‘Tiny Iceland’ preparing for Ebola in a globalized world

ABSTRACT

Background: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland.

Objective: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers.

Methods: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team.

Results: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a ‘tiny’ nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans.

Conclusions: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.

KEYWORDS:

• Global health
• prevention and control
• public policy
• qualitative evaluation
• emergency responders
• communicable diseases
• emerging
• fear

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We are grateful to participating institutions for giving permission to conduct the study, but not the least, to the participants who contributed with their time and experience.

Disclosure statement

Dr. Gunnlaugsson reports he was the Chief Medical Officer (CMO) for Iceland, Directorate of Health, in the period 2010-2014. Other authors report no conflict of interest.

Ethics and consent

The study was reported to the Data Protection Authority and approved by the National Bioethics Committee in Iceland (number VSI-15-192). Subsequently, the study was approved by the University Hospital Ethical Committee on 4 February 2016 (number LSH 13-16). Participants signed an informed consent form before taking part in the study.

Paper context

The manuscript builds on the work of Íris Eva Hauksdóttir towards a MSc in Global Health, Section of Global Health, Department of Public Health, Copenhagen University, Denmark.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Not applicable.

Notes on contributors

Geir Gunnlaugsson

Geir Gunnlaugsson conceptualized the study, and took part in all necessary steps towards its completion, such as analysis and interpretation of data, and writing the manuscript for submission.

Íris Eva Hauksdóttir

Íris Eva Hauksdóttir collected and analysed the data as part of a master thesis work conducted under the supervision of all three co-authors, revised the manuscript, and approved the final version.

Ib Christian Bygbjerg

Ib Bygbjerg took part in the interpretation of data, revision of the manuscript, and approved the final version.

Britt Pinkowski Tersbøl

Britt Pinkowski Tersbøl took part in designing interview tools and in the thematic analysis of interview data, interpretation, revision of the manuscript, and approved the final version.