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Abstract
Introduction Routine health service provision decreased during the 2014–2016 Ebola virus disease (EVD) outbreak in Sierra Leone, while caesarean section (CS) rates at public hospitals did not. It is unknown what made staff provide CS despite the risks of contracting EVD. This study explores Sierra Leonean health worker perspectives of why they continued to provide CS.
Methods This qualitative study documents the experiences of 15 CS providers who worked during the EVD outbreak. We interviewed surgical and non-surgical CS providers who worked at public hospitals that either increased or decreased CS volumes during the outbreak. Hospitals in all four administrative areas of Sierra Leone were included. Semistructured interviews averaged 97 min and healthcare experience 21 years. Transcripts were analysed by modified framework analysis in the NVivo V.11.4.1 software.
Results We identified two themes that may explain why providers performed CS despite EVD risks: (1) clinical adaptability and (2) overcoming the moral dilemmas. CS providers reported being overworked and exposed to infection hazards. However, they developed clinical workarounds to the lack of surgical materials, protective equipment and standard operating procedures until the broader international response introduced formal personal protective equipment and infection prevention and control practices. CS providers reported that dutifulness and sense of responsibility for one’s community increased during EVD, which helped them justify taking the risk of being infected. Although most surgical activities were reduced to minimise staff exposure to EVD, staff at public hospitals tended to prioritise performing CS surgery for women with acute obstetric complications.
Conclusion This study found that CS surgery during EVD in Sierra Leone may be explained by remarkable decisions by individual CS providers at public hospitals. They adapted practically to material limitations exacerbated by the outbreak and overcame the moral dilemmas of performing CS despite the risk of being infected with EVD.
- ebola virus disease
- health systems
- maternal health
- global surgery
- disaster resilience
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Footnotes
Handling editor Stephanie M Topp
Twitter Gustaf Drevin can be tweeted at @drevinho
Contributors GD, HM-A, HAB and JVS made significant contributions to the study’s conception. GD, AvD, HM-A, APK, HAB and JVS made substantial contribution to the study design. GD, AvD and APK participated in and/or were consulted during data acquisition and facility selection in Sierra Leone. The interview guide was designed by GD, HM-A and JVS. Data analysis was conducted primarily by GD, HM-A, AvD and JVS throughout the study. All authors have revised the manuscript and cleared it for publication. All authors take responsibility for the content and ensure accuracy for the manuscript in full.
Funding GD was supported by a Minor Field Studies grant from the Swedish Development Agency and the Carl Erik Levin Foundation. The authors have not declare other specific grants for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Sierra Leone Ethics and Scientific Review Committee granted ethical approval dated 9 September 2016. Particular care was taken to protect participants’ anonymity of personal information and confidentiality of the recorded material. Written informed consent was obtained before the interviews. This research adheres to the principles of the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.