Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone's Ebola epidemic.
Although research on the epidemiology and ecology of Ebola has expanded since the 2014-15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms-and to prevent the spread of Ebola-researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings.
The Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, 69120, Germany Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Shannon A
SA
McMahon
International Rescue Committee, New York, NY, 10017, USA lara.ho@rescue.org.
Lara S
LS
Ho
Department of Anthropology, Durham University, Durham, DH1 3LE, UK.
Hannah
H
Brown
International Rescue Committee, Freetown, Sierra Leone.
Laura
L
Miller
Department of Parasitology, Faculty of Biological Sciences, Liverpool School of Tropical Medicine, Liverpool, L35QA, UK Department of Community Health and Clinical Studies, School of Community Health Sciences, Njala University, Bo, Sierra Leone Mercy Hospital Research Laboratory, Bo, Sierra Leone.
Rashid
R
Ansumana
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Caitlin E
CE
Kennedy
D000328:Adult; D003695:Delivery of Health Care / Q000379:methods; D058872:Epidemics / Q000517:prevention & control*; D005239:Fear; D005260:Female; D066296:Grounded Theory; D006268:Health Facilities; D006282:Health Personnel / Q000523:psychology*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D017053:Infection Control / Q000379:methods; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D036301:Qualitative Research; D012807:Sierra Leone / Q000453:epidemiology; D012934:Social Isolation / Q000523:psychology*; D035502:Trust
Ebola; Sierra Leone; frontline health workers; mental health and psychosocial support; qualitative research