ArticleBMJ global health2019
"For this one, let me take the risk": why surgical staff continued to perform caesarean sections during the 2014-2016 Ebola epidemic in Sierra Leone.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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12 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Investigating Organizational Learning and Adaptations for Improved Disaster Response Towards "Resilient Hospitals:" An Integrative Literature Review.Prehospital and disaster medicine · 2022Pooled it
- Healthcare system disruption across WHO-declared PHEICs: a 4S comparative case analysis.Frontiers in public health · 2026Article
- Resilience of health systems in Africa to infectious disease shocks: A qualitative evidence synthesis.PLOS global public health · 2026Article
- Health systems resilience in fragile and conflict-affected settings: a systematic scoping review.Conflict and health · 2024Article
- Healthcare Workers' Resilience Toolkit for Disaster Management and Climate Change Adaptation.International journal of environmental research and public health · 2022Article
- Article
- How clinicians manage routinely low supplies of personal protective equipment.American journal of infection control · 2021Article
- The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone.BMJ global health · 2021Article
- Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review.BMJ global health · 2020Review
- Global guidance for surgical care during the COVID-19 pandemic.The British journal of surgery · 2020Review
- Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration).Journal of postgraduate medicineArticle
- Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review.Inquiry : a journal of medical care organization, provision and financingArticle
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6 authors at 3 institutions in 3 countries.
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No grant is acknowledged in the PubMed record.
Abstract
introductionRoutine 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.
methodsThis 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.
resultsWe 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.
conclusionThis 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.
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