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UK Military Deployment to Sierra Leone

July is the fifth month of the Ebola Project. Recruitment continues until the end of July. Individuals from a variety of groups who deployed with the military field hospital have agreed to take part; these include doctors, nurses, biomedical scientists, Personal Protective Equipment monitors and Combat Medical Technicians.

The deployment of UK military medical personnel to Sierra Leone is drawing to a close as the outbreak is being brought under control and transmission is falling in Sierra Leone. The World Health Organisation had reported more than 27,500 cases and 11,200 deaths globally by 1 July 2015. To date (16 Jul 15) Sierra Leone has reported 13209 total Cases (suspected, probable, and confirmed) 8688 laboratory-confirmed cases and 3947 total deaths2. 4 July 15 saw many medical personnel return leaving approximately 150 personnel in the country to provide logistic support.

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Ethics training materials taster

June is the fourth month of the Ebola Project; the UK armed forces that were initially deployed to Sierra Leone as part of Operation Gritrock have been returning to work from post-deployment leave since March. To date 15 personnel from tranches 1 and 2 have agreed to be interviewed in order to help us understand the nature of the ethical challenges that they faced in Sierra Leone as healthcare workers in the Armed Forces.

These invaluable firsthand accounts will allow us to develop training materials that can be used better to prepare healthcare workers who respond to future humanitarian crises involving deadly pandemics. Patients’ ‘in extremus’ suffering from Ebola and the highly infectious nature of the virus accentuate even the most common ethical dilemmas. On top of this, serving members of the armed forces had to contend with their dual obligation as healthcare professionals/military coupled with the context of Sierra Leone, with its extreme heat and already limited infrastructure damaged by the outbreak. The pressure and challenges upon individual healthcare workers were considerable.

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Respondent Fatigue & Research Co-Operation

We are now halfway through the third month of our project, which explores the ethical challengesfaced by British military personnel who deployed to Sierra Leone to deal with the Ebola crisis. So farwe have conducted thirteen interviews, and the initial analysis of the transcripts is under way. Basedon the data collected so far, and working with members of the COST Action Disaster Bioethics, weare making good progress with producing training materials. Heather has also contributed to thepre-deployment ethics training for Tranche 4 and observed part of the simulation field hospital atthe Army Medical Services Training Centre near York, which contains a replica of the EbolaTreatment unit in Sierra Leone. Some striking themes are arising from these preliminary data, andthese will form the main findings of the study. However, they are not the only thing that the teamhas learnt so far from the project. We have encountered our own ethical challenges in doing theproject. Challenges like these will be familiar to anyone undertaking formal research, and fall intothe area of “research ethics”.

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Should we admire people for ‘just doing their job’?

“When pestilence prevails, it is their duty to face danger and continue their labours for the alleviation of suffering, even at jeopardy of their own lives” (American Medical Association 1847).

Less than a month into our project we learned that one of the deployed medical staff had contracted Ebola and was, with two colleagues, being flown back to the UK for treatment. Thankfully the patient, Anna Cross (a reservist and intensive care nurse), made a full recovery after being treated with an experimental drug.

The announcement that one of the team had been infected was a sobering reminder of the risks that have been taken by the healthcare workers who have responded to the Ebola crisis. Early on in the outbreak, the WHO reported that healthcare workers were disproportionately affected compared to other disasters and emergencies. As one of our early informants put it “Ebola feeds on the milk of human kindness”. The people most likely to be infected are those who nurse the sick – be these family members or professionals. Indeed, ensuring care for the carers (local as well as international) is a key driver in Operation Gritrock, which established dedicated beds for Ebola-affected healthcare workers. These were the beds being staffed by the medical military, and therefore presumably by Anna Cross.

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Col Jeremy Henning, currently deployed on Operation Gritrock and Chair of the Advisory Group, for this project posted our first blog:

6 months ago Ebola was a distant disease, and we were re-posturing the military into a contingency role after years in Afghanistan, looking after trauma patients. Times change quickly and I now find myself, once again in the front line (this time on a ship) involved in a new fight, this time against an illness that threatens the world.

In many ways this is a unique deployment for the military. We have got used to dealing on a multi-agency basis to re-build communities, but have not had such a close association with medical charities before – indeed this is possibly the first time they have directly asked for our help. On top of that, this is predominately a public health deployment, rather than the peace-keeping or combat roles we have had before.

All of this brings new challenges, very few of which we had actively prepared for. However, this is proving to be a successful mission, and we can see similar being mobilised in the future. It is therefore vital we capture the ethical issues and challenges that our personnel faced so we can not only help them, but also inform any future deployments.