Australian GP Dr Rosalie Schultz learnt a number of valuable lessons when she travelled to West Africa to work with Ebola patients.
Dr Rosalie Schultz has spent much of her medical career working to help those most in need.
As a GP and public health physician, Schultz has worked with disadvantaged patient populations in a number of Australian and overseas locations.
‘I really have a sense of wanting to use my medical expertise for promoting social justice,’ she told Good Practice. ‘And, in Australia, I think to be working with remote Aboriginal people is really the greatest need for social justice.’
Schultz currently works at the Central Australian Aboriginal Congress in Alice Springs.
She has previously worked at Anyinginyi Health Aboriginal Corporation in Tennant Creek, Northern Territory, and undertook a two-year placement in rural Solomon Islands and had a brief stint working in East Timor.
‘The Solomon Islands was quite a formative experience for me because I really learnt so much about how health is determined,’ she said.
‘I think my desire to work in poorer overseas countries is part of that same sense of wanting to promote health as a right for all of humanity.’
West Africa
Schultz’s most recent overseas effort to promote health was six weeks spent working with Ebola patients in the West African nation of Sierra Leone, where a severe Ebola epidemic has killed more than 10,000 people since the beginning of the March 2014 outbreak.
Despite her background in working overseas and in public health, Schultz was initially somewhat hesitant about the idea of taking her much needed medical skills away from Alice Springs to treat a disease outbreak on the other side of the world.
I was aware of Ebola from early last year. However, I have this sense that there’s always these disease crises all over the world and, really, they are actually tiny when we know the big things that are killing people are things like tobacco, overweight, poor diet and cardiovascular disease. Ebola is a relatively minor thing,’ she said.
‘Then I received an email from an advocacy organisation. It said they actually really needed people on the ground. There was plenty of money, but what they needed was people with skills.
‘I thought, “Well, maybe I have got the skills. Maybe I should apply and see whether they feel I have got something to offer”.’
Schultz’s considerable skills proved very welcome and she was soon contracted to work in Sierra Leone through Aspen Medical, an Australian-owned global healthcare provider that works with governments and non-government organisations to provide essential medical services to places in need around the world (refer to breakout above).
New approach
Once on the ground in and working at the Australian-run Ebola treatment centre in Sierra Leone, Schultz quickly realised she would have to adjust her healthcare attitudes to a very new reality, one likely diffi cult for any healthcare practitioner to face.
‘I think what really makes Ebola outside of normal experience, especially experience in Australia, is that most people die,’ she said.
‘There is no medical experience that can set you up to prepare you for where you have to expect people to die.
‘That was the most unique part of it.’ What needed to be done at the treatment centre was quickly evident, however, and Schultz and the other Australian doctors and nurses who had travelled to Sierra Leone were able to get to work.
‘Working in the Ebola treatment centre, the main purpose was actually to isolate people,’ she said. ‘Yes, it was fantastic when we could treat them and they would actually get better, but the main purpose is to stop them spreading it: not spreading it to us and not spreading it to their families so we can end the epidemic.’
Given the disease is primarily passed on via direct person-to-person contact, eliminating that contact as much as possible is one of the keys for the healthcare practitioners working Images Aspen Medical; Rosalie Schultz towards halting the Ebola epidemic.
‘In the workplace, and in our whole existence over there, you don’t touch anybody,’ Schultz said. ‘ABC is the acronym: Avoid Body Contact. You don’t shake hands, you don’t hug your friends.
‘We were going to have a game of beach volleyball and one of the staff members said, “We can’t play beach volleyball. We might actually touch each other”.
‘You don’t do anything where you might touch each other.’
That policy of avoiding body contact extends, of course, to the treatment centre and means the medical staff go through a number of strictly monitored safety procedures before and after seeing patients.
‘In the workplace you are completely covered from head to foot with the PPE [personal protective equipment],’ Schultz said. ‘Every time you prepare to go into the “red zone” you are aware that it might kill you so you wear the PPE.
‘Every aspect of putting on the gear is supervised. Even more important is when you are taking it off because since you have been in contact with patients you know you have got virus on your equipment. So as you come out you get sprayed down, you take off one aspect and wash your hands, you take off the next aspect and wash your hands.
‘It’s all very closely supervised and a very structured removal because that is probably where many healthcare workers get infected with Ebola – when they take off their PPE.
Once inside the ‘red zone’ and doing the ward rounds, Schultz and other PPE-clad doctors were accompanied by local nurses and other staff, such as hygienists, who would assist with working through language barriers and ensuring all equipment and furniture stayed as clean as possible.
According to Schultz, the presence of local medical staff is a very important aspect of working in a country experiencing a disease epidemic.
‘In the treatment centre there were about 140 local staff. We had mainly local nurses who knew the people, knew the community and spoke the language. They were the key in our team as far as understanding culture and talking to people,’ she said.
‘Having really strong local ownership of the response meant that we were really part of what was happening in the community.’
Always learning
The time she spent in Sierra Leone provided Schultz with a number of valuable healthcare lessons.
‘I think one of the things that I learnt was what we really need for a good healthcare system is quality primary healthcare,’ she said. ‘Because if there had been good primary healthcare in Sierra Leone perhaps this would never have happened. Perhaps the fi rst child who was infected with Ebola [and subsequently spread the disease] would have been diagnosed in a timely way.
‘There was three months until we actually knew that there was Ebola in the region. Whereas if there was good primary healthcare someone would have noticed that people were dying of an unknown disease and done a more rapid investigation and clarifi ed that this was Ebola and determined what they needed to do.’
Schultz and the other Aspen Medical doctors and nurses lived in the same building and often started the working day at 5:00 am, which helped her understand the importance of successfully working together. The single-minded goal of fi ghting the disease meant friendships and working relationships were never really a problem.
‘We had a very clear, common goal,’ she said. ‘Even with the country in complete chaos, unlike in a war zone, everybody wants the same thing. From the highest government ministers to the most povertystricken families, everybody wants to get rid of Ebola.
‘Within the team it was very clear what needed to be done, how to best divide up what workforce we had to make sure everybody was using their skills as well as they could.
‘We’d then come home on the bus in the evening and enjoy a meal together. We enjoyed one another’s company. We also had good accommodation, so we were clean and housed and not sharing rooms with too many people.
‘I feel like we had really good camaraderie.’ Schultz is somewhat reluctant when it comes to recommending other Australian GPs head overseas to work with disadvantaged populations – ‘I am very much against telling people what to do’ – but she does acknowledge the advantages for patients and healthcare professionals.
‘I feel very privileged that I was able to go over there and see so much and learn so much,’ she said. ‘As far as having an experience where you are able to use your clinical skills and sense of wanting to promote health … we are so privileged to be well educated and have these skills and abilities. It’s just such an opportunity to promote health on a much bigger scale.’
First published in Good Practice May 2015 14 - 17