On the frontline of ebola fight

Professor John Wright led a team of NHS Volunteers who spent six weeks in Sierra Leone during the Ebola epidemic. He talks to Chris Bond about his experiences.

Prof John Wright, a Yorkshire health chief, based at Bradford Institute For Health Research, who has recently returned from Sierra Leone where he has been helping tackle the ebola virus. 6 February 2015. Picture Bruce Rollinson

Like many people, Professor John Wright watched the initial news reports filtering out of West Africa about Ebola with a passing interest.

It wasn’t the first time the virus had struck impoverished African countries and it wouldn’t be the last. But within a couple of months the director of the Bradford Institute for Health Research had downed tools and was on a plane from Heathrow heading for Sierra Leone, at the heart of the latest deadly outbreak.

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So what changed his mind? “I’d been following the story on the news as a lot of people had, but then in October the Centre for Disease Control and Prevention in Atlanta published a report saying the projected number of people with Ebola by January was 1.4 million. This was a wake-up call, because if that many people had the virus it meant it was out of control and we were facing a potential catastrophe,” he says.

With the dawning realisation of the scale of the threat doctors and nurses from around the world offered to help. Prof Wright had worked intermittently in Africa for 25 years tackling TB, cholera and HIV, but not Ebola.

Even so, as an experienced clinical epidemiologist with a background in hospital medicine, he felt compelled to offer to help. “I put my name forward along with about 1,500 others, although I secretly hoped they wouldn’t need me,” he says.

A few days later, though, he received a phone call asking him if he was ready to go and after being put through his paces at an Army base in York he flew out to Sierra Leone in November.

Prof Wright, who headed a team of international volunteers, says the scene that greeted them was desperate. “There were fever roadblocks wherever you went, vats of chlorinated water at every doorway and fear of this disease was everywhere.”

Sierra Leone is one of the world’s poorest countries and until just over a decade ago had been in the grip of civil war, so when the disease spread it decimated the fragile health service and paralysed the economy. “Any tourists had long gone and the last overseas businesses were pulling out, leaving behind people living under the shadow of this malignant, malevolent disease.”

Prof Wright, speaking from his office in Bradford, says we shouldn’t underestimate the enormity of the threat posed by this latest Ebola outbreak, which he calls “the biggest global public health emergency in modern history”.

He likens it to a “forest fire”. But what made this particular epidemic so bad? “What made this different was the late global response. It started in March but the international community didn’t really get mobilised until the end of the summer.”

He says that around $1bn has been spent by the international community in an effort to contain the spread of the disease. “If this money had been spent on improving health services, hospitals and providing clean water and better sewage systems two years ago then Ebola wouldn’t have been a problem. Too much is spent on treatment rather than prevention.”

Prof Wright helped set up a hospital in Moyamba, a five-hour drive from the capital Freetown, where they helped treat the influx of patients. It was the first time he had seen this unforgiving disease. “It causes cognitive impairment, diarrhoea, vomiting and headaches, you get a sudden rash and you bleed from your eyes and nose – and from every extremity.”

The death rate is just over 50 per cent. “You know on average that one in two people will die and there’s no effective cure.” It has claimed the lives of young and old, men and women, boys and girls and Prof Wright admits that being unable to comfort a terrified, dying child was hard to take. “You never get used to that,” he says.

It is a cruel disease that can appear to be fading only to return with a vengeance. “Patients would come in and seem quite fit and healthy and you think they’re going to be OK, then they take a nosedive for the worse.”

Given the fact he and his team were working in close proximity to such desperately ill people, did he fear for his own safety?

“You’re aware of the risks but we were taking every possible precaution. The risk is greatest in the later stages and then immediately after a person has died their body is swarming with the Ebola virus.”

Which is why when he returned home to his family just after Christmas and began the 21-day “quarantine” period there was a sense of relief. However, his elation at being reunited with his wife and children was tempered by the news a few days later that his colleague Pauline Cafferkey had contracted the disease. Thankfully she survived and is now recovering but it shows just how dangerous and unpredictable Ebola can be.

In between shifts at the hospital he wrote a series of eloquent and informative blogs. In one, written shortly before he returned home, he talks about an older woman called Saffie who recovered, despite being in a bad way when she was first brought in. “There are two exits from the red zone,” he wrote. “The first is the mortuary exit, and half our patients will pass through this door on their way to safe burial. The second is the ‘happy door’ with a shower of chlorinated water and then the sweet freedom of the green zone. Saffie exited through the happy door to pick up her life once more. She will continue to face adversity as she tries to integrate back into her village. Ebola survivors are stigmatised and shunned. Their community will fear them as carriers and be suspicious of their return.

“Everything she owns will be burnt (clothes, blankets, mattresses) or decontaminated, in a scorched earth approach to Ebola eradication. But she is alive, and the whole team is buzzing with excitement. This is what we have come here for: Curing Ebola, one patient at a time.” It was one of those little, heart-warming victories that gave the doctors and nurses hope in the face of a tide of human misery.

It’s estimated that more than 8,900 people have now died, mostly in Sierra Leone, Guinea and Liberia, but the worst is now over. “It’s very much on the wane, there might be a few little spikes but it’s under control,” says Prof Wright, who is among the experts on BBC Radio 4’s Ebola Junction programme later this month.

But what happens next in Sierra Leone? “The country has been ravaged by this disease, the health service has been obliterated and many of the dead are health workers. “People don’t want to go to health clinics because they’re scared of catching Ebola. Maternal mortality is at record levels, family planning services have collapsed and diseases such as TB and HIV neglected, so the biggest challenge is rebuilding the shattered health services there.”

Lessons have to be learned, too, by the international community. “We have to make sure we are prepared and can intervene quickly next time Ebola hits Africa, because it will return.”