”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Drevin, Gustaf; Mölsted Alvesson, Helle; van Duinen, Alex; Bolkan, Håkon A; Koroma, Alimamy P; Von Schreeb, Johan

This I will confess. In our nursing schools, they do teach us universal precaution, that's how to put on your gloves, your apron maybe. /…/ But before the outbreak of Ebola we really did not practice the universal precautions. (ID 3, Midwife) Increased dependence on the surgical team Most participants highlighted that clinically active, surgically skilled practitioners were essential to maintain CS provision during EVD. Participants felt pressured to work harder during the outbreak because colleagues had died of EVD. Absenteeism from work initially increased due to fear of infection. In addition, staff were reallocated to work at EVD treatment units. Especially in the first half of the outbreak, medical officers and SACHOs in particular were overworked and without human and material support from the MoHS. Despite this they stayed. We found no difference in perceived workload between surgical staff at high-performing and low-performing public hospitals. The essential role of the broader surgical team to keep theatres open and active was acknowledged by most participants. Surgical staff reportedly faced little absenteeism compared with other cadres at the hospital. Scrub nurses, anaesthesia nurses and midwives continued to show up for work and prepare patients for CS, sterilise equipment, and oversee admissions and discharge of CS patients.