Juan Carlos Hurtado: "The smell of chlorine is still with me"

Which were your first impressions when you landed in Monrovia?

When I reached Monrovia, I clearly perceived what one could read in the press: the disease was present and had affected the daily life of the people living in the region. When I got down the plane, I noticed that the normal routine of any other airport had changed due to the concern of controlling or avoiding any risk of new infections. For example, there are water reservoirs with bleach so you can wash your hands and infrared thermometers to control your temperature even before going through customs. All this makes you feel that the memories of the outbreak persist in the daily life and this feeling lasted throughout my stay.

Tell us about your mission

The mission consisted in evaluating the laboratory of the St Joseph Catholic Hospital of Monrovia. Before the outbreak, this lab provided diagnostic support to the hospital and other nearby health centres. It even received samples from other regions of the country and was considered a high quality reference laboratory. However, after the Ebola crisis, its strength in terms of staff and equipment was severely diminished. Two team members no longer work in the lab, as one of them contracted the disease. All the lab records had to be buried or burnt. Part of the equipment became obsolete because the Liberian government closed the lab during the outbreak as a measure to control disease transmission. This move affected the maintenance of the little equipment they had.

All the lab records had to be buried or burnt My goal was to detail and evaluate the current state of the laboratory and recommend measures to help restart the lab to achieve, and even improve, its former standards.

Which were the main obstacles you had to face?

The main obstacle was the complete lack of records. I did not find any record previous to November 2014 since everything was buried. I could not evaluate the operating condition of the equipment because there were no reagents available. The capacity to perform a laboratory technique to know whether an equipment was working was very limited. 

In addition, each day there was the problem of having to enter the lab with the full personal protection equipment, since it considerably limits the number of hours you can stay in the lab; two hours at the most. One cannot physically support the heat of the suit together with the local temperature. That was a limitation I had to adapt to; I had to wait for several hours to go back in the evening or at night so as to not disturb the routine of the staff that performs a very limited number of techniques (the basic ones, such as blood typing or rapid tests to discard infections in blood donors).

Apart from that, I did not encounter other obstacles. The lab staff keep working and collaborating in a remarkable manner. They remember with pride how they used to work before and are eager to recover that level, even improve it. Overall, the rest of the health-care team (doctors, nurses, midwives) is quite engaged with its work. Fear and respect for the disease clearly persist but they surmount it and handle it in the best way possible.  

Why is it so important to restart the hospital's laboratory?

 Liberia had been growing at a good rhythm in the last years, despite the sequels left by the internal wars. For a country that was slowly recovering, dealing with such a devastating crisis has meant a major setback.  It has lost civilians, health care workers, infrastructures and has seen a rise in the morbidity and mortality of diseases that were no longer diagnosed or treated. For example, people that died from malaria could have been saved when in other conditions. 

For a country that was slowly recovering, dealing with such a devastating crisis has meant a major setback Restablishing the microbiology laboratory is a key step in the diagnosis and treatment of the different infectious and parasitic diseases that affect the region.  

The crisis has left huge sequels behind in every aspect of daily life. What impressed you the most?

 I had relatively little contact with the general population because the hospital is far from the city centre. In the few occasions I visited the city, I realized that there has been a change in habits, such as not shaking hands but simply nodding the head, waving the hands or touching with the elbows to say hello. This has been something difficult to change because it is deeply embedded in the culture. There is also the frequent and methodical hand washing, not only at the hospital entrance, but also in bars, restaurants and hotels. I once saw someone who tried to enter a bar without washing his hands but the owner came out and asked him to do it. This gives you an idea on how habits have changed.   

Liberia has been declared free of Ebola by the WHO – a great achievement. From now on, which are the main health challenges the country faces?  

Liberia is a poor country with many needs. The outbreak has disrupted the health system and amplified the lack of health professionals. It has increased the incidence and severity of other curable diseases for which people stopped going to the health centres because they were shut down or they were afraid to get infected. Rebuilding the health system and the trust people have in it is one major challenge.  

Rebuilding the health system and the trust people have in it is one major challenge

In addition, the working method needs to be revised. New knowledge on the virus is coming out- it has been seen that it can persist for longer than previously thought, for example in the semen. Live virus was detected in the eye of an American doctor that had recovered from the disease several months before, indicating there may be reservoirs we do not know.  Thus, when a country is declared free of Ebola, we are not absolutely sure this means there is no virus left. Survivors could be a source of new infections if adequate measures are not taken. This will change the handling of patients and their samples. For how long, it is not clear. In the lab where I worked, it is still unclear how much time they will use the protective equipment, knowing that it considerably limits the type and amount of work that can be done.   

What feelings did you bring home?

I come back with lessons and good memories, such as the kindness and solidarity between people. On the other hand, the smell of chlorine is still with me, it is a constant smell that permeates you every time you wash your hands. Apparently, it is something frequent in people that return from ebola-stricken regions.