Twenty students sit in a classroom in Freetown listening to a trainer. It should be a common scene, but the topic, Ebola and their ages (mostly 40s), makes this a different type of lesson.

The students are all health workers, including nurses and doctors, learning how to prevent infection in a highly contagious environment. The training is being given by members of the Center for Disease Control and Prevention (CDC) in Atlanta. It has been organised by UNICEF, in collaboration with the Ebola Response Consortium (ERC), the International Rescue Committee (IRC), Concern Worldwide and Save the Children, with funding from DFID.

The training aims to teach health workers how to work correctly with personal protection equipment (PPE) to screen all patients, isolate suspect cases, and continue providing routine health care services relating to immunization, nutrition, ante-natal care, HIV, TB, malaria, pneumonia, to the population – especially women, and children under the age of five.

This is critical to restore confidence in the health system for both health workers (they feel safe) and the population (they feel healthcare workers are professional and know what to do to protect them).

Since the beginning of the outbreak more than 80 health workers have died due to Ebola, while more than 100 have become infected. Preventing the infection of health workers is an important priority as the response grows.

This was a training-of-trainers – allowing these health workers to go out and train more health workers in infection prevention and control, across the country. Those trained will go onto train a further 1200 health units country-wide.

The needed luxury: infection control

“In countries with fragile health systems, infection control is a luxury, more than a necessity”, says Ben Levy from the CDC.

Ben reinforces that stopping contagion seems to be a question of knowledge and resources, and that while health professionals in Sierra Leone are very engaged and have many years of experience, “they are not used to the appropriate level of infection prevention control, neither for the patients nor for them”.

In the initial stages of the out break equipment was also not available.

Now knowledge and medical materials are arriving in country. UNICEF has airlifted almost 230 tonnes of equipment like chlorine, latex gloves, plastic bags for corpses, to support infection control and stop the loss of more valuable lives of health workers. The country has an average of one doctor for 33,000 people.

Knowledge and confidence

Rebecca Amara (35) is a nurse attending the workshop. She says there are no specialists in infection control in health units in Sierra Leone, and she is interested in the training. Much of the information is new to her.

Her colleague at the table confirms. “I see health workers exposing their boots to the sun as a way to ‘wash’ them, now I’m going to tell them to use a 0.5 chlorine solution and let them soak for half-an-hour and put them upside-down to dry.”

The solution has to be adequate, “if it’s too strong it damages materials, if it’s too low it doesn’t kill the virus”, says Ben.

After the theory, it is time for practice. The attendants learn how to use the protective gear correctly so that the can avoid being infected.

The protocol doesn’t seem easy at all. “It’s difficult”, confirms Abu Conteh, a nurse attendant, “but the practice makes me feel more confident”.

Now the last challenge looks like shortening the working hours for the health workers to avoid mistakes due to tiredness – the crucial and unpredictable human factor.

Yolanda Romero is a consultant working with UNICEF Sierra Leone.