Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic

• Published in: Health policy and planning 2016-11, Vol.31 (9), p.1232-1239
• Main Authors: McMahon, Shannon A., Ho, Lara S., Brown, Hannah, Miller, Laura, Ansumana, Rashid, Kennedy, Caitlin E.
• Format: Article
• Language: English
• Subjects: Adult; Attachment; Behavior problems; Connectedness; Context; Coping; Data collection; Delivery of Health Care - methods; Disease; Disease control; Districts; Ebola virus; Ebolavirus; Ecology; Emergency response; Epidemics; Epidemics - prevention & control; Epidemiology; Fear; Female; First aid; Grounded Theory; Health administration; Health care facilities; Health care industry; Health Facilities; Health Personnel - psychology; Health services; Hemorrhagic Fever, Ebola - epidemiology; Hugging; Humans; Infection Control - methods; Inhibition (psychology); Interviews; Interviews as Topic; Male; Medical screening; Mental disorders; Mental Health; Middle Aged; Original; ORIGINAL ARTICLES; Outbreaks; Patients; Planners; Prevention; Prevention programs; Protective equipment; Psychosocial factors; Qualitative Research; Relatives; Rescue workers; Sierra Leone - epidemiology; Social Isolation - psychology; Suffering; Trust; Viral diseases
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czw055

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. Bien que la recherche sur l’épidémiologie et l’écologie du virus Ebola se soit développée depuis l’épidémie de 2014-15 en Afrique de l’Ouest, on accorde peu d’attention à ses répercussions sur la santé mentale et le contexte psychosocial de la maladie pour les prestataires travaillant dans les établissements de soins de santé primaires (plutôt que des unités chargées spécifiquement du traitement d’Ebola). La présente étude se fonde sur 54 entretiens qualitatifs avec 35 prestataires travaillant dans huit centres de santé périphériques des districts de Bo et Kenema en Sierra Leone. La collecte des données a commencé peu avant le climax de l’épidémie en décembre 2014 et a duré 1 mois. Les prestataires ont relaté les changements survenus dans leur vie professionnelle, personnelle et sociale puisqu’ils étaient devenus de fac