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Carrie Jo Cain helps train healthcare workers in Sierra Leone on how to use protective suits to prevent the spread of Ebola, which has spread across West Africa.

Ebola epidemic | St. Paul nurse returns to Sierra Leone to train healthcare workers

When Carrie Jo Cain heard about the most recent Ebola outbreak in West Africa—particularly in Sierra Leone—she said, “It was just like a knife twisting inside my gut, because I knew what Ebola meant.”

As an emergency room nurse at Children’s Hospitals in St. Paul, Cain understood the severity of infectious diseases, and she knew how quickly they can spread and the devastation they can cause.

But Cain also has a personal connection with Sierra Leone and the thousands who are suffering through this latest outbreak.

She has always felt at home in the West African country. Her parents became missionaries to Sierra Leone when she was just six months old. For the first 12 years of her life, she lived on a college campus close to the country’s capital.

“We didn’t have electricity,” she recalled. “Most of the time we didn’t have running water, but we had comfortable houses, lots of great friends on the Christian college [campus]. Still a very different culture, completely different culture, but it was really a neat experience being able to bridge the two cultures.”

Her father was the principal and one of the leading theologians at the college, while her mother taught reading, writing and basic math, and helped develop a course that prepared women to be pastors’ wives.

Cain came back to the States for junior high and then spent part of her high school years in Sierra Leone. As an adult, Cain has made her home in the U.S.

The recent Ebola outbreak became even more personal for Cain as her family—Cain, her husband and youngest child—are in the midst of returning to Sierra Leone as full-time mission workers. The family hopes to move next year; and Cain will work at Kamakwie Hospital.

So the Ebola outbreak hit home for Cain for numerous reasons.

“Ebola is one of those words that, to people who have worked with any infectious disease, it makes our blood run cold,” she said. “Because of the severity of it, the virulence of it and knowing what it could mean in that setting without the infrastructure in place to deal with it, without the supplies and without the understanding of how its transmission is, it made me very afraid for that whole area.”

As the disease spread over the summer, Cain knew she could help. Not waiting until next year when her family would return as full-time missionaries but now—in the middle of the horrendous disease outbreak. She has medical training, personal connections in the country and a love for its people. She wanted to return home and use her skills to help the people of Sierra Leone in one of the country’s most challenging battles in recent years.

She also felt as if God was telling her to go now.

“I want you to go do this, and I created you for this and this was why I’ve given you this life and this experience,” she believes God told her. “Now, go.”

“What made me really feel like I had a role to play in this was because I am from both cultures,” she said. “I’m bilingual, I’m bicultural, I can cross a lot of bridges that a lot of other expatriates can’t cross just because they haven’t had the background that I’ve had. I knew that God was saying this is something He was calling me to do. I had a role to play.”

And she did.


Ground zero of an epidemic
Cain left for Sierra Leone on August 26 on a 2-week mission to deliver essential medical supplies and lead training for hospital workers on how to treat infectious diseases like Ebola.

When she arrived on the ground in Sierra Leone in late August, Cain realized almost immediately that in addition to the horrific epidemic of Ebola that was gripping the nation, the epidemic of fear of the disease was perhaps just as devastating.

“Within the first couple of hours that we got there—we got there right as night was falling—within the first few hours, the clearest sense I had was that Ebola is a horrible epidemic,” Cain said. “But even more than that is the epidemic of fear that has gripped Sierra Leone, and I’m sure Liberia and Guinea.”

The fear Cain saw and experienced came out of a lack of education on the part of local residents.

“Fear has just taken over, and there have been a lot of instructions or edicts given in the name of trying to protect or trying to keep safe, but they’re really no good at all,” she said. “All they do is build a bigger groundswell of fear, and then impede those that are trying to speak truth and speak facts and bring a true way to handle this. The edicts and that huge fear are just getting in the way of that.”

Cain said that in Sierra Leone disease is believed to originate in the spiritual world.

“[Disease] is part of the spirit world,” she said. “Illness is caused by somebody putting a hex on you, or ‘You’ve done something wrong to somebody and the spirits are going to get you.’ Illness there is seen as a real spiritual thing, not just as germs and bacteria.”

