TIME magazine named Ebola health workers their Persons of the Year for good reason. These dedicated professionals are risking their own lives to save others in a job full of hazards, many of which are currently unknown. As the disease continues to spread, researchers have realized there is a need to understand the culture of behaviour these frontline workers contend with to identify potential preventative measures.
Doctor Lara Ho, technical adviser for health programs with the International Rescue Committee, is working in Sierra Leon to discover the levels of knowledge and risk perceptions among local health workers. In early December, her team began to do in-depth interviews, focus group discussions and structured observation to explore the experiences of health workers during the Ebola crisis. “We are talking to Ministry of Health staff at peripheral health units, which are mostly primary care health facilities,” she explains. These facilities are outside of the district hospitals and provide primary health care as well as some beds for short-term observation of patients.
The focus of Dr. Ho’s research is investigating the barriers – likely caused by customs, beliefs or taboos – that staff face in adhering to standard precautions. “We aren’t sure what these are yet, although anecdotally we have heard that lack of water can be an issue and that some health workers have been infected when performing traditional rituals of washing the body when burying a colleague,” she explains.
She notes that before staff received training in some facilities, particularly hospitals, there was not appropriate triage for all patients arriving at the facility. “This meant that potential suspected cases of Ebola could end up in regular wards where staff were not using appropriate protective equipment because they weren’t expecting to see possible Ebola cases,” she says.
As the research progresses, health workers and district health management teams will participate in the analysis of issues uncovered by the interviews and observation. They’ll use this information to develop improved practices or strategies that will make it easier to adhere to standard precautions for infection control. The information will also be shared with other facilities and districts.
Is there an educational component to the project? “We don’t know yet whether knowledge or risk perception are actual problems preventing adherence to standard precautions. The research is an iterative process and the improved practices that health workers propose will depend on the results of the initial phase of research. That way they will be adapted to the real experience and context of health workers delivering primary care in Sierra Leone,” explains Dr. Ho.
The IRC-led Ebola Response Consortium has already supported the Ministry of Health and Sanitation to roll out training on infection prevention and control in peripheral health units nationwide. “We hope that the research will show that health workers are using the training to protect themselves, and that the research will allow us to improve conditions even further,” she says.
Her research team comprises six co-investigators including those from the Republic of Sierra Leone Armed Forces, Mercy Hospital Research Laboratory, Charité Universitätsmedizin Berlin, and Durham University. The project, budgeted at £185,621, is scheduled for completion by April 2015. It is funded by the UK Department for International Development (DFID) and the Wellcome Trust that have designated £1.34m from a joint fund for several research projects to combat the Ebola outbreak in West Africa.