A week after Scotland on Sunday published Pauline Cafferkey’s diary of her efforts to save victims of the Ebola virus, the nurse was battling for her own life
WHERE there was suffering, she brought hope. At times of fear, she showed fortitude. Not that Pauline Cafferkey would ever see it that way. For her, the choice to help others was automatic, an almost instinctive reaction forged by years of voluntary aid work in some of the world’s most embattled regions.
When the veteran nurse spoke to Scotland on Sunday on 20 November, she was training at a Ministry of Defence facility in York, preparing for the fierce temperatures that would await her less than 72 hours later in Sierra Leone.
The impoverished West African nation, still emerging from the shadows of a bloody decade-long civil war, was beset by an Ebola epidemic, a crisis that has to date claimed more than 7,800 lives. Cafferkey was under no illusions about the challenge that lay in wait. But when reporter Kevan Christie asked if she was concerned about the risks she would face, her reply was sober and to the point.
“You know there’s some degree of risk there, particularly with this response that we’re doing, but it certainly wouldn’t stop me,” she explained. “I’ve done aid work before, so I jumped at the chance to volunteer and get another opportunity to help.”
Playing back the interview, Christie says what struck him most about Cafferkey over the course of their conversation was her resolve. She was, he realised, a woman who “wouldn’t take a backwards step”.
“Listening back, I was struck by how resolute Pauline is, a typical down-to-earth Scottish woman completely focused on what she was about to do,” he says. “One of those people who you instantly know is motivated by wanting to help others.”
Cafferkey’s journey to Sierra Leone was decades in the making. It began at home in the village of Crossgates, where she and her sisters, Karen, 42, and Toni 40, were raised by Michael Cafferkey, a former miner, and his wife, Jean.
From their corner of Fife, the television offered a window on to the wider world. One day in 1983, Cafferkey, aged nine, sat on the couch and watched one harrowing report after another. The images showed staving children with distended stomachs. Some were around her age; others just babies, clinging on to lives that had only begun.
It was to prove a defining moment in the young Scot’s life. Cafferkey resolved there and then to dedicate her life to helping others. “The reason I went into nursing was 30 years ago, when I was a wee girl. I saw the big famine in Ethiopia,” she told Christie. “I felt compelled to go and help.”
After attending St Columba’s in Dunfermline, she achieved her ambition in 1998, qualifying as an NHS nurse at the age of 23. She had recently relocated to the central belt, living in Cambuslang and working as an associate public health nurse in the health centre of the South Lanarkshire town of Blantyre, a place with its own strong ties to the Mother Continent.
Over the years, Cafferkey travelled far and wide, her trips borne partly out of wanderlust – Bermuda was among her favourite destinations – but primarily a wish to help others less fortunate. She had extensive aid experience and had worked in south Sudan and Bangladesh.
This autumn, she opened her inbox to discover an email asking for NHS volunteers to help in the effort against Ebola in Sierra Leone. Without giving it a second thought, Cafferkey applied. “For me it was kind of a natural thing, I couldn’t think of any reason not to go,” she told BBC Scotland’s Bill Whiteford on the day she left Scotland. “I didn’t really think about it actually, I just did it.”
In all, around 1,000 staff from across the UK applied to go to Sierra Leone. Thanks to her past aid work, Cafferkey was among just 30 people chosen, with nurses joining forces with GPs, psychiatrists and emergency medicine consultants. She was one of five Scots in the group, which included Dr Roger Alcock, a consultant in emergency and paediatric medicine at Forth Valley Royal Hospital.
Together, they were sent to the MoD facility in York, where they underwent nine days of training. It was to prove as intensive as it was invaluable, with volunteers put through psychological tests and asked to work in a makeshift hospital under simulated high temperatures.
On 23 November, she and the group left for Africa. Her neighbour, Jimmy McLindon, recalled seeing her leaving wearing a “big backpack”, adding: “We knew she was a nurse, so we told her jokingly to take care.”
During her chat with Whiteford, the presenter asked if she was excited or worried about what lay ahead. “All of the above,” she answered. “There’s a lot of emotions I’m going through right now. I’m pretty much looking forward to getting there, getting my feet on the ground and getting stuck in.”
Not quite 24 hours later, she did just that. The first thing that struck Cafferkey was the smell: chlorine, an essential cleaning agent used to kill the virus. The 30-strong contingent was split up, with Cafferkey assigned to a Save the Children managed treatment centre on the outskirts of the capital, Freetown.
A cluster of white tents in a forest clearing, the Kerry Town centre was designed by the UK Department of Health and constructed by the Sierra Leonean military under the supervision of Royal Engineers. A series of buildings behind two lines of fences is known as the Red Zone: it is where infected patients are held.
When it opened in late November, the centre increased the nation’s bed capacity for Ebola patients by a fifth, testament to the paucity of the previous provision rather than the size of the modest facility.
One of 14 British volunteers, Cafferkey soon witnessed first hand the devastating effects of the virus. In one particularly emotive entry in a diary she emailed to Scotland on Sunday, she told of how she was looking after a young woman who “didn’t have long”. As the Scot tried to make her final moments as comfortable as possible, she saw a young boy looking in through a window, and waved to him. A few minutes later, the woman died.
“I heard the boy crying outside the ward,” Cafferkey recalled. “When I went to him, he asked if she had died. I said yes. He said she was his mother. He had already lost his father to Ebola, and now he had no parents. I tried to console him, and he said he had a sister who also came to the treatment centre with him and his mother, but he did not know where she was.”
