Main themes and key findings
| Themes | Overcoming moral dilemmas | Adapting to clinical challenges | |||||
| Categories | EVD triggered heightened dutifulness | Increased dependence on the surgical team | Prioritising maternal health | Improvised safety precautions | Changes in healthcare utilisation and referral patterns | International actors essential | Pre-EVD constraints to surgery and safety |
| Subcategories | With medical training comes great pride and responsibility. Outbreak fostered loyalty to the communities served. | Staff deaths. Staff overworked amidst dangers. Little absenteeism. Need for surgically skilled individual. | Obstetric emergencies prioritised highly. Elective surgery ceased. | Controlled slowing down of surgery. Improvised early to overcome hazards. Reinforced by the arrival of IPC and PPE. Symptomatic similarities with EVD a barrier. | More obstructed labours due to delayed presentation. Patients shunted from closed private facilities. Public campaigns (sensitisations). Ambulances redirected to obstetric emergencies. | Broader EVD containment facilitated surgery. Provided EVD diagnostics, technical support and protective gear. | Barriers to surgery before the outbreak. Few surgical specialists. Broken supply chains and coordination. Lack of operative protection. |
Underlying results sorted by WHO building block categories: see online supplementary material 2 for full category tables.
Exploratory analysis of findings in the six predefined categories yielded results pertaining to the importance of the functioning surgical team, heightened dutifulness, maternal health priorities, safety precautions, referral and care utilisation patterns, and the role of international actors.
EVD, Ebola virus disease; IPC, infection prevention and control; PPE, personal protective equipment.