When I first heard that research activity relating to the Ebola Virus Disease (EVD) outbreak was planned my interest was immediately triggered. The outbreak in West Africa is the largest ever recorded, and what previously occurred in relatively small numbers over a short time frame, was dramatically different in the number of positive cases, countries affected and potential global impact.
In January 2015, with the support of the Emergency Medicine Research Group Edinburgh (EMERGE), the Emergency Department at the Royal Infirmary and NHS Lothian I was offered the opportunity to work as Field Trial Coordinator, (Team 2) with the Centre for Tropical Diseases and Global Health, University of Oxford in Monrovia, Liberia. The trial was investigating an antiviral that was nominated by the WHO as being potentially beneficial against EVD. A team from Oxford developed a protocol, applied for and was awarded funding and got the study approved in and across a number of regulatory bodies, countries and continents. Getting the trial to implementation stage so swiftly was a huge achievement.
As Field Trial Coordinator I was responsible for ensuring the study was run in accordance with Good Clinical Practice (GCP) guidelines and in line with the trial protocol. Other members of the team included a clinical team lead, 2 trial doctors, 2 research nurses and six Liberian research nurses.
My interest was multi-factorial;
1. I was particularly interested in the research process, how was it possible to achieve a credible, quality assured, fully approved and run trial, up and running in the time-frame of an ebola outbreak, and what were the challenges, constraints and issues? How could this be done? What do we need to learn to do it again? Can we improve patient outcomes against such a deadly disease in such a context?
2. I have worked in areas of humanitarian crisis over a number of years, so my interest in international population health is part of my professional identity and experience. I wanted to be involved, to learn and I wanted to share. Outbreaks and pandemics could affect us here in Edinburgh, probably not ebola but perhaps some other emerging infectious disease. It could also happen again elsewhere, how good would it be to have the experience to respond if the need or opportunity arose again?
3. I had previously spent a year working in Lofa County, Liberia with the International Committee of the Red Cross so I had some knowledge of the country and the reasons why this disease may have taken hold so aggressively. I felt a desire to support the people of Liberia in some small way, to show that people in other countries do see what’s happening and do care.
The outcomes for me included; the re-invigoration of my belief in the importance of research in all aspects of health care. Research gives patients the opportunity to teach us about their condition, their experience. Whatever the patient outcome, research ensures that every individual contributes to better medical understanding, the possibility of new therapies or treatments, and improved results for other people even if not themselves, in the future. As humans, when we are given the opportunity to help someone we usually thrive, it is simply in our nature – not just health care workers, but all people. Often we don’t see the opportunity to assist. Research is one way we all can.
Seeing clinical and research activity unite to contribute towards the best possible patient care is inspiring. Many times we prioritise clinical care over research, yet to be able to do our jobs as health care workers our practice must be evidence-based. Supporting and engaging in research activity as part of clinical care is increasingly accepted as standard, everyday practice. I value this working relationship, and see our teams uniting in strength because of it. I like being part of this.
The mental challenge of being away from home and my social network always excites me, the adventure of the unknown that lies ahead; meeting new people, coming together as a team, discussing and debating informed consent and trial issues, solving the multitude of problems that we faced every day. Coping in the humid heat of West Africa, eating new foods and being restricted to our accommodation compound for our own safety, working long hours and observing the damaging impact that ebola has had on the communities in Liberia – entire families devastated, children orphaned, survivors ostracised from their villages out of fear. I was a witness to the events; this outbreak is happening and as the posters and billboards across West Africa repeat ‘Ebola is Real’.
I think this experience has been a highlight in my career to date, and feel that many of my previous experiences working in research, in the ED as a clinical nurse and overseas in developing countries provided a good base. A base that allowed me to function effectively, with immediacy and with the flexibility required when adapting to the actual situation on the ground (which is never what you expect). I return to EMERGE feeling happy and grateful for the comfort of a job I enjoy and a team who have supported and embraced our collective effort. Our team has come together to support research in a humanitarian crisis, not all teams can say that and I am very proud to say we have!
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