An epidemiologist in Monrovia describes hazmat training — from hand washing to elbow bumps

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Marco Werman: Let’s talk claustrophobia for a moment. You might not think you’re susceptible, but then again, you’ve probably never worn PPE -- Personal Protective Equipment. PPEs are those hazmat suits worn by medical personnel in West Africa and anywhere else where Ebola patients need care. Last week we met Sharon McDonnell, she’s an epidemiologist from Maine who wanted to do her part to help stem the Ebola crisis. Well, Sharon has just finished her first full week in Monrovia, Liberia, so we wanted to check in with her again. As for that claustrophobia, Sharon says she wasn’t quite ready for how her PPE would make her feel.


Sharon McDonnell: I can only really compare it to when I was in Afghanistan and I was trying to pass as Afghan and I wore a burka. I had the similar sense of being really separate from the world. So, for five days, we go through first about the virus, how it’s transmitted, so basic background. And there’s a lot of hands-on things. We learn handwashing and then we wash our hands many times and show that we can do it right. Then we try the personal protective equipment and try to demonstrate that we can do it without being too much of a clutz, because you actually lose a lot of your vision, your hearing, and your dexterity, which is useful in things like trying to practice medicine.


Werman: It doesn’t sound like a lot of fun getting into the personal protective equipment, those hazmat suits. Is it kind of nerve wracking to have your senses closed off and to realize that if you’re maybe not getting the right information you could put yourself in jeopardy?


McDonnell: I find that maybe since I’m a bit claustrophobic, which I really didn’t clearly understand until I tried some of this, but it’s nerve wracking because as a nurse and as a physician, you get a lot of training about doing it right and not breaking sterile field, not breaking the protective barriers, which you’re trying to do very carefully and keep track of a lot of things, as well as continuing to breath, stand up right, that kind of thing. As an epidemiologist, one of the things I have to do is pay attention to how long people can work in personal protective equipment, what can they do in the equipment? For example, they shouldn’t be trying to think deeply or chart things, that kind of thing, so we have to really pay attention to the kinds of things we want them to do while they’re completely geared up.


Werman: That sounds like it’s new territory for you and I was wondering, when you were talking about cold training, you’re learning about transmission of Ebola, the importance of handwashing, I suspect that’s kind of epidemiology 101. What are YOU learning as an epidemiologist on the ground?


McDonnell: Well for me, I think the sorts of things that catch my attention that might not catch other people’s attentions is when I came to town, I noticed that everybody has chlorine solution outside of every business, so every place I go, I must wash my hands 15 times a day in 0.5% chlorine solution.


Werman: Is that insignificant?


McDonnell: It’s stronger than anything you’d take in the US; it’s not insignificant. But to keep working as a business, Liberia passed a law basically saying that people had to provide this kind of handwashing facility for everybody if they were going to keep open for business. So, everywhere you go, you wash your hands -- just to go into a coffee shop, just to go into the grocery store, just to go into the military base. So, you just keep washing your hands and there’s somebody there to make sure that you do. I began to get excited about the fact that this is the most amazing public health intervention there is. Handwashing is the holy grail for public health people, to try to get more people to wash their hands, and hoping that, in fact, maybe we could track and find out that there are fewer gastrointestinal illnesses or respiratory illnesses, that sort of thing. I’m not sure that the surveillance systems will allow us to actually find that out, and if anybody has any ideas of ways to study that, it’d be delightful to know.


Werman: Is there a culture developing among the healthcare workers that kind of takes the treatment of Ebola to the next level? Are people starting to have some odd sense of gallow’s humor about this whole thing?


McDonnell: Well, health workers usually have a dark streak in their humor. The cultural transition that happened much more quickly with Ebola for various reasons has been the lighthearted messaging about “Don’t touch; greet each other, be friendly, but don’t touch.” So now, if you come up to someone, the two of you have to figure out how to greet each other. “Shall we bump elbows? Shall we bump feet? Maybe we’ll do a combination of both.” So, you start doing this little dance with people, and maybe even snapping your fingers, and then somebody will say “Don’t touch,” and everybody sort of laughs and leans back and enjoys it, which is an adaptive way, perhaps. There are lots of signs and messages up about Ebola. Today, the driver came to pick me up and sprayed my feet off, and he said “Ebola is real.” That’s the message that’s everywhere, coming out on the sides of cars and everything, is “Ebola is real.”


Werman: There’s even a song that goes “Ebola is real.” It’s become a big hit.


McDonnell: Is that right?


Werman: Yeah. Hot FM, you’ll find it on the dial in Monrovia. I gather that with medical workers everybody has an opinion on duct tape and how to use it too?


McDonnell: Well, there’s nothing more interesting to medical workers than discussing the vagaries of personal protective equipment. Duct tape has been the newest controversy raging through about is it better to have it so that your sleeves don’t go down, or is it worse because it might tear your gloves?


Werman: Sharon McDonnell, an epidemiologist from Maine who is in Liberia right now, helping out with the Ebola crisis there. We’ll be speaking with you again soon Sharon. Happy Thanksgiving to you.


McDonnell: Thank you.