Abstract
One of the 11 Ebola Treatment Centers built and operated by Médecins Sans Frontières (MSF) during the West Africa outbreak was the first of its kind: a Maternity Ebola Treatment Center (METC). Staffed with trained midwives, nurses, and obstetricians/gynecologists, the METC was established to provide Basic Emergency Obstetric Care (although not surgery) to pregnant women with confirmed Ebola virus disease and to those suffering from pregnancy complications that symptomatically overlapped with Ebola, who could not be admitted to any health care facility without two negative Ebola tests 48 hours apart.
This chapter describes the experiences of two coauthors, an obstetrician/gynecologist and a midwife, as frontline medical workers at the METC during the later phase of the outbreak. It also portrays how the MSF team navigated the challenges of balancing both sides of the ‘safety versus rapid access to care’ dilemma, especially in caring for pregnant women suspected of having Ebola. Lastly, through this lens, it addresses some broader consequences of the Ebola epidemic on maternal health in Sierra Leone.
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Notes
- 1.
WHO case definition for Ebola virus disease includes fever plus three of the following symptoms: headache, vomiting, anorexia/loss of appetite, diarrhea, lethargy, stomach pain, aching muscles or joints, difficulty swallowing, breathing difficulties, hiccup or inexplicable bleeding (WHO 2014a).
- 2.
All names of patients have been changed to protect patient privacy.
- 3.
In Sierra Leone, the prevalence rate of FGM among women aged 15–49 years exceeds 90% (Yoder et al. 2013). FGM is common practice as part of the initiation ceremony of the Bondo society, a powerful all-women-led group, signifying that a girl has become a woman in her community.
- 4.
WHO protocols recommend oxytocin IM for prevention of PPH. However, in the setting of an ETC, the preference is for misoprostol, which is also effective in preventing PPH and can be given orally.
- 5.
Personal communication, Sonia Guinovart.
- 6.
At this time in the epidemic, many rumors were being spread about false positive tests.
- 7.
Guinovart, unpublished.
- 8.
Informal communications between Elin Erland and women at the Maternal and Child Health Post in Magburaka.
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Acknowledgments
We would like to thank Patricia Lledo and Olimpia de la Rosa, who managed MSF-Spain’s maternal health response during the epidemic and who provided us with tireless support both while working at the METC and in the writing of this chapter. Additional thanks also go to Sonia Guinovart and Severine Caluwaerts for their insightful comments to this chapter and to Michelle Olakkengil and Eleonora D’Amore for expert editorial assistance.
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Burkhardt, G., Erland, E., Kahn, P. (2019). Nowhere to Go: The Challenges of Caring for Pregnant Women in Freetown During Sierra Leone’s Ebola Virus Epidemic. In: Schwartz, D., Anoko, J., Abramowitz, S. (eds) Pregnant in the Time of Ebola. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-97637-2_20
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