The Services and Sacrifices of the Ebola Epidemic’s Frontline Healthcare Workers in Kenema District, Sierra Leone

  • Michelle M. DynesEmail author
  • Laura Miller
  • Tamba Sam
  • Mohamad Alex Vandi
  • Barbara Tomczyk
  • John T. Redd
Part of the Global Maternal and Child Health book series (GMCH)


Sierra Leone is a country in West Africa with a population of between six and seven million people. To most of the world, Sierra Leone is best known for its natural resources—particularly diamonds—and the 11-year civil war that they fueled until 2002. Twelve years after the end of the war, a recovering but fragile Sierra Leone was thrust into global attention again—this time by the largest Ebola outbreak in history. During the outbreak, health care workers became 21–32 times more likely to be infected with Ebola than people in the general population. Over 350 health care workers were infected in Sierra Leone, 92 of whom worked in Kenema District, the site of one of the largest ever reported clusters of health care workers infected with Ebola. This chapter is the story of the first few months of the outbreak in Sierra Leone in Kenema District. It describes the challenges and successes of health care workers who tried to continue providing maternal, reproductive, and child health care, within the deadliest, longest, and most widespread epidemic of Ebola ever recorded. It focuses on the local health care workers and the lifesaving services they risked their lives to deliver.


Ebola Health care workers Infection prevention Infection control Kenema Maternal and child health Reproductive health Sierra Leone Pregnancy Maternal health Maternal death Ebola virus disease Infant heath Maternal morbidity Maternal mortality Neonatal death Nosocomial transmission 



The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


  1. Central Intelligence Agency. (2016). Sierra Leone. The World Factbook. Retrieved January 3, 2017.Google Scholar
  2. Dynes, M. M., Miller, L., Sam, T., Vandi, M. A., & Tomczyk, B. (2015). Perceptions of the risk for Ebola and health facility use among health workers and pregnant and lactating women—Kenema District, Sierra Leone, September 2014. Morbidity and Mortality Weekly Report, 63(51&52), 1226–1227. Retrieved May 16, 2018, from
  3. Hageman, J. C., Hazim, C., Wilson, K., Malpiedi, P., Gupta, N., Bennett, S., et al. (2016). Infection prevention and control for Ebola in health care settings—West Africa and United States. MMWR Supplements, 65(3), 50–56. Retrieved May 18, 2018, from Scholar
  4. Kilmarx, P. H., Clarke, K. R., Dietz, P. M., Hamel, M. J., Husain, F., McFadden, J. D., et al. (2014). Ebola virus disease in health care workers—Sierra Leone, 2014. Morbidity and Mortality Weekly Report, 63(49), 1168–1171. Retrieved May 17, 2018, from
  5. McMahon, S. A., Ho, L. S., Brown, H., Miller, L., Ansumana, R., & Kennedy, C. E. (2016). Healthcare providers on the frontlines: A qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic. Health Policy & Planning, 31(9):1232–1239. Retrieved May 16, 2018, from Scholar
  6. Senga, M., Pringle, K., Ramsay, A., Brett-Major, D. M., Fowler, R. A., French, I., et al. (2016). Factors underlying Ebola viral infection among health workers, Kenema, Sierra Leone, 2014-2015. Clinical Infectious Diseases, 63(4), 454–459. Retrieved May 18, 2018, from Scholar
  7. Sierra Leone Ministry of Health and Sanitation. (2014). Unpublished data.Google Scholar
  8. Statistics Sierra Leone (SSL) & ICF International. (2014). Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone and Rockville, Maryland, USA: SSL and ICF International. Retrieved December 20, 2016, from
  9. Statistics Sierra Leone (SSL) & ICF Macro. (2009). Sierra Leone Demographic and Health Survey 2008. Calverton, MD: Statistics Sierra Leone (SSL) and ICF Macro. Retrieved December 20, 2016, from
  10. UNDP. (2015). Overview: Human Development Report 2015 – Work for human development. Retrieved May 18, 2018, from
  11. UN IGME. (2017). Levels and trends in child mortality: Report 2017. Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund.Google Scholar
  12. UNICEF. (2014). Sierra Leone Health Facility Survey 2014: Assessing the impact of the EVD outbreak on health systems in Sierra Leone. Survey conducted 6–17 October 2014. Retrieved May 18, 2018, from
  13. World Health Organization (WHO). (2014a). Global atlas of the health workforce. Geneva: World Health Organization. Retrieved from
  14. WHO. (2014b). Case definition recommendations for Ebola and Marburg virus diseases, as of 09 August 2014. Retrieved May 19, 2018, from
  15. WHO. (2015a). Health worker Ebola infections in Guinea, Liberia, and Sierra Leone: A preliminary report 21 May 2015. Retrieved May 19, 2018, from
  16. WHO, UNICEF, World Bank, & United Population Division. (2015b). Trends in maternal mortality: 1990 to 2015. Geneva: World Health Organization; 2015.Google Scholar
  17. Witter, S., Brikci, N., Harris, T., Williams, R., Keen, S., Mujica, A., et al. (2016). The Sierra Leone Free Health Care Initiative (FHCI): Process and effectiveness review. Freetown: Health and Education Advice and Resource Team, Oxford Policy Management. Retrieved May 18, 2018, from

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Michelle M. Dynes
    • 1
    • 2
    Email author
  • Laura Miller
    • 3
    • 4
  • Tamba Sam
    • 3
  • Mohamad Alex Vandi
    • 5
  • Barbara Tomczyk
    • 6
  • John T. Redd
    • 7
  1. 1.Division of Global Health Protection (at time of Ebola epidemic in West Africa)Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Reproductive HealthCenters for Disease Control and PreventionAtlantaUSA
  3. 3.IRC Sierra Leone (at time of Ebola epidemic in West Africa)FreetownSierra Leone
  4. 4.International Rescue CommitteeNew York CityUSA
  5. 5.Kenema District Health Management TeamSierra Leone Ministry of Health and SanitationKenemaSierra Leone
  6. 6.Center for Global HealthCenters for Disease Control and PreventionAtlantaUSA
  7. 7.Center for Global Health, Division of Global Health ProtectionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations