WorldLink: The 'disease detective' on Ebola's case

 

[00:00:02 Kathleen] Many doctors and other professionals were deployed to the Ebola hit regions between 2014 and 2016. And of these professionals there were a group of detectives whose job it was to figure out how Ebola was spreading. Joining me now is one of those detectives. Dr. KATRINA ROPER is an epidemiologist from the Australian National University. She was in Sierra Leone on three separate deployments during the epidemic as part of the World Health Organization's response. She joins us now over the phone from Canberra Australia. Dr. Roper thank you for joining us.

[00:00:36 Katrina] Thank you very much Kathleen. Happy to be speaking to you.

[00:00:38 Kathleen] So give us an idea of what the day to day life is like if an epidemiologist or a disease detective what are you doing from day to day to find the virus.

[00:00:47 Katrina] So we worked quite long days. We were based in Freetown in the capital of Sierra Leone and it was a large multidisciplinary and multicultural, multi-organization, multi-country team as part of the National Emergency Response Centre. We'd wait for the laboratory results to come through and we look at all the positive cases and with that we would know where we needed to start our contact tracing and quarantining. And then we'd also start working with our teams of locally engaged staff and actually going out into the town itself and literally walking the streets. We were just looking for people who might be sick, talking to people, just gathering information. It really is detective work. And as you gather information you find out who might have moved into an area, who's left an area, who's feeling sick and you of course would be looking for any dead bodies.

[00:01:37 Kathleen] Well one issue that you spoke to the World Health Organization about in an article that's on their page was about communication just generally trying to establish facts. And I just want to read one of those examples so you give the example of trying to figure out who had gone to a particular party that had taken place. And you give the example of speaking to somebody and saying ‘Hi have you heard about an engagement party involving this person’.  They respond ‘Yes, they attended an engagement party’. And then you say ‘When was the party?’ and they say ‘Well they were planning the party but it never took place’. And then you say ‘Are you sure?’ And they say ‘no’. So I kind of laughed when I read that example because I thought oh there must be some very big differences that you had to deal with. Could you tell us a little more about what you were saying with that example and how indicative it was of the general communication issues that you were dealing with there?

[00:02:28 Katrina] You know I'm a foreigner coming into their country and I'm asking a lot of personal questions and I'm being very persistent and that can really be quite confronting for the person being questioned. So we’d spend a lot of time trying to explain why it was important to find out all the information and point out that no one was in trouble for being sic. That it was not their fault, but that it was about trying to provide care to them and help for them. And early on one of the issues we had was a lot of the messaging was around how lethal the Ebola virus is. And so some parts of the community kind of adopted the attitude of ‘Well if the disease is that lethal then why would I bother trying to get care? I might as well die at home with my family’. So then we asked for the messaging to be changed that you know we can lower the fatality rate if you come in early for care. We can provide you with care; we can we can try to help you survive.

[00:03:21 Kathleen] I wonder if a lot of people think that this is part of the doctor's job you know because when you think of containing a virus you think of curing patients and not so much going out into the communities. Was there surprised at the fact that you were going from door to door?

[00:03:34 Katrina] Going door to door was a somewhat surprising thing I guess, for the population and it was hard. There were a couple of communities when the peak of the outbreak had passed and, as with everything, the last part of any activity is always the hardest part. And so the last people to find, that you can find, are the people who are the hardest to find are the are the ones who don't want to be found. So the people that are really fearful or very worried and they just don't want to be identified as having had contact with an Ebola case or being an Ebola case themselves.

[Kathleen ] They were afraid because of the stigma?

[Katrina ] Very much so. They were scared of the fact that they might die. They were scared of the fact that they might be blamed for bringing it in into their community.

[00:04:19 Kathleen] How did you keep going every day because you were there from 2014 to 2015?

[00:04:23 Katrina] That's correct. I was there for quite a long time and I don't think anything really prepares you for the first time you see a lot of bodies lying on the side of the road or the first time you watch a group of people walking down the road and then coming into a clinic because someone's sick and then all of a sudden that person just collapses and they just lose consciousness. You know, seeing such vast numbers of sick people and dead and dying people is really very confronting. I think for me keeping strong meant that I had to look after myself first in terms of making sure I did eat and drink properly, make sure I got some sleep. We also looked out for each other. We became really firm friends within the various outbreak teams and we did look out for each other and we had a few light-hearted moments when we could in the evenings. But most of the time during the day it was just a lot of work. You just have to keep focussing that it's all for the betterment of the country and eventually it will pass.

[00:05:21 Kathleen] It was an unprecedented epidemic in terms of Ebola in Africa and you know by the end of it over 11000 people had died and nearly 30000 people had been infected over those two years. And so would you say that your work as an epidemiologist in your field was impacted by how that case was handled, how Ebola was handled?

[00:05:41 Katrina] Yeah it's interesting I mean Ebola was discovered, first identified and named in 1976. And so in the first 38 years of us knowing about the virus there were less than two and a half thousand cases worldwide. So in 38 years, two and a half thousand cases. And then in the space of two years we had over 30000 cases. You know it was a phenomenal jump in numbers and as you say it was unprecedented. There was literally no other word to describe this. It has also highlighted the fact that fragile health systems leave a country vulnerable and there's no point having a whole lot of people who can deploy to provide a response. It's actually better to start before that happens and to start building up the health system capacity within the country.

[00:06:30 Kathleen] So you mentioned that one of the takeaways for your field has been just in how to deal with Ebola. But on the other hand you talk about how difficult it is when you're on the ground. You have to take very good care of yourself. And I'm just wondering you know there is another Ebola outbreak, not at the same level, but there is one going on in the Democratic Republic of Congo. Do you think that people who were deployed during the epidemic would be able to go in and help if there were a second epidemic?

[00:06:56 Katrina] I think there are a lot of people who would go back in again. There are certainly some who probably never want to go into the field again but a lot of people would. Sometimes I think, you know, is there something wrong with me? And then I think, no, firemen train themselves to fight fires and they run into burning buildings. I mean, but they do it with risk mitigation plans in place. They don't do it in a risky fashion and they don't put themselves at risk. And I think that's how it is for disease detectives and epidemiologists who work in communicable disease outbreaks. It sounds a little bit perverse that we are the first people to put up their hands and say yes we want to go there but it's because we know we have useful skills. We know it can be part of it.

[00:07:40 Kathleen] Dr. Katrina Roper is an epidemiologist from Australian National University. She was stationed in Sierra Leone for the World Health Organization during the Ebola epidemic. She joined us over the phone from Canberra, Australia. Dr Roper, thanks for being on the show.

[00:07:53 Katrina] Thank you very much Kathleen. It's been a pleasure. 

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Katrina Roper

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