Cafferkey retraced the morning’s events. A young girl had died. On leaving the Red Zone later that day, she checked the medical notes; it was, it turned out, the boy’s sister who had lost her fight.
Indeed, during her time there, the Kerry Town treatment centre saw – and lost – a remarkable number of patients. By 12 December, into Cafferkey’s third week, it had admitted 103 confirmed cases, 34 of them under the age of 17, including seven below the age of five. Come Boxing Day, its 80 beds were full, with Save the Children admitting over 200 patients and discharging 66. The mortality rate, the organisation says, is around 50%.
Little wonder, then, that even during the long, humid nights, Ebola still consumed Cafferkey’s thoughts. “The dreams that I do remember always seem to have an Ebola theme,” she wrote. “It seems to be all-consuming.”
The threat posed to her and other volunteers was always keenly felt. Every time one worker passed from the safe Green Zone into the Red Zone – having taken around 20 minutes to get dressed in their personal protective suit – they wished one another good luck. It was a “bizarre” ritual, Cafferkey told Scotland on Sunday, but also “a sobering reminder of what we are doing.”
Mercifully, the suffering and loss was not constant, with a few, rare moments of hope shining through. Near the end of her time at Kerry Town, Cafferkey was cheered by a late rush of discharges, with patients cleared of the virus able to take their final chlorine wash – known as “happy showers” – and reunite with whatever family they had left.
“One particularly nice discharge was a brother and sister,” she remembered. “There were lots of smiles and they were fortunate to have a mother and father to take them home, which is not often the case.”
As her time in Sierra Leone came to an end, Cafferkey’s own thoughts turned to home. At 2.30am last Sunday, the day her diary was published in Scotland on Sunday with her picture on the front page, she boarded Royal Air Maroc flight A596 from Freetown to Casablanca, where she was reunited with the group of 30 NHS volunteers on board the 12.20pm Royal Air Maroc flight AT0800 to Heathrow.
Sat beside her was Dr Martin Deahl, a consultant psychiatrist from Newport, Shropshire. As they chatted over the course of the flight, the 58-year-old recalled how the “delightful, charming” nurse seemed “perfectly fine” and was looking forward to visiting her parents.
“We talked about getting home and enjoyed having a big catch-up with everyone,” he said. “We swapped stories and agreed it had been the most rewarding experience of our careers.” Others on the same flight who spoke with Cafferkey said she told them she planned to return to Sierra Leone in the spring.
At 3.50pm, the flight arrived at Heathrow’s Terminal 4. By then, Cafferkey was complaining of feeling a high temperature, one of the key symptoms of the disease. Her temperature was taken seven times – once on arrival and six times over the course of a half-hour period after she told staff she thought she might have a fever.
But her temperature was found to be within the range defined as acceptable – the maximum is 37.5C – and she was allowed to continue with her onward journey. Dr Deahl, who was also tested, described the process as “chaotic”, and warned that there were too few staff on duty, and that the rooms where returning volunteers were held were too small.
Cafferkey travelled through to Terminal 5 and whiled away the hours before she boarded her final flight of the day, British Airways BA 1478 to Glasgow, arriving in the city at 11.30pm.
She then took a taxi home to Cambuslang for what should have a been a deep and restful sleep in her own bed. But overnight Cafferkey realised her condition was deteriorating. Well versed in the protocol of such situations, she rang the NHS for help.
As Monday morning dawned, so did the realisation that the nurse might be in grave danger. Her neighbour, Jimmy McLindon, walking back home from a nearby newsagents, was taken aback when he saw the scene outside Cafferkey’s front door.
“There were ambulances, police cars and squad cars waiting outside and I thought, ‘Something’s not right,’” he said.
Cafferkey, her symptoms still minor, was taken to Glasgow’s Gartnavel Hospital and placed in specialist isolation in the Brownlee Unit for Infectious Diseases at 7.50am.
Authorities at NHS Scotland, Health Protection Scotland and the Scottish Government then consulted their English counterparts, and a timetable was agreed to move Cafferkey to the Royal Free hospital in north London, where nurse Will Pooley was treated after being evacuated from Sierra Leone with Ebola in August.
In the early hours of Tuesday, she was taken to Glasgow Airport and placed in a quarantine tent in an RAF C-130 Hercules transport plane. By 8am, she was back in London, arriving at the hospital in an RAF ambulance. She was taken the top floor of the Royal Free, where a state-of-the-art polythene “patient isolator” unit with in-built hats, sleeves and gloves allowed staff to begin treating her.
Over the course of the day, Cafferkey held talks with Dr Michael Jacobs, clinical lead in infectious diseases at the Royal Free, about the next steps. With no evidence that potential Ebola drugs work, their discussions were candid. “She’s a nurse, a fellow professional, so we have been able to discuss things in great detail,” Jacobs said.
One potential drug, ZMapp, which was used to treat Pooley, was ruled out, with none available in the world at present. Ultimately, Cafferkey decided to receive an experimental anti-viral drug along with a convalescent plasma from survivors of the disease, including Pooley. It will be around a week before medics know how the experimental treatment has worked, but as of Hogmanay, Cafferkey was sitting up in bed, talking and reading, and had been able to speak with her parents via an intercom.
The coming days, Dr Jacobs said, will be crucial. “As we’ve explained to Pauline, we can’t be as confident as we would like,” he explained. “There’s obviously very good reason to believe the treatment’s going to help her, otherwise we wouldn’t be using it at all, but we simply don’t have enough information to know that’s the case.”
Valuable lessons will be learned from her treatment. The events of the last week have been an arduous time for Pauline Cafferkey and her family, but even now, she continues to play a small but vital role in the fight against Ebola.