On a recent autumn afternoon Ruth Kauffman, a midwife and nurse invited by Einstein’s department of obstetrics & gynecology and women’s health and Global Health Center, shared her experiences administering maternal healthcare during the Ebola crisis in Sierra Leone.
The trip to Sierra Leone was Ms. Kauffman’s 10th humanitarian assignment with Doctors without Borders. Having recently returned to the United States, she gave her talk just days after finishing the 21-day monitoring period recommended by the Centers for Disease Control and Prevention.
Even before the Ebola outbreak, Sierra Leone faced grave maternal healthcare challenges. With just 17 nurses and 3 doctors per 100,000 people, expectant mothers lacked access to care and had difficulties obtaining emergency obstetric care. Between 2010 and 2014, it was the only country with more than 1 woman dying per 100 live births.
Assessing Needs During a Health Crisis
Now, with midwife schools closed and the healthcare infrastructure and workforce crippled by Ebola, the situation has become more critical. “When a pregnant woman comes into the clinic with obstetric difficulties, healthcare workers must determine if the cause is a normal miscarriage, malaria or Ebola,” explained Ms. Kauffman. “Identifying which these is the most likely underlying cause determines the level of protection required by healthcare workers and other patients, as well as whether to transfer care to another facility.”
Adding to these difficulties, if a pregnant woman contracts Ebola, she will invariably pass the virus to her fetus. That fetus will die before labor or shortly thereafter. And the outlook for mothers is nearly as grim. As an example, Ms. Kauffman mentioned an outbreak of the virus that occurred in the Democratic Republic of the Congo in 1995, in which only 1 woman survived, out of 15 Ebola-stricken pregnant women who were surveyed.
In Sierra Leone, Ms. Kauffman treated several pregnant women who were or had recently been infected with Ebola. After the women overcame the Ebola infection, Ms. Kauffman or another member of her team would induce labor. Consistently, they found that all of the fetuses were dead and the womb was still highly infectious. In one case, a woman’s viral load fluctuated and she started to develop a fever again. Immediately after birth, her fever disappeared.
“We found that in order for the mother to survive, we needed to get the baby out.”
Challenges for Patients and for Caregivers
She noted that clinicians have learned that sperm, amniotic fluid and breast milk all remain infected with Ebola for up to three months after a person tests negative for the virus. In Sierra Leone, where condom use is low, family planning interventions could be a powerful means of helping to combat Ebola.
Ms. Kauffman also discussed the logistical challenges of working in an Ebola-stricken environment, and the psychological impact of returning home. “The experience is so intense and, when you come home, you have to be by yourself. It’s hard.”
Even so, she plans to return to Sierra Leone during December. “I first went there with the Peace Corps right after college … it’s really important to me, because I feel like I owe Sierra Leone something.”
In concluding her talk, she encouraged students to pursue a similar path, noting “It’s beautiful but hard work.”