Hand-washing stations, quarantine checkpoints, burial teams, and ambulances traversing the countryside were new sights for Dr. Heather Clayton, 2010 College of Public Health PhD graduate, who said she had only vaguely imagined that level of ground-zero public health duty before deploying to Sierra Leone this fall as part of the Centers for Disease Control’s role in the Ebola outbreak response.
It was by no means her first overseas public health experience. In fact, Clayton said, her first international public health endeavor was a COPH international field experience in Niger. She has since traveled to other continents several times with the CDC.
“I did imagine that I would have several opportunities to do frontline work as an epidemiologist, particularly during my time as an EIS officer,” she said, “but I never imagined in my life that I would be working on an Ebola outbreak.”
Clayton said she had felt her first pangs of a public health career while an undergraduate in chemistry at the University of California at Irvine.
“During my undergraduate studies, I took a public health class and just fell in love with epidemiology,” she said. “I liked thinking about health from a population perspective, and with that perspective, the potential for impacting health on a large scale.
“The required reading for the course was Laurie Garrett’s book The Coming Plague. I think it was the first non-fiction book that I can recall reading late into the night. I was just fascinated by the early history of the HIV/AIDS epidemic, outbreaks of hemorrhagic fevers such as Ebola and Lassa, as well as other diseases of concern.
“Garrett’s book also exposed me to the work of disease detectives at the CDC and inspired additional readings, such as Level 4: Virus Hunters of the CDC. I just thought CDC sounded like the most amazing place to work. It became my goal to get there someday.”
After completing her chemistry degree, Clayton said, she remained inspired by public health and her CDC dream, so she enrolled in MPH studies at San Diego State University. It wouldn’t be long before she would get a real-life introduction to that special place she had first imagined in late-night readings.
“After finishing my master’s degree, I got an ASPH-CDC fellowship in reproductive epidemiology and got to work at CDC for two years,” she recalled, “and I realized it’s like many places. There are cubicles and offices, and it’s not always as glamorous as what you think when you read the books – but sometimes it is as glamorous as that. That’s when I decided to go back and get a PhD, and that’s when my path led me to USF and the Department of Community and Family Health,” she said.
After graduating from COPH, Clayton made it to her CDC promised land, where she is 4-1/2 years into a career in adolescent health surveillance systems and research (6-1/2 including her fellowship). During her 30-day deployment in Sierra Leone, it struck her that she was getting the ultimate exercise in applying theory to practice.
“We landed at about 6 in the morning, and the very next day,” she said, “I was off in the district – kind of a very rapid, hit-the-ground-running-when-you-get-there experience. I think that, for me, what was really a new experience was being somewhere where Ebola was a very real presence. Everywhere you looked, there were signs for Ebola. Television programs were constantly covering the outbreak. In the evenings, all of our discussions were about Ebola. While interviewing a villager in an area where there had been several cases of Ebola, it dawned on me that, for this brief period of time, I had joined the ranks of the CDC virus hunters.”
While less than ideal, Clayton said, her living conditions there were reasonably high-end, given the setting.
“I was in a hotel,” she said. “I had a room to myself, with a bed. I definitely used my mosquito net and took my malaria medicine, but I had a very western toilet and shower. Electricity was on and off a lot, and there were a lot of challenges with Internet, but basically, it was a pretty good facility.”
A small wall-mounted air conditioner that might be dubbed a “window-shaker” in the States even provided some comfort against the oppressive heat and humidity – but of course, only when the electricity was on. Meanwhile, teamwork and comradery filled in the dark spaces that like to show up with distance from family, friends and familiarity.
“My most positive experience was working with my counterparts, the folks in the Ministry of Health in the Bo District, as well as our international partners,” she said. “I got to work with the special pathogens branch of CDC, so I got to actually work alongside several folks that I had only read about in books. It was a public health geek moment to work with my idols.”
She and her CDC colleagues were part of an international contingent that included personnel from Doctors Without Borders, the World Health Organization, UNICEF, World Vision and International Rescue Committee.
“We were working with so many international partners,” she said, “and it was amazing how we were all on the same page in doing what we needed to do to help with the outbreak. It was a very collegial experience just going out there and working with folks, pulling together different disciplines and really trying to have a good impact on the outbreak.”
Of all who were there to fight the outbreak, Clayton said, it was the local workers who left the biggest impression on her.
“They’ve been dealing with Ebola for many months now, with very little rest, and a great deal of emotional stress,” she said. “Many have lost colleagues, friends and even family to the Ebola outbreak. When you walk around the district health office compound, you can see several memorial flyers that have been posted with pictures and names of health care workers who have died in the line of duty. I can’t really express in words how amazing my Sierra Leonean colleagues were – even now, they are literally working around the clock to save their country and their people.”
After 30 days in the afflicted West African nation, Clayton admitted that her perspectives have changed a bit. The sight of the makeshift clinic alone has left a lasting impression.
“To see this facility just carved out of this cassava field … it was huge, it was like several football fields, with numerous tents, risk areas divided by orange fencing, and patients resting outside in chairs in the distance. And it just really hit me – the magnitude of the outbreak – on an emotional, visceral level. As a scientist, on an intellectual level, I understand the outbreak and the need to respond, but when you’re there and you see it, it’s a whole other experience that’s definitely going to stay with me for a very long time.”
As a precaution, Clayton was on “active monitoring” for 21 days upon her return. She was required by both the CDC and the Georgia Department of Health to check in twice a day to report her temperature, any suspicious symptoms, and any travel plans. That was routine, so there were no surprises on a professional level, but she said there were a few in store in her personal life.
“My career in public health has taken me to several challenging settings in the Middle East and Africa,” she said, “so my friends and family weren’t surprised that I would volunteer to work on the response in West Africa. My parents were worried about me being exposed to Ebola, and they also were concerned that I would see and experience things that would be deeply upsetting. But regardless of their concern, they were very supportive of my decision to deploy to Sierra Leone. Of course, they’re happy that I’ve returned to Atlanta, and they’ve told me that they’re proud of my service.
“However,” she noted, “I was surprised to hear that some of my family members were worried about spending time with me – even going so far as to express concern about me traveling to their homes or them attending Thanksgiving dinner at my house. There is definitely an issue of stigma for health care workers and public health responders returning from West Africa.”
Undeterred, Clayton said her latest and most intensive taste of the public health front lines has her ready for more.
“I would definitely do it again, now that I’ve rested,” she said. “It was really difficult to work 12- to 16-hour days for 30 days straight, but I would definitely go back. I would love to return to the district that I worked in and continue some of the systems that I helped to establish during my deployment. That being said, I’m happy to work wherever there is need.”
Story by David Brothers, College of Public Health. Photos courtesy of Dr. Heather Clayton.