Ebola Changes You: Reflections of a Nurse Upon Return from Liberia

By Deborah Wilson, RN. The author is currently an IV infusion therapist with the Berkshire Visiting Nurses Association in Pittsfield, Massachusetts, and is completing her BSN at UMass Amherst. In October, she returned from Liberia, where she worked with Doctors Without Borders at a 120-bed Ebola treatment center. Names of patients mentioned in the article have been changed to protect patient privacy.

At the cemetery, newly dug graves

At the cemetery, newly dug graves

I have recently returned from Liberia, where I worked as a nurse for six weeks along with a dedicated team of physicians, nurses, and other professionals, treating 60 to 80 Ebola patients a day. My 21-day transition time is recently over and, although I am back at work and school, my heart is with the West African nurses who I worked with for those weeks in September and October.

I worked in a town called Foya, managing a 120-bed Ebola treatment center (ETC). During the first two weeks, I wondered if I would last. In the grueling heat, dressed up in all that personal protective equipment (PPE), constantly sprayed with chlorine, each day I was haunted by the question of whether I’d somehow gotten infected.

It all took its toll. Twice a shift the nursing team would put on PPE and enter the confirmed Ebola isolation area. People lay on mattresses on the floor, vomit and diarrhea everywhere. In our bulky gear, double-gloved, goggles fogging and sweat running out of every pore, we would insert IVs, push meds, try to help someone eat a little something, tell the hygienists that a body needed to be removed to the morgue.

So how did I go from wondering how I would make it through my six-week assignment to now actually considering going back? It was thinking about the nurses and teams who are still there going in every day, never having a 21-day transition period like mine to look forward to, all with colleagues and family who died during this devastating outbreak.

With staff at the 120-bed Ebola clinic in Foya

With staff at the 120-bed Ebola clinic in Foya

Our lives were in each other’s hands—we helped each other dress in PPE and double-checked each other before going in. Talking with one patient, I said, “we must look really weird,” and he laughed, which made us all laugh.

But there was not much laughter in the area for confirmed cases. We never knew who would live or die; sometimes the healthiest would suddenly be dead. We delivered babies who were so small and premature—I think about the young 19-year-old mother dying only an hour after her little boy had been placed in a white body bag and given a name so he could be identified in the morgue. I find myself wondering what her and her son would be doing now if there had been a way to save her.

I wonder about Joy, whose love and dedication to her husband touched all of us deeply. Daily she would come to the fence with his favorite food and George would come out and sit on the other side. When he got too sick to come outside, we dressed her in PPE and took her in, where she prayed with him. We all rejoiced when a pregnancy test revealed that Joy was pregnant, then saw her nearly immobilized with grief the next day when George died. Joy’s cries and sobs as the psychosocial team sat with her is something I still wake up to. I wonder how she is doing and where she is now. Will she have a boy or girl and what will she tell him/her about George?

The Liberian nurses still call me on the phone. They tell me that there is not one case of Ebola now in the ETC! Many have to go back to the health clinics where they worked before. All of them lost colleagues because, when sick people came to their clinics, they had no gloves, masks, or chlorine to protect them. Will they have basic protective equipment now?

They also haven’t been paid for September or October. The Liberian Ministry of Health keeps saying that they will get paid, but I fear that this outbreak has wreaked such havoc on the economy that they have risked their lives, working in conditions we will never have to endure, perhaps only to also risk earning no income as well for their efforts.

My three-week transition involved learning the news of the two nurses in Texas who were infected caring for Thomas Eric Duncan, of physician Craig Spencer testing positive in New York City and Kaci Hickox being locked up in an unheated New Jersey tent with no shower. At times I thought I would go mad—watching as a collective insanity gripped our nation about a virus unlikely to ever take hold in the U.S., I yearned for the day when we could instead turn our attention to what I believe this terrible epidemic in West Africa could really be teaching us:

  • That we are an ever-more-interconnected global community. America could be leading the fight against Ebola—bringing to bear our generosity, love of heroes, and “can do” attitude to support nations that are struggling to contain a true epidemic. We don’t need to close borders or ban children from school just because they are Liberian.
  • That we should remember that health care workers take risks every day to care for people. The only two people infected in the U.S. have been nurses—there are so many more nurses and others who have been infected by HIV and hepatitis C.
  • We need to make sure that appropriate protective measures are in place and people are trained to use them. We must also respect that, even with the perfect measures, there is always a risk for any health care worker.
  • Let’s pause to evaluate our own level of adherence to infection control measures. Too many patients leave the hospital infected with something that undoubtedly has been spread by us.
  • Look at how lucky we are. Liberia is fighting Ebola as a country reported to have only 51 physicians for the whole population. Most of the country does not have running water or electricity, and the health clinics and hospitals function with no gloves, masks, or protective gear.

