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After Ebola: NEIDL Infectious Diseases Expert Returns to Africa

Nahid Bhadelia launches effort to help unpaid local health teams

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Last August, Nahid Bhadelia traveled to Sierra Leone during the Ebola epidemic’s peak, hermetically clad in the protective spacesuit-like gear of a biosafety level 4 researcher. Funded by the World Health Organization (WHO), Bhadelia went there to share her expertise on infection control and to help care for patients infected with the virus.

A year later, the School of Medicine assistant professor of infectious diseases and director of infection control and medical response at BU’s National Emerging Infectious Diseases Laboratories (NEIDL) returned, this time ungloved and unmasked, to interview African health care and burial workers, many still unpaid for their work during the epidemic. Appalled by their financial plight, Bhadelia recently launched a GoFundMe campaign, Support Sierra Leonean Ebola Workers, with the goal of raising at least $50,000 to help compensate them. As of August 26, donations had reached $13,026.

The Centers for Disease Control and Prevention estimates that 13,470 people in Sierra Leone were infected during the 2014 Ebola outbreak and that nearly 4,000 died, along with another 2,500 in neighboring Guinea and 4,800 in Liberia. In May, Newsweek reported that burial workers as well as health care workers were sidelined as $3.3 billion in international relief funds poured in last year to fight the epidemic. Rather than paying frontline workers, most of the money went to United Nations agencies and a score of nongovernmental organizations, fueling protests in Sierra Leone and Liberia. Having witnessed firsthand the tireless efforts of these frontline workers, Bhadelia, who specializes in infection control issues related to emerging pathogens and highly communicable infectious diseases, launched her fundraising campaign on June 19.

She says that one of the nurses has used some of the proceeds “to pay a year of rent for a house farther from water. His last tiny place was by a stream in the dry season, and now it’s regularly flooded in the rainy season. This arrangement will keep his family healthier.” Another nurse, she says, has used money she received from the campaign to take care of, feed, and clothe her own son and the son of a fellow nurse who died in August 2014.

As well as clinical training in infectious diseases, Bhadelia has a master’s degree in international affairs from the Tufts University Fletcher School of Law and Diplomacy and a background in international affairs and human security. She has worked on projects with the UN International Strategy for Disaster Reduction and the Global Fund to Fight AIDS, Tuberculosis and Malaria and was a senior policy and technical advisor to the Partners in Health Ebola response program in Sierra Leone.

BU Today asked Bhadelia about her return to the former Ebola zone, her inspiration for the fundraising effort, and the challenges those who helped fight the epidemic continue to face.

BU Today: Is your fundraising campaign the only one you’re aware of aimed at compensating nurses, ambulance drivers, and other Ebola workers who have received little or no pay?

Bhadelia: I know that some of my co-expat Ebola response volunteers are also interested in helping out, and I am hoping that those avenues open up soon for more help for these health care workers. None of us are trying to replace pay for the Ebola workers. That is not sustainable, and it is not our place. We are trying to help our friends in Sierra Leone and their families make ends meet during this hard time.

How have you been able to contact the workers you’re hoping to help?

I was able to meet six of the health care workers I knew from last summer and distribute the first set of funds to them at the beginning of July. It was a powerful day to spend time with them and hear about what they have gone through over the last year. I sent the second set of funds for three more health care workers with a friend traveling to Sierra Leone at the end of July. We are hoping to send more funds later this month.

In documenting the workers’ stories, what have you found they have in common, and what are some stories that particularly moved you?

They all spoke about staying and continuing to work in the Ebola treatment units despite the fear they felt, because they knew it was the right thing to do. One of the nurses shared this with me: “The hardest thing for me was when we admitted health care workers to our Ebola unit, because I would look at them and I would think, she is a nurse and I am a nurse and tomorrow this will be me.”

Tell us about the stigma associated with treating, transporting, or burying Ebola victims. What can be done to fight it?

One of the nurses was kicked out of her mom’s house because she was working with Ebola patients. Health care workers in Sierra Leone routinely shared stories about how they had been driven out of villages. Another nurse, who was pregnant, went to the capital to clarify why she had not been paid and was thrown in the back of an ambulance with an Ebola patient without any protection and told that since she worked with Ebola patients, she too must have the disease. It wasn’t until she reached the treatment center that she was released.

Many of my expat coworkers would tell stories about having their children disinvited from parties and being told not to return to work by their employers. I was asked not to return to my apartment building by management and was given a month’s rent to stay away after I returned the second time from Sierra Leone. It’s fear that drives the stigma, and it’s lack of information and education that drives fear. We need to see beyond our fear and continue to see the humanity of those around us. This is what allowed the Ebola workers to continue their work, and their doing that is what kept all of us safe.

Why was so little of the international donations earmarked for frontline workers? How can people like you raise awareness so that more will go to them in the future?

The issue was not just that such a small amount was earmarked for them in the first place, but also that the amount that was earmarked has been taking a very long time to make it to them. It is hard to work for months without pay, because as human beings we need to continue to pay for food and shelter. I am hoping that by putting a face to these brave people and bringing their stories to the forefront, we can create pressure to rectify these injustices, but also ensure that they are not overlooked during the next crises.

What is life like now for the health care workers who treated Ebola patients? Has Sierra Leone honored or acknowledged their sacrifices in any way?

Many of them are working as volunteers in their hospitals, as there is no pay. One of my nurse friends who received part of the funds we’ve raised had not been paid since February. I heard that there may be a fund that is being put together for the families of deceased health care workers, but it is not clear if the funding is getting to where it needs to be. Many health care workers I spoke with said that they felt the world had stopped thinking about them now that the epidemic was over: “We were your first soldiers and we fought naked, and many of us paid with our lives. Now we are forgotten.” They felt that the international donors were only interested in Ebola survivors, and in related research, and in making new jobs for people in higher ranking positions. Nothing had changed for them. If anything, they had lost their position in society, they had lost their friends to this disease, and they had spent months risking their lives in their jobs.

The workers you are hoping to help—what is their standard of living?

Nurses in Sierra Leone make the equivalent of about US $150 to $200 a month. It is usual for their pay to be delayed due to the poor administrative structure of the national system. Their living standard is at the subsistence level. As I mentioned earlier, one of the nurses and his family lived in a small house that was constantly flooded during the rainy season. The gratitude that they feel to the amazing people on this side who contributed to the fund is immeasurable. Even the $400 to $600 that each of them has received through this fund drive has changed the lives of their families for months to a year.

You must have made friends in Sierra Leone when you worked there. Can you talk about the commitment of the health care workers and what you admire most about them?

Kenema Government Hospital, where I worked last summer, lost 35 health care workers to Ebola and a total of 50 contracted the disease. We can only imagine continuing to work when we see so much death around us, when we are losing our own friends to the disease, and when we aren’t getting paid or getting recognized for the work that we do. If that is not a testament to the heroism of these workers, I am not sure what is.

As someone at the outbreak’s epicenter, what are the most important lessons you took away from the epidemic?

As has been said many times over the last few months, we need to invest in the health care delivery and public health systems of countries like Sierra Leone. Our common global health security depends on it. But as we move toward putting money into the efforts to build these systems, we cannot forget the importance of economic justice for health care workers.

Contribute to the Sierra Leonean health care worker fund here.

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