A GP trainee from London, Rita, has started a meetup group for humanitarian aid workers (multi-disciplinary) who have done field missions, which is a great way of getting connected. Join here. If you want to start one in your locality, get in touch and we’ll support you through the process.
Interview series – Dr Luke Kane, ST3 Lewisham VTS, London
Luke was one of the first people I wanted to interview for this blog. We had only met a year ago at the WONCA conference in Copenhagen and I was rather struck by this young GP trainee from Lewisham, London. With some careful Facebook stalking and after some shameless messaging, he’s agreed to meet me for a coffee to talk about his Ebola mission and also about being the ship doctor for the Channel 4 programme Mutiny. Totally poor form but I arrive 20 minutes late but Luke is totally forgiving – I’d forgotten how huge London is. The conversation was riveting and, to do it justice, I’m splitting it into two posts.
The West Africa Ebola crisis in 2014 dominated the media, whether it was about the indiscriminate spread of the disease, to the slow reaction of the international community and then to the hysteria of the potential global pandemic. I don’t think I’ve ever spoken to anyone in-depth about working in a humanitarian response so this experience is new to me too. What was it like to truly work there? How much support do you get? Can you really help as a GP trainee?
“They had set up a huge multi-million pound Ebola centre which was paid for by several NGO’s and UK DfID . The accommodation, paid for by the Norwegian government, was luxurious and was outside of the Ebola centre. You would go into the white zone which is the perimeter and then into the green zone to get changed and make plans and the red zone is where the patients were”.
“There was a triage area where patients would come and tests would be done. And there were different tents based on the probability of someone having Ebola. It was important that we didn’t cross contaminate people with Ebola with people who might just have malaria.”
“The maximum time you could go into the red zone was one hour because you’re wearing a suit which was made of impermeable plastic so you were so hot sweating you couldn’t be in one for too long. Sometimes, especially when it was colder, we could push it to 90 minutes but sometimes it was just 15 minutes. Obviously if anything happened, you would be out immediately for a chlorine shower.”
Luke is a natural story teller with a killer sense of humour and I wonder if I’m being distracted from the gravity of the situation by the free-flowing anecodotes. But from the conversation, one thing really strikes me over everything else – the intensity. The intensity of the heat, the intensity of being at such close quarters with a team you barely know, the heartbreaking intensity of dealing with the tragedies of the disease but, most of all, the emotional intensity of the fear. Despite the safety suits and the protocols, any slip up could lead to contracting the virus with devastating consequences. I can’t imagine how someone could learn to trust a colleague in these circumstances.
“It’s insanely high pressure and very emotional. There’s a lot of kids dying in horrific ways so there was all this emotion around so there was a lot of fear and anxiety. It was a tinderbox for insanity which was really fascinating”
Although the clinical aspect and the logistics of Luke’s mission were enthralling, I’m transfixed hearing about the public health aspect of this outbreak. I’m learning so much about how this particular virus has been genetically traced back to one particular child who was playing in a hollow tree with bat droppings. I’m hearing snippets about how previous outbreaks had been confined to small villages but, with the improvement of national infrastructure, it rapidly became an epidemic, and that in turn could have had a global impact with increasing international infrastructure. The latency period of 21 days meant that a patient could be blissfully unaware of infecting others. I’m engaged by the tragic stories of individuals who become Ebola survivors, accompanied back to their villages with the community mental health officer to try and reduce the stigma and the doubts around reintegration. But when whole families were wiped out, the aftermath for a survivor must have been unthinkable.
“It was a horrific crisis. The potential for it was absolutely mind-blowing. It could be truly a global pandemic.”
“The risk of it overspilling into the Europe and the US meant that there was an incredible response. You can’t fault that bit but it was way too late.”
We also talk about the unfairness of the system. “I’ve never been more humbled than meeting all the local doctors and nurses who had been working on it for 8 months before we got there, using reusable latex gloves.” They were all experienced doctors and nurses who were treating Ebola victims, fully aware of the risks, with no safety equipment and no funding before international aid was thrown at the crisis. If any of the “international” doctors felt unwell, they could be flown in a private jet home and receive top-notch care by the best specialists in the country. If a local member of staff had a fever? Well, they might get admitted to the multi-million pound tent in the middle of the jungle. Click here for an excellent BBC synopsis. “Sierra Leone, Liberia and Guinea are some of the poorest countries in Africa. It was the worst possible combination of events.” The WHO were criticised for the delay in response, although arguably this may be with the benefit of hindsight. I wonder if there was no risk of Ebola spreading to our shores, would there have been such a crescendo of an international response?
Interestingly, the conversation then turns to well-intentioned but misplaced enthusiasm of volunteers which reminds me of a lecture I attended about the Sphere Project, launched in 1997 following the un-coordinated response to the Rwandan genocide. Its main aims is to set standards amongst humanitarian agencies and to demand accountability although the argument against it is that a disaster response becomes a protocol rather than a human response. Just because people need help doesn’t mean that any help is good enough. “How do we maximise the good that we are doing here and minimise the damage. Of course there is going to be damage.” I’m not saying that there is always a better alternative but there was a small wince when I heard of people jumping into their vans to head to the Calais jungle during the refugee crisis. Well-intentioned? Definitely. Ultimately helpful? Not sure. This touches on the impossible topic of the ethics of volunteering which I lack space to expand on here. (I might get our JIC Beyond Europe team to write a post on this based on the ethical toolkit they are currently writing – comment below if this would be of use). It’s so hard to stand by and watch humanity crumble but is that worse than intentionally creating collateral damage?
“In hindsight, it should have been more about how to empower local staff with extra support. It felt like a very colonial response of “let’s spend a billion pounds of this and place a western hospital in the middle of the jungle.””
“We all know it’s about capacity building and trying to strengthen local communities but it’s very hard. It’s easier to take the large donation money and drop a centre in a jungle. Of course that’s easier.”
“A response should be 99% logistics, infrastructure and water and sanitation with a few key people heading local teams and empowering people to respond appropriately.”
Somehow I feel jealous of Luke’s experience. When I think about it, I probably wouldn’t have had the same courage to see the bigger picture beyond my own heightened emotional state. But I do see that this experience has shaped him. Learning to trust oneself is an important lesson as a doctor and when I ask Luke if he would do it again, there was no hesitation in the affirmative.
“It has taught me so much about being a doctor and about humanity and it was one of the most profound experiences of my life. But it was very intense. I think you should go into it with the full understanding that it’s a very messed up world and the response is not quite what you think it’s going to be. But do it. The world needs good people with good intentions and realistic expectations to go and help. I think it was amazing but one of the worst things I’ve seen in my life.”
Luke took part in the NHS response via Medicos del Mundo (Spanish Doctors of the World) and spent 2 months in Sierra Leone during his GPVTS ST1. The London deanery accepted OOPE’s from everyone accepted on an official programme with indemnity covered and he is making the 2 months up at the end of this ST3.