Rather than shunning others, ostracizing them, and overreacting, perhaps we could be inspired by our brush with Ebola to step up and respond with the best of ourselves to our neighbors, our nurses, and our global brothers and sisters.

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2016-11-21T13:03:33+00:00 November 12th, 2014|infectious diseases, Nursing, nursing perspective|18 Comments

About the Author:

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

18 Comments

  1. Lorena Restrepo July 22, 2015 at 9:32 pm

    I know that I am replying to this entry a few months late, but as a nurse I would like to thank all the health care providers that worked against the Ebola outbreak. It is comforting to see that people still believe in putting themselves at risk to help others because these individuals would be left to die with no hope of any care. It is distressing that an outbreak in an underdeveloped nation must be controlled by sending health care personnel instead of technology or medicines that would keep the patients and care givers safe without having to introduce more individuals that may get sick.
    New technological advances and the interconnectedness of the world have unfortunately not resulted in the desired outcome of improved patient safety and efficiency of care. More effort should be placed on using technology to improve global health issues such as the dangers associated with poverty, maternal health during child birth, communicable disease control, and child mortality. In my personal view the Internet should be employed to increase global communication in two important areas, the improvement of nursing core competencies in underdeveloped nations and the development of inexpensive technology that addresses health concerns. Global communication could be used in the training facilities of developing countries to allow experienced nurses in developed countries to teach young nurses techniques that are beneficial for regular nursing care and during outbreaks. The nurses in developed countries would also be educated on how the nurses in developing countries can cope with disease and injury without the equipment found in modern hospitals. Initiatives can also be started to spread the word about the need to develop inexpensive technology to solve global health issues. I think that organizations should dispense information about health care problems that poor communities are suffering from around the world, to give the opportunity to more would-be inventors to tackle these issues and possibly solve them. An assignment given to Rice University students and designed to develop a cheap blood centrifuge led to the development of a thirty-dollar blood separator that does not rely on electricity. These are some of the ways that I believe technology can help global health, hopefully leaving the world better prepared for the next disease outbreak or environmental disaster.

  2. Veronica July 21, 2015 at 3:21 pm

    First of all, I want to express my gratitude with the work you did while in Liberia. It is simply amazing for the experiences you must keep with you. I am sure all of those experiences make you an incredible nurse within your community. As for some points you made, I could not agree more. We cannot simply overlook the incredible work being done in areas where Ebola is very much an issue. This disease is affecting so many communities on a global level. I could only imagine how your family felt during the time you were doing your work with Doctors Without Borders. I know all of the work your did will help you become a better nurse during your career.

  3. Jessica Caprile July 18, 2015 at 3:25 pm

    First of all, I want to express my gratitude to all the doctors and nurses that traveled to countries such as Liberia to fight the Ebola outbreak.
    As you stated in your article, Liberia is fighting Ebola without even basic resources, such as: electricity, water, gloves, gowns, etc. This demonstrates how important the help of our country and our trained professionals is to obtain the resources to build enough treatment wards and control the outbreak. When we graduate as registered nurses we take an oath to save lives, and it is in situations like the one in Liberia where our advocacy and knowledge is needed. It takes a lot of courage and heart to risk your life in order to help others. Thank you for your service.

  4. Carlos Orive July 16, 2015 at 1:59 pm

    Work like the nurse Wilson does in Africa is the reason why many nurse like me entering in the health care profession. Inspirational histories like these were nurse Wilson travel to Liberia risking his life for the love of the nursing profession and help people when they most needed deserve to be in the news more frequently that they appear. Risking his life in a place with no luxury, were the possibilities to acquire a fatal illness is very high, were patients really needs the care of other human being and at the same time realize and excellent job require a tremendous passion and set an example for all us. You deserve not only our admiration and respect, you set up what will be the vision of the nursing career. Help patients in normal conditions like our hospital is what we do every day, but help patients in a hostile environment is really awesome. Thank you nurse Wilson for show us the passion needed in the nurse career.

  5. Carlos Orive July 16, 2015 at 1:39 pm

    These are why I entering in the health care profession. Inspirational histories like the nurse Wilson, who travel to perform the nurse profession were find a nurse is a luxury, were the possibilities to acquire a fatal illness is higher, were patients really needs the care of other human being. You deserve not only our admiration and respect but you set an example of what is the vision in the nursing career, help the needed where is needed. Thank you nurse Wilson for show us the passion needed in the nurse career.

