Researcher volunteers for moral duty on Ebola’s front line

When the director of the London School of Hygiene and Tropical Medicine told staff and students at the institution that they had a “moral responsibility” not only to study the Ebola virus but also to travel to Africa and help relief efforts, employees might have been forgiven had they responded with a polite “thanks, but no thanks”.

Instead, the number of people wishing to take up the challenge made by Peter Piot, who was a member of the team that discovered the Ebola virus during its first known outbreak in 1976, currently stands at almost 500. At the time of writing, eight people from the institution have either been to the region already or are based there now.

One of the first academics from the London School of Hygiene and Tropical Medicine to land in West Africa was paediatrician Shunmay Yeung, senior lecturer in health economics and policy. She spent three weeks in Sierra Leone, where she was involved in setting up a new Ebola treatment centre in Kerry Town.

“There was a genuinely positive reaction to Peter’s suggestion within the school,” Dr Yeung told Times Higher Education. “I certainly felt like it was something I should do. I have skills I can use, and I have flexibility that others don’t have. Peter’s announcement gave those people who were thinking about it the permission and encouragement that they required.”

Dr Yeung was charged with training volunteer doctors and nurses about the correct clinical procedures and the use of personal protective equipment, including how to remove it safely to avoid coming into contact with infected bodily fluids that might be on the exterior of the suit.

She also drilled volunteers in procedures for dealing with accidental exposure, such as how to react to a tear in the equipment or what clinicians should do if they were potentially exposed to the virus – for example if they got vomit or spit in their eyes.

Potential research opportunities

Despite the difficult nature of the work, Dr Yeung hopes to return to the centre in the new year to ensure that it is operating smoothly and to explore research possibilities.

“I didn’t really go out with my research hat on,” she said. “But it was really clear that there is so much we don’t know [about containing an Ebola outbreak] that lends itself to creating an evidence base that would help us manage patients better and improve mortality in the future.”

In addition to the opportunities such outbreaks provide for trialling new drugs and vaccines, “for which there is a research agenda”, Dr Yeung believes that academics can also learn much about how such situations are managed clinically – and it is in this area that she hopes to investigate further.

“There are dilemmas about resuscitating, how much fluid you should use…how you get fluids into patients,” she said. “You have to consider what is good for the health worker as well as the patient.”

Dr Yeung is now considering how to prioritise a piece of research that can be turned around quickly, and then seek ethical approval to proceed. “The speed of things like [Ebola vaccine] drug trials made us realise that, in the research field, it is possible to get all this paperwork done really quickly if you really want to.”

Since the outbreak, two Ebola vaccines have been fast-tracked from animal studies into human trials. Usually it would take far longer to make such progress.

“I am now thinking of research proposals around supportive treatment,” Dr Yeung said, adding that the increased interest in the disease could make such study attractive to grant awarding bodies.

Although the science may have been accelerated by the Ebola outbreak, the Kerry Town centre itself, set up and run by the charity Save the Children and funded by the Department for International Development, has drawn criticism over the perception that it has been slow to open its doors.

At the start of December, according to a Channel 4 News report, only 20 beds were operational out of its 92-bed capacity. However, Save the Children has pointed to the necessity of ensuring that operations at the centre are scaled up in a safe manner.

Race to hit deadlines

“Sometimes it felt like what we were doing was a huge, enormous task, and we were worried about whether we would be able to achieve it, and achieve it safely,” Dr Yeung said.

“It was a real fear, and we felt under a lot of pressure to open the centre. It was supposed to open in late October, and while I was there it was delayed 10 days. There was a huge amount to do in a short space of time.”

In the face of many challenges, Dr Yeung said, the team that set up the centre had worked tirelessly to hit deadlines. “I thought I would keep on top [of my day-to-day duties in the UK] via email in the evenings, but there was no way – we were working flat out.”

In addition to gaining research ideas, Dr Yeung said that the experience would sharpen her teaching as she learned a lot about improvising, motivating students and working in trying circumstances – particularly considering the huge responsibility she carried for her students’ safety.

“Lots of the doctors and nurses were Cuban, while the patients would be Sierra Leonean and speak Creole,” she said. “At one point there was me…worrying about how I was going to get their respect and attention, because if they didn’t listen, they were going to be in danger.

“I had to go in with a schoolteacher attitude. I was worried about whether I could get the respect necessary for them to learn these drills.”

Ultimately, Dr Yeung said, the experience enriched her as a scholar and as a teacher and offered her new opportunities for research. She has also contributed to the development of a new massive open online course. Titled Ebola in Context: Understanding Transmission, Response and Control, the Mooc examines the science behind the outbreak and covers topics including the principles of infectious disease transmission.

“I learned a lot from the process,” Dr Yeung said of her time in Sierre Leone. “It felt like we had a very clear purpose. In our daily life as academics, our time can be spread quite thin. You have to teach and to supervise PhD students; you have research projects and papers to write up and other papers to review. There are lots of different things pulling you in different directions.

“It was refreshing to have a single purpose.”

chris.parr@tesglobal.com