On the Frontlines: A Student’s Reflections on Ebola Crisis Oral History Research Trip to Sierra Leone and Liberia
I had the privilege of joining the Center for the Study of Social Difference working group, On the Frontlines: Nursing Leadership in Pandemics on a week long trip to Freetown, Sierra Leone and Monrovia, Liberia in August of 2019. While there, we recorded oral histories of nurses and midwives who were active during the Ebola crisis that afflicted both Sierra Leone and Liberia between 2014 and 2016. These interviews recorded perspectives from nurses working at the level of ministries of health, to those engaged on the front-lines. Nurses interviewed included some who treated the earliest cases, and others who were there as the last patients were discharged from the Ebola treatment centers. Two of the nurses interviewed were themselves survivors of Ebola and everyone the project encountered had a personal story of loss from that time.
This trip marked my first foray into the field of global health work. My responsibilities mainly revolved around handling the logistics of recording the interviews, taking photos of the participants, and ensuring that the group could function efficiently over the course of a very short trip. In the process, I was able to sit with and listen to the stories of those who came to give their testimonies. We interviewed almost 40 nurses and midwives and met many other everyday heroes who told us their stories about Ebola. As someone in the process of applying to medical school, this trip gave me a new perspective on the role of nurses, why they have so often been sidelined in the decision-making process, and the remarkable lengths to which they go daily to serve their patients.
The interviews of nurses were conducted exclusively by nurses. Our delegation included two professors from Columbia University, Dr. Jennifer Dohrn of the School of Nursing and Dr. Susan Michaels-Strasser of the School of Public Health. They were joined by two other leaders in the fields of nursing and midwifery, Dr. Annette Mwansa Nkowane, formerly WHO Headquarters Technical Advisor for Nursing and Midwifery in the Department for Human Resources for Health, and Dr. Margaret Phiri, formerly WHO AFRO Nursing Technical Advisor and Maternal Health Advisor for the WHO in Sierra Leone.
Prior to departure, we participated in an oral history training session with Professor Mary Marshall Clark, Director of the Columbia Center for Oral History Research. Professor Clark went over the fundamental principles of the life story approach to oral history. She also led our group in developing a set of areas of inquiry to guide us in the field.
Getting to Sierra Leone is not a simple endeavor. Freetown was founded by formerly enslaved people from the United States, with a group of British abolitionists, on a protected and mountainous peninsula that juts out into the Atlantic Ocean. With no flat land on which to build an airport closer to the city, visitors must fly into Lungi on the mainland and take a ferry across the mouth of Tagrin Bay. We rode across the bay on the bow of a small ferry. Bouncing in the waves, happy to be out of a plane after so many hours, that little jaunt foreshadowed a week of adventure.
Upon arrival our delegation was welcomed by the project’s local leader Dr. Joan Shepherd, who walked us through our schedule for the coming days. Dr. Shepherd is the Principal of the National School of Midwifery and was a tremendous resource. She identified all of the nurses and midwives to be interviewed and led the delegation to meet with local leaders. We were all extremely grateful for the assistance of Dolphine Buoga and the rest of the ICAP Sierra Leone team who hosted the project in their facility.
Eid al-Adha fell on Monday August 12th in Sierra Leone. As a result, the ICAP offices were closed for regular business, leaving plenty of space for the interviews. It was the rainy season and the sound of intermittent downpours can be heard in the background of nearly every recording.
Fonti Kargbo, an Ebola survivor and advocate, was interviewed on that first morning. Fonti spoke about the death of his wife Hawa Kamara, also a nurse, who contracted the virus after being directed to wash the body of a recently deceased patient. Fonti wore a shirt printed with the names and faces of all of the healthcare workers who died as a result of contact with that single patient.
The second day of interviews included Josephine Sellu, a nurse who had worked alongside the late Dr. Sheik Umar Khan, who led the country’s early efforts against Ebola and lost his life to the disease. Josephine was profiled in a front-page story in the New York Times on August 23rd, 2014. She was quoted in that story as saying, “You have no options. You have to go and save others. You are seeing your colleagues dying, and you still go and work.” Josephine’s story has remained central to Professor Dohrn’s class on the subject, but until this trip the two nurses had never met.