  6. blessing Godwin-okechuku April 19, 2015 at 3:33 pm

    Wow.. how inspiring. thank you nurse wilson for your bravery. As an African, I am sometimes astounded by the poverty in our nations. You braved the lack of water and electricity and so many amenities we take for granted here in the US to go to a poor country thousands of miles away from your home. You defied these odds, you stayed on taking care of people sick with a terrible disease that you could have gotten infected with. All you cared about was to save a life. You are a hero and nurses like you make me love my career more everyday.
    Oh my God what heart wrenching stories. You said “our lives were in each other’s hands” O wow! how true. Ebola is a deadly disease and because of you and other nurses and doctors like you, we are able to at least curb its spread. Thank goodness. As an African, i say a big thank you to you and others like you. May God reward you for your bravery and kindness.

  7. Ivis C Gonzalez April 19, 2015 at 12:08 pm

    There are incredible acts of selflessness in the world; but putting at risk one’s health, in order to help sick people, is a very humanitarian act. Health care providers risk their lives on a daily basis, to help others overcome diseases. Ebola is a deadly virus. I feel tremendous respect for those that participate on efforts, to nurse and care for others, especially under such circumstances. Hopefully, the issue with the Ebola outbreak is going to increase awareness on communicable diseases. Also, more resources need to be designated to the education, and the safety, of health care providers worldwide.

  8. Debra Lewis April 18, 2015 at 10:39 pm

    Nurse Wilson you are an inspiration to the nursing profession. Your kindness and compassion for those patients in Liberia afflicted with the Ebola virus is very poignant as well as you undertaking the task of going to a developing country with limited or none of the necessary protective equipment. I agree with all of your bullet points especially the one referring to the risks nurses face daily with some of the other diseases, such as Hepatitis C and HIV. I know the nurses in Liberia is very appreciative of all that you did. Keep sharing these heartfelt experiences.

  9. Kenia April 18, 2015 at 1:20 pm

    Global health concerns have never been so present to modern Americans as it was with the nationwide hysteria prompted by the Ebola outbreak. The Ebola outbreak took many Americans by surprise. One would think that with all the technology and the medical advancement that we would have been prepared to take care of any epidemic. Moreover, numerous nurses also felt unprepared and feared for their lives not knowing if the next patient that they would receive would be diagnosed with Ebola. It’s astonishing to read how these Liberian nurses had so much bravery and love for humankind. They put their fears aside and took care of people knowing that at any time they could also be contaminated. Furthermore, these nurses worked with limited staff and resources in an unhygienic environment. I can’t imagine how these nurses may have felt seeing their coworkers die yet still have the strength to get up the next day. As a nurse and as an American, I am encouraged that all people, in all countries will take greater precaution and interest in further global health concerns so that the work of these brave nurses was not done in vain.

  10. Ottis Brown April 13, 2015 at 5:34 pm

    Anyone who reaches out to save another is to be commended. Anyone who puts himself or herself at great risk to save another, is to be revered. Acts like those go beyond just being a nurse, they speak to the character of the person. Nurse Deborah Wilson, could have stayed in Massachusetts, but she went to Liberia, one of the most feared places on earth during the Ebola outbreak. And she rendered care to the sick, in horrible conditions. Her story is inspirational. Thank you nurse. What was also touching was her concern for those left behind, and her thoughts of possibly going back. This takes a special kind of people. I am oh, so motivated! Now, like nurse Wilson said, ”let us step up and respond with the best of ourselves to our neighbors, our nurses, and our global brothers and sisters.”

  11. Christine Riano April 7, 2015 at 3:39 pm

    Nurse Wilson, you have been an inspiration to me and many other people reading your blog. You have the strength, courage, and selfless service to help with the fight against Ebola. Several months ago, people were panicking about the Ebola outbreak and doctors and nurses volunteered to help care for those who were infected, knowing how much of a risk it could be to their own health. You, and other nurses and doctors that volunteered, show such compassion and make a significant impact in healthcare by touching the lives of others and inspiring future nurses to follow in your footsteps. Your blog has brought awareness in that people take what they have for granted. We have all of the basic necessities and more, while other countries do not even have running water, electricity, or proper protection. Thank you for all that you have done and sharing your story that will continue to touch people’s lives and provide inspiration to others around the world.

  12. B. Lucas April 2, 2015 at 2:56 am

    Your blog post was very interesting and touching. You were at the center of the ebola epidemic and put your health at risk everyday to care for ebola patients. In America, we were freaking out about the handful of people on this soil who had contracted the ebola virus. Hospitals were even taking ebola precautions, which now seems to have suddenly vanished even though the virus continues to remain active in Africa. You touched many lives in Liberia and many lives have touched yours; that is what nursing should be all about and not just pushing medications.

  13. Barbara Thompson March 5, 2015 at 8:06 pm

    Not too long ago, the United States was in a semi state of panic with the few Ebola cases that crossed into our borders, but no one, no lay person, or healthcare worker, that has not been in West Africa, can relate to what you went through. Americans feared the few Ebola patients that were treated here, but volunteer nurses and doctors who were in the “trenches”, administering compassionate and empathetic care for the sick and those clinging to life. I think that this past scare might has opened health care workers eyes, or at least renewed our realization of how such a potent virus can be transmitted and how proper use of PPE can make all the difference in the world. You certainly inspire fellow nurses to lend a helping hand to those less fortunate and in need.

  14. Musa November 24, 2014 at 8:14 pm

    Nurse Wilson, You have brought tears to my eyes with your story. I have been an RN for about a year now and I feel that I will not feel fulfilled as a nurse until I do something as amazing as you have. I feel that at times, healthcare professionals in the United States take advantage of all the supplies and technology that we have here at our fingertips. There are so many countries that can not afford the luxuries that we have here and do to this the patient’s suffer day in and day out. I think that your article definitely brings awareness to all of us that have not had the courage to go and put ourselves at risk as you have. Thank you for your service to those people and I’m sure that they remember you everyday!

  15. Peggy November 14, 2014 at 9:32 pm

    Thank you! Both for your service to the greater world community and for sharing your heart wrenching experience. Your common sense comments are truly needed. I was so disappointed with the overwhelming response of fear by nurses in the USA and particularly the skewering that went on towards Kaci H. Please know that I for one admire you and others that have assisted those countries directly! Please keep writing, you have a gift.

  16. Hawa November 13, 2014 at 1:11 pm

    Wow as a Liberian, I want to first of all, a Big Thank u for ur Sacrifice! ! May God bless the work of your Hands. I can only imagine the Devastation. I still have all my immediate family back home. Even Tough I live in the US, I am living in fear everyday, thinking about my love ones.i pray that our land will be healed again!! And to all the nurses, n doctors, your reward will not be in vain!!!!

  17. Christine Collins, ARNP, MSN, FNP-C November 13, 2014 at 7:57 am

    First Debbie, thank you for your compassion and commitment to go to Liberia to care for victims of this horrible global crisis. You really demonstrate the core of what nursing is!
    We need to respond as a world to help fight this situation. We need to treat these generous volunteers as heroes protecting the world! Quarentine is really not necessary. It is in the best interest of the HCW to self monitor for symptoms and seek treatment at the earliest possible moment when symptoms begin! At that point casual transmission is very unlikely. The whole situation with Kaci Hickox was embarrassing, politically based. I made a comment on Web MD and was severely criticised, mostly because I was not a physician!.
    You are so right, that even with the best adherence to infection control precautions inadvertent unnoticed exposures can occur. HCW do put themselves at risk every day, something that we at times take lightly. These precautions not only protect us but our patients! ie, nosocomial transmission of infections. However, hospitals also have to provide adequate PPE and that they have appropriate training in their use. There were some issues initially with Thomas Duncan and the nurses in Texas. These have been corrected. The CDC has issued very definitive instruction for doning and doffing PPE. Having institutions designated as treatment centers to ensure that they have adequate environmental biocontainment units as well is also critical to the care of the patient and protection of the HCW and adequate handling of biological waste etc. This is very complex and requires sophisticated integrated systems involving multiple departments in the health care system, nursing, medical services, laboratory, radiology, envirnmental services and more,
    Immediate reporting of any inadvertyant break of protocols or HCW exposures need to be reported immediately. HCW need full support in a non-punative and supportive way!! As a Employee Health professional for over 25 years, I worked with Infection Control and departments to ensure that HCW had a safe environment and adequate support to perform their jobs safely. In the event of injury or illness they have full support and access to care! In 25 years, I only had two incidents of transmission of blood-borne infections, both Hep-C. Fortunately both spontaneously cleared infection on their own within 3 months!
    The US has developed good treatment protocols for treating victims of Ebola. So far all have survived except Mr. Duncan. We know that they need to seek treatment early! Quarantine is probably not necessary. Early stages of infection are not highly contagious. This is a virus spread by contact with infectious body fluids, not air borne transmission.
    Our courageous HCW need support and the greatest respect for the work they are doing. The fight against this global crisis must be fought and won in West Africa. Thank you Debbie for sharing your story.

  18. Linda Appleby November 12, 2014 at 3:05 pm

    Thank you, Nurse Wilson, for sharing your story and your reflections with us. I have been deeply moved by the written accounts and interviews of nurses, both American and Liberia, who have been caring for Ebola patients. Their courage, strength, and compassion represent the heart and soul of nursing. Yes, learning and using the power of science is important, but this hands-on, heart-felt care is what provides the context for everything else. Please keep writing and sharing your stories to provide a touchstone for nurses in generations to come.

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