The Ebola crisis: four lessons for the NHS

The mission of King’s Health Partners is to transform healthcare locally and globally – both in south London where the organisation is based, and in the developing world. 

One of its members, King’s College Hospital, began working with Somaliland 13 years ago with charity the Tropical Health and Education Trust to support the development of medical and nursing schools.

‘King’s Health Partners’ mission is to transform healthcare locally and globally’

Clinical staff flew out to train both fledgling healthcare professionals and their trainers.

Their success led to the establishment of the King’s Centre for Global Health in 2011, directed by surgeon Andy Leather who pressed the partnership to expand to Sierra Leone – another post-conflict country with strong links to the UK.

This time they wanted to take a broader emphasis on policy and service provision as well as training.

Learning from Africa

So, two years ago King’s College London teaching fellow Oliver Johnson, along with a couple of volunteer junior doctors, flew to Freetown to support its government in strengthening its vulnerable health system. 

Jill Lockett, director of performance and delivery of King’s Health Partners, said it was not a hard decision as she clearly saw benefits to the NHS from the learning, as well as the assistance given to Sierra Leone. 

But she had no idea at that time of the pivotal role her team would come to play in the devastating Ebola outbreak.

The harder decision was whether to stay once the disease took hold as other organisations and individuals pulled out. 

By the time the outbreak started, Dr Johnson and his team had built up a good relationship with the Ministry of Health and the leadership of the 300 bed Connaught Hospital in Freetown.

‘The hard decision was whether to stay once the disease took hold as others pulled out’

Ms Lockett says: “Part of the success we’ve had around keeping the Connaught Hospital systems safe is because of the bedrock of work in the relationship with the government and the fact that we were there much earlier, pre-Ebola. There is a relationship of trust, something we have worked very hard at.

“The Sierra Leonean government know that we’re there to support them; we’re not there to build our own hospital, we’re helping them run their hospital as best they can.”

Ms Lockett believes that the consistency of practice imparted to local health workers by Dr Johnson has been “phenomenally successful” in saving lives.

“Oliver and his team have been able to work across the hospital and with the government so that good clinical practice and good solid guidelines are applied consistently,” she says.

“They are now discharging patients alive from the Ebola pathway, which if you’d asked us three months ago we would have thought was unlikely.”

With one full time employee on the ground, between six and 20 volunteers in the country at any one time, aided by the London programme office, Ms Lockett describes the King’s Sierra Leone Partnership as “a very small investment for a significant outcome”.

She says: “We know that the virus will run its course and we will revert back to our normal practice.”

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On the Ebola front line

When Dr Johnson, now programme director of the partnership, arrived in Sierra Leone in 2012 his role was to coordinate and manage capacity building - as a specialist in global health he had moved away from clinical practice.

But in August this year, when the Ebola outbreak started to overwhelm Freetown, he had to step in to coordinate the 16 bed isolation unit at Connaught Hospital, alongside his infectious disease consultant colleague Marta Lado.

They did whatever it took, including bagging up bodies and mopping floors, in order to keep the unit and the hospital open.

He has still found what is happening in Freetown as “devastating and draining”.

He says: “It’s unprecedented and overwhelming. Precedent is a bit of a problem - we’ve been working off the old manuals and it’s taken a long time to realise we were dealing with something different.”

At the start of the outbreak, King’s was asked by the health minister to join her Ebola taskforce, working on a national preparedness plan for hospitals.

He remembers: “We were still being told by the experts there has never been a major outbreak of Ebola, and if this gets really bad there will be a few hundred cases. No one thought we’re going to see a massive urban outbreak or one that spreads across the entire country.”

In August, there was a shift, with a huge increase in cases around Freetown, including the tragic death from Ebola of the local doctor in charge of the isolation unit.

“We were asked to step up our support and take over the management of the unit as part of the effort to keep staff safe and the hospital open,” Dr Johnson says.

“Suddenly our ‘backseat’ training role really changed.

‘A few hours after kids walked in they were dead and you’re putting them in a body bag’

“For a couple of months, every day was so extraordinary, I come home and it felt like my brain had not processed what I’d seen. Kids would walk in and chat with you about their lives; a few hours later they’re a bit confused; a few hours after that, they’re dead and you’re putting them in a body bag.

“Particularly when it’s people you know, such as your colleagues, it’s devastating, and you wonder who’s next? For months, it was the grind of deterioration.”

Three months after this nadir, the operation has become more sophisticated, with IV lines, the use of anti-vomiting agents and antibiotics, better screening at the hospital door, and a high throughput of patients in the unit. 

His team of volunteers from the UK has now expanded to 15 healthcare professionals, including seven senior doctors, a pharmacist and a community psychiatric nurse, working with local staff whom he describes as “inspiring… their heroism is vivid”.

In total, the unit has seen 700 suspected Ebola cases, with more than 400 confirmed. The aim is a 100 per cent patient turnaround in 24 hours. On average they have 10 new admissions a day into the unit with three deaths, two negative discharges and five positive cases referred on to treatment centres.

He is hopeful for the future. “We are still seeing more patients every day than we are opening up beds. But close on the horizon a lot of capacity is coming online. I wouldn’t say we’re turning the corner - but we’re at the corner.”

Generally, global health experience can only benefit the UK, according to Mr Leather.

He says: “From an NHS point of view, we’re not going to solve our current problems by looking in; we have to look out, we have to learn, and there are all sorts of learning that we bring back.”

Specifically, King’s Health Partners believe there are lessons that the NHS can learn from its team in Sierra Leone in:

• infection control;
• the psychology of dealing with such a virulent virus;
• how to use NHS staff with experience of Ebola; and
• how to bring on excellent healthcare leaders.