The afternoon of August 13th included a meeting at the office of the Chief Nursing Officer, Mary Fullah, who had been interviewed the day before. The meeting was an opportunity to introduce the team, explain the purpose of the project and to get feedback and input. That meeting included Senesie Margao, also interviewed by the project, who was the president of the Sierra Leone Nurses Association during the Ebola crisis.
Later that afternoon, we toured the Princess Christian Maternity Hospital where a model ward is supported by ICAP. The hospital is adjacent to Magazine Wharf, a neighborhood which was one of the hotbeds of Ebola.
Before leaving Sierra Leone, on our final morning in that country, Hassinatu Kanu Karoma, the former Chief Nursing Officer, who was in that role during Ebola, sat for an interview. She had featured prominently in many of the stories told in the preceding days and collecting her own story was an important step towards understanding the experiences of nurses during that time.
Upon arrival in Monrovia, Liberia, we were warmly welcomed by the Liberian Board for Nursing and Midwifery. The board’s offices contain space for the staff of a number of local organizations and associations, all related to nursing and midwifery. Our group is indebted to the staff of the board and its leader, Cecelia Kpangbala, for their hospitality and critical assistance in bringing together a diverse group of nurses and midwives to be interviewed. As Cecelia was unfortunately unable to participate due to a scheduling conflict, Darboi Korkoyah led the team during the visit.
Stepping through the board’s front door, visitors are immediately confronted by a powerful sight: on a simple bulletin board, an informal memorial to 32 nurses who died battling Ebola.
After a brief introduction, Darboi escorted us to meet with Liberia’s Chief Nursing and Midwifery Officer, Tarloh Quiwonkpa and her deputy Diana Sarteh who would be interviewed the following day. Quiwonkpa, who was trained in the US after leaving Liberia as a child with her family and seeking refuge in the US, oversees 400 clinics and hospitals across the country.
In addition to interviewing Darboi, the project was introduced to the leadership of the Liberian Nurses Association and the Liberian Midwifery Association. In each case, oral histories were also collected.
Among the front-line nurses interviewed in Liberia was Marthalyne Freeman. Marthalyne’s story is an incredible one because it includes her care of her own daughter, now a survivor, in an Ebola treatment center. What struck the team about this interview was the inclusion of a simple question from Marthalyne herself. She asked, “Why has it taken five years to do this?” Like so many of the nurses interviewed, she knew that her story needed to be recorded and shared, and that nurses and midwives must be given the recognition for the sacrifices and valor they demonstrated.
On the last day in Liberia, one of the nurses interviewed, James Harries, came to the board’s offices after having worked a 48 hour shift. Instead of going home to sleep, he came to tell his story. His and every other interview showcased the hunger that still exists in these healthcare workers to be heard, acknowledged, and respected.
In Liberia, we encountered stories of nurses who worked through the entire Ebola crisis without being compensated and others who were cast out by their families and forced to sleep in the hospital for a year. The interviews recorded in great detail the complicated precautionary decontamination rituals nurses found necessary to ensure their family’s safety from becoming infected with the Ebola virus when they came home at night, if they did come home at all.
Finally, before the trip came to a close, the stories of Dr. Phiri and Dr. Mwansa were collected. These two nursing leaders, active themselves during the crisis at the level of international policy, offered their own synthesis of the stories collected, lessons learned and the necessary next steps which must be taken to prevent future disasters.
The On the Frontlines working group is grateful to the Center for the Study of Social Difference’s support. This fall, we will begin the analysis of the interviews collected during this incredible trip in earnest.
This trip pulled back the lid on a valuable, and largely untapped resource: the collective wisdom of nurses and midwives who have served with dignity and perseverance despite the lack of any recognition or equitable compensation. I was deeply moved by the sacrifices of these healthcare workers and hope to be able to honor them through our project over the coming year.
Contributed by Jeremy Orloff, Premedical Post Baccalaureate Student, General Studies, Columbia University and On the Frontlines working group Coordinator