Because of that, providing sound medical treatment procedures or options for people to prevent contracting Ebola can be challenging.

However, that didn’t stop Cain. Her first mission when she arrived was to deliver much-needed medical supplies to Kamakwie Hospital and also to train hospital staff on procedures for treating infectious disease.

According to the World Health Organization, nearly 2,500 people have died from Ebola during this latest outbreak—with just under 5,000 probable, confirmed or suspected cases. The numbers continue to rise, and officials currently do not see a decline on the horizon.

One of the major concerns of health officials has been to ensure that those showing symptoms of Ebola remain isolated from other people and patients in order to prevent the disease from spreading. Continued contacts between infected persons and other people is a major factor in this outbreak.

Cain wanted to make sure in her short time in Sierra Leone that the hospital was able to establish an isolation unit and be prepared for the wave of Ebola patients if it came to that part of the country.

“We had tried to set up an isolation ward in one of the [hospital] wards, and there was nobody following what isolation meant—that it needed to be separate,” she said. “So this way we built a shelter completely separate from the hospital—like, 50 yards from the hospital but within the fence—and it is physically separate, and now there is a security guard who sits and nobody is allowed to go near.”

Cain also delivered critical medical supplies and trained staff members on how to put on and remove personal protective equipment.

She helped ramp up “the infectious disease protocols in the hospital and did spot checks ad nauseam to make sure everybody was following them—like never touching a patient without gloves on and washing hands after every time you touch the patient, which just isn’t done there because there’s not a tap in every ward. So it means you have to physically walk out to the chlorine bucket and wash your hands. Well, that takes time and that takes energy.”

Since Cain has lived in Sierra Leone and has visited several times in the years since her childhood, she has friends and colleagues who know and trust her.

“I have established relationships, established trust relationships and collegial relationships … so it’s much easier to come in … and pick up right where we were and go forward,” she said. “They trust me, and I trust them and I know their skill level. It’s really easy to just come in and pick up and go forward.”

Cain said even though she was visiting a country where an Ebola outbreak was currently underway, she was not fearful. She clearly understood her role as teaching and preparing staff. In fact, Cain said the staff was very protective of her.

On past visits to the hospital, medical staff would say, “‘Carrie, come down and see this patient.’ ‘Come see this patient,’” Cain said. “Not once [during this most recent trip] did they ask me to come and consult on any patients. In fact, when I would come in the wards just to talk and do spot checks, they [would] always kind of shepherd me out of the area.”

But with every patient visit and interaction, Cain wanted to make sure that Jesus remained at the center. She wanted to make sure that every patient had the opportunity to hear about Jesus. Regardless of the situation or prognosis, “speak Jesus into every person” was the priority of her trip to Sierra Leone—a place she will once again call home next year.


Where does Ebola come from?
While the origin of Ebola is unknown, many experts believe fruit bats are the likely host of the disease.

How many people have become infected and died as a result of Ebola?
According to the World Health Organization, nearly 5,000 people have become infected with Ebola (Sept. 16 report). Of those, 2,453 have died. The death rate of 49 percent is noticeably lower for this outbreak than for past outbreaks.

Who is at risk?
Healthcare workers, those who come in close contact with infected patients, and those who may have direct exposure to deceased bodies (e.g. in burial ceremonies).

How is it contracted?
“Infection occurs from direct contact through broken skin or mucous membranes with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen or used needles.”

What is the incubation period?
The incubation period is from 2 to 21 days. Once symptoms begin to show, a patient becomes contagious.

What are the symptoms?
Symptoms include sudden fever, muscle pain and headache, followed by vomiting and diarrhea.

At what stage is it contagious?
Ebola becomes contagious once the symptoms begin to show.

What is the U.S. doing to minimize exposure/spread to U.S.?
President Obama recently announced a plan to send 3,000 military personnel to the area, as well as provide additional hospital beds, medical personnel and doctors. These efforts are aimed at limiting the spread of the disease.

When did it start?
Ebola was first discovered in 1976 in Sudan and the Democratic Republic of Congo. The outbreaks occurred simultaneously.

Source: World Health Organization: www.who.int/csr/disease/ebola/faq-ebola/en.

— by Scott Noble


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