This file has some audio problems, please see access copy of interview (OH3/17/3) for clearer audio. [00:00:00] Background: Medical training at King’s College London; study of international health; move straight to academic post in 2010; teaching global health with focus on health systems and policy. Work developing King’s Centre for Global Health across King’s Health Partners. Policy director role in UK parliament with Nigel Crisp and MPs/peers. [00:05:00] First visit to Sierra Leone in 2009 for medical elective at children’s hospital. Proposal for new long term partnership in Sierra Leone based on language, health system similarities and diaspora links in south London. Early project development: Return to Sierra Leone with small DFID grant; initial solo period; arrival of volunteer colleagues; collaboration with Ministry of Health; slow expansion to small team of six by March 2014 including doctors, nurse, pharmacist, policy specialist. [00:07:50] Arrival of infectious disease consultant Dr Marta Lado in March 2014 and retired senior physician Terry Gibson. [00:09:00] Initial Ebola awareness: First cases in Guinea in March 2014; rapid reactivation of cholera taskforce by Minister of Health Miatta Kargbo as Ebola taskforce. [00:10:00] Early multi agency meetings at Ministry of Health with WHO, MSF, Red Cross, Save the Children, GOAL, IRC, UNICEF, UNFPA, King’s. [00:11:40] Low level of Ebola clinical expertise noted in the room. Initial planning for limited rural outbreak; expectation of few cases; assumption that Sierra Leone well prepared due to Kenema Lassa Fever Centre. Early tension between WHO messaging (“under control”) and MSF warnings (“out of control”). [00:16:00] Early preparedness actions: Need for isolation rooms in hospitals; limited capacity in case management team; lack of resources; initial mapping of hospitals; perception of having “dodged a bullet” by late April–early May. [00:18:00] First suspected cluster in rural Kailahun in May; misidentification as cholera; movement of patients into community; delays tracing early cases, ambulances, lack of finances, assertiveness with partners. [00:23:00] Early Freetown preparations: Establishment of small isolation units in hospitals (Connaught, 34 Military, Emergency). King’s unit at Connaught created in April with two beds; early suspected cases tested. [00:25:00] First confirmed cases in Freetown in June at Macauley Street clinic. Rapid expansion of Connaught isolation space from two beds to nine beds in one night due to multiple suspected patients. Continued expansion from June to July with increasing suspected and confirmed cases. [00:27:40] Deterioration phase: Arrival of numerous cases by July; oversight by consultant physician Dr Modupeh Cole as unit lead; involvement of King’s staff inside PPE where necessary. [00:28:30] Observation of Monrovia collapse triggers recognition of potential for major urban outbreak in Freetown. Inability to secure small funding early for expansion. [00:30:30] First infections among senior clinicians: Dr Modupeh Cole and Dr Khan. Heavy reliance on Kenema for patient transfers despite long transport and full capacity. System pressures: Limited readiness of other Freetown hospitals; minimal MSF involvement locally; WHO focus on surveillance rather than case management; internal Ministry tensions; unclear leadership in Western Area. [00:38:00] Flight cancellations; NGO withdrawal; hospital closures; strikes; widespread collapse of confidence. Shift to emergency clinical role: King’s decision to run Ebola unit clinically after deaths of senior Sierra Leonean doctors; negotiations with London; confirmation of medical cover including Medevac issues. [00:40:00] Severe staffing shortages; Kings staff on knife edge of being evacuated, shift in thinking when Chris Lewis comes out scaling up, finances. management of up to 23 patients with minimal team; cases of multiple deaths overnight; emphasis on safe isolation over complex clinical care. [00:44:50] Opening of additional units at Lumley and other hospitals within days; work with police training school, Sierra Leone army and others; Lakka and other sites established, recalls lots of people dying, bodies everywhere, needing to be assertive around how many patients they can take at Connaught Hospital. [00:47:00] Command centre: Early creation of local command centre at District Health Management Team office; coordination of ambulances, bed management, Connaught hospital full, patient tracking; co-ordination [00:49:30] management of political pressures around body collection versus high risk suspected cases