Not the glittering weapon fights the fight, says the proverb, but rather the hero’s heart. For the hundreds of healthcare and humanitarian response workers during the Ebola Crisis in 2014 and early 2015, fighting the disease required courage and selflessness. One of these workers was Australia Awards Alumna Juliana Ndolo Juma, who left her home country of Kenya, far from the Ebola hotspots of West Africa, to bravely join the fight in Sierra Leone.
The latest case count by the Centre for Disease Control and Prevention (CDC), in conjunction with the World Health Organization (WHO) on 11 October 2015, reported a total of 28,490 suspected, probable and confirmed Ebola cases and total deaths of 11,312. This has been the deadliest Ebola outbreak in history.
With such a large number of Ebola cases being reported on a daily basis and the death toll increasing, Juliana made the decision to join the fight against Ebola after completing her Masters in Public Health (MPH) at the James Cook University in 2014.
Now equipped with world-class expertise to operate in a wide range of contexts through her Australia Awards Scholarship, Juliana responded to an appeal from the African Union (through the Kenyan ministries of health and foreign affairs) for healthcare workers in Ebola-affected countries and applied for a nursing position to work in Sierra Leone. However, due to her Masters qualification, she was offered a Public Health Officer position instead.
In January 2015, Juliana, together with 178 other healthcare personnel from Kenya, were seconded to the African Support to Ebola Outbreak in West Africa (ASEOWA) – an initiative by African governments to support the West African countries affected by Ebola through the provision of healthcare workers.
Feeling a mixture of excitement and apprehension about joining the mission to Sierra Leone, Juliana decided to focus on the opportunity to put into practice the skills she had acquired during the MPH program and contribute towards changing the situation in West Africa. “My biggest motivation was Africa doing something for Africa. Having benefited from my Australian scholarship, it was an opportunity to serve humanity and give back to the community.” Juliana also felt the responsibility to join Africans responding to the crisis – actually going to meet it head on and not depending solely on assistance from developed countries. “Most of the time, we have blamed the West for not responding in time, but what were we doing ourselves? Are they not as human as we are? Are they not as scared as we are? If we do not have the money, what about the manpower?”
Upon arrival, the team was taken through a five-day training by the International Organisation for Migration (IOM), WHO and CDC, which helped alleviate the anxiety. The response team was divided into five pillars: doctors, nurses and laboratory personnel under the case management pillar, epidemiologists and public health officers under the epidemiology and disease surveillance pillar, psychologists and social workers under the social protection and mobilisation pillar, data managers under the data management pillar, and communication officers under the communications pillar.
Juliana described the mood in Sierra Leone as sombre. “People had seen so much death in the streets and in hospitals, to the point that they just had to get on with living one day at a time.” Juliana says there was a stigma attached to Ebola, despite communication efforts to explain the disease, which made people stay away from health facilities, making the team’s work even more challenging. “People were afraid of accepting that they were sick due to the fear of being picked up by the ambulance, which was associated with Ebola, and then being taken to holding centres or Ebola treatment centres.”
Juliana’s roles included case investigation, contact tracing, quarantine and the follow-up of exposed cases, observation and community engagement. She was also involved in strengthening Sierra Leone’s health systems by working with the District Health Medical Team (DHMT) to conduct supervisory visits to health facilities where they would assess infection prevention measures and how case definition criteria were being applied. Juliana says her most memorable moment was when she had to supervise a team that had to deliver a baby in a quarantined home. The team had to wait several hours for proper arrangements to be made for the delivery and transfer of the expectant mother to the holding centre for observation as she had been exposed to Ebola. This delay, however, put the life of the mother and the baby at risk, but fortunately enough, they managed to deliver the baby safely. The birthing incident helped Juliana and her team to reform the management of expectant women in quarantine by making arrangements for them to be transferred to healthcare facilities before the expected date of delivery.
A crucial aspect of Australia Awards is to create capacity for Alumni to actively take up leadership positions and develop an attitude of endurance (based on the knowledge and experience they gain on-Award) to grapple with challenges that could threaten development and progress on the continent. Juliana exemplifies the success of this capacity building and hopes that the show of Africans responding to crises on the continent will continue, and Africans will be the change-makers at the forefront of pertinent public health issues. “I felt [the Ebola outbreak] was a starting point for us to realise that we can support one another as Africans. We are better placed than the West to understand the culture and practices of our people and so are better placed to reach out to them for the much desired change. I am so glad that this crisis has led to the birth of the African Centre for Disease Control and hope that such initiatives will continue to be used to respond to future humanitarian emergencies.”