure-cooker environment, and the patients fighting off the deadly disease

Doctors on the Ebola frontline: 'You can see the fear when they look at us'

The fear hit Dr William Fischer hardest in the four or five days before he set off. A clinician from Chapel Hill, North Carolina, he told the Guardian that when he wasn’t busy packing, he watched “gruesome” media portrayals of the Ebola outbreak he was going to fight. It consumed him. But when he arrived at Conakry, the capital of Guinea, West Africa, everything seemed rather low-key. Only a warning placard at passport control with “EBOLA” in frightening red letters hinted at what was to come.

On 28 May, he received his marching orders from the World Health Organisation to head to Guéckédou, near the border with Sierra Leone and Liberia, in the south-west of Guinea, an area which he described as the epicenter of the outbreak. He sent a brief email to friends and family that said “I love you all.”

The WHO said the number of confirmed cases of Ebola now stands at 1,603, of whom 887 have died. Benoit Carpentier, the team leader for public communications at the International Red Cross, told the Guardian that there had never been an Ebola outbreak on this scale. “What makes it more complicated is that it’s a regional outbreak,” he said. “You have to coordinate in three countries.”

The disease is currently spreading across Guinea, Liberia and Sierra Leone, and there are now cases in neighbouring Nigeria. Fischer was called in as a consultant; his area of expertise is in clinical care in resource-scarce environments.

Medical aid workers work on a roughly three-week rotation, which for Fischer meant a week of consultation and two weeks on the front line at a treatment facility run by Doctors Without Borders. The time limit, he said, is important. “It gets emotionally taxing. You need a break.”

There are a range of aid organisations working in the area, including the World Health Organisation, Doctors Without Borders and the International Red Cross, as well as Christian aid organisations like Samaritan’s Purse, with which the two American missionaries who have contracted the virus work.

The Red Cross has had 2,400 people in the region since March, of which 70 were international medical staff and consultants and the rest locally employed medical and other staff. The WHO has deployed 428 people, including 170 “surge personnel”. Doctors Without Borders has over 500 people there.

Guéckédou is in the middle of the bush, where clean water and electricity were limited. After the relative calm of Conakry, Fischer said that the fear and despair in the outbreak areas was palpable. All the personnel at the Guéckédou facility ate dinner together. “Dinner was the time people came together and talked about what was going on, would try to support each other,” Fischer said. “That’s key. When I missed dinner, those were tougher nights.”

Dr Kent Brantly, a US missionary who contracted Ebola while working in Liberia, wears protective gear. Photograph: Reuters

The clinical work is hard. Monia Sayah is a nurse who has worked full-time for Doctors Without Borders since 2012. Originally from France, she now lives in Brooklyn. She told the Guardian that doctors and nurses work 15 or 16 hours every day, seven days a week. When in the treatment facility they wear thick protective yellow impermeable suits, rubber boots and respirator masks, two pairs of rubber gloves, thick goggles and rubber full-length aprons to protect them from the disease.

In the warm, humid climate, this gets extremely hot. One day, Fischer took a thermometer with him in his pocket to measure the temperature in his suit; it was 115 degrees. Dehydration or fainting from heat exhaustion are ever-present dangers; in a day, one person can lose as much as eight litres in sweat. Sayah said that when they de-robe, workers are drenched “like somebody’s poured a bucket of water on us”.

Everyone has their own ways of coping. One group of hygienists – responsible for maintaining and applying the Personal Protective Equipment suits, commonly just called “PPEs” – were on a Celine Dion kick which, Fischer told friends, required “its own coping strategy”.

Within the high-risk zone, the medical staff have protocols much like divers. “You make sure the other one is not going to make a mistake, or about to faint, or about to trip on something,” said Sayah. “And you keep track of how long you stay inside.”

“We’re totally dependent on each other,” Fischer agreed. He said that the bravery and support from the patients inside the facility were also important: “The smiles, the thumbs-up.” He recalls one older patient doing callisthenics to show he was getting better. “That was an incredibly moving experience,” Fischer said. “That meant the world to me.”

The American and international personnel are working alongside dedicated local doctors and staff. Fischer said the pressure-cooker environment brought people together. “There’s true friendships that have developed between us and local physicians,” he said. He said he is in touch regularly with people in Guinea by phone and email.

Sayah, who returned from her latest tour of duty in Guinea last week, is also in frequent contact with friends back in Guéckédou. “When you’re in a bad place, you really need to talk to someone who’s going through the same thing,” she said. “Someone who has lived it. We get very close.” She plans to return as soon as she feels rested – in Brooklyn, while on leave, she fills her days with yoga and meditation to get her mind and body ready to go back.

She said that one of the most difficult things to deal with out there is the stigma attached to the disease. “A lot of the time, the patient will not be truthful because they are afraid,” she told the Guardian. “They don’t want to come to the treatment facility.”

“Even though we do a lot of education and information,” she continued, “sometimes it’s very hard to get the message across. They know that if they come, they might not come back.” In an email to friends back home, Fischer said that the fear is “almost as dangerous as the virus itself”. When a patient recovers, staff have to make sure it is safe to send them back to their village. Sometimes, recovered patients can be ostracised.

The best moments, said Sayah, happen when a patient recovers. “It’s a celebration,” she said. “The people cleaning the floors, people who do the laundry for us, everyone, the nurse, the doctor – everyone is so happy.”

When a patient succumbs to the disease it can be very difficult for everyone to bear. Traditionally, in the region, when someone is sick family members crowd around their bedside – they are never alone. This is partly why Ebola, which is most virulent in its final stages, spreads so quickly here. Whole families can be decimated.

“You can see the fear, the desperation when they look at us,” said Sayah. “They can only see our eyes. They hold your hand and don’t want to let go. That’s really difficult, because when you’ve been inside for an hour, and you know you’ve reached your limit, or you’re about to faint, you have to let go of his hand and say, ‘I’ll be back.’”

“It’s difficult,” she added, “because sometimes, when you’re back, it’s too late.”