Australian nurses are on the frontline in the health response to the Ebola epidemic sweeping West Africa.

As the death toll from the virus continues to climb, Australian Red Cross aid worker and nurse Amanda McClelland is on the ground in Sierra Leone, heading up the international Red Cross response.

Ms McClelland is one of a small team of Australian Red Cross health professionals sent to West Africa, including nurse and epidemiologist Marshall Tuck, while an anaesthetist is also on the way.

An International Federation of Red Cross (IFRC) emergency health senior officer, Ms McClelland is working to set up the first Red Cross isolation unit.

Ms McClelland said nurses are wearing full personal protection equipment (PPE) from overalls and goggles to two pairs of gloves and apron gumboots while they work, and using social distancing and good hand washing practices in the community.

Nurses receive specialised training on arrival, including use and removal of PPE, and are then supervised in the isolation unit for up to two days.

“The ideas may be frightening, and the consequences of a mistake can be high, but the care of Ebola patients comes down to the basics that all nurses should have,” she said.

“Many of our African colleagues have died - 21 so far in the hospital that we are about to support.

“This is because of lack of quality education, quality equipment and extremely long hours causing fatigue and possible errors.

“Many of the nurses were actually infected from friends and family at home rather than at work where they had access to the right protection equipment.”

The organisation has deployed a full field hospital and will open a 60-bed unit in Kenema, Sierra Leone’s third largest city.

Ms McClelland said patients are presenting with fever, malaise, vomiting and diarrhoea.

“Haemorrhagic symptoms are surprisingly rare and only come late in the condition but they can be confronting,” she said.

“We haven’t started clinical care yet, as the hospital is being built and the focus has been on breaking community transmission through good public health practices.”

Ms McClelland, who oversees safety, policy procedures and guidelines and manages the relationship with partners including the World Health Organisation and the Sierra Leone Ministry of Health, said the Red Cross has been involved since the first cases appeared in Gueckadou, in Guinea, in March, sending specialist aid workers from across the globe to the three affected countries.

She said the Ebola response comes down to basic public health.

“It is good hygiene, burial practices and a simple transmission cycle that can be broken through early case indication and treatment,” she said.

“We utilise public health nurses with good community experience to assist the national Red Cross society in working with a large network of volunteers in communities, personal and psychological support and contact tracing activities.

“It helps if these community nurses have a good understanding of infection control, and epidemiology.

“In terms of clinical care, the nursing procedures are basic skills - good interpersonal communication, use of personal protective equipment and supportive care that includes treatment of sepsis and shock.”

Ms McClelland said a lack of understanding about the disease has led to rumours and misinformation in the population, making clinical care difficult.

“There have even been cases of civil unrest or the population attacking a vehicle or hospital,” she said.

“This fear and lack of understanding makes bringing the outbreak under control very difficult.

“In terms of clinical care, the high case fatality rate is difficult and working in the personal protection equipment in hot conditions is a big challenge.

“Nurses are losing up to two litres of fluid in one set of rounds, so keeping hydrated and avoiding heat stress is extremely important.”

Regardless of the hurdles, Ms McClelland said it’s rewarding to work alongside Red Cross volunteers in the midst of the epidemic.

“Despite the fear and stigma they turn up to work every day and do what they can to help their communities - they are amazing and an inspiration,” she said.

The other highlights are the survivors.

“There are big celebrations when someone survives,” she said.

“The counters take them back to their village and assure everyone they are now safe and not infectious.”

Ms McClelland said nursing in outbreaks is more than the provision of clinical care.

“That is one component but what will stop the outbreak is the public health and community nurses out at the village level…talking to people, educating and convincing them that Ebola is real, that the virus can be stopped and that we need to work together to stop this outbreak.”

 For more information about Red Cross international aid work visit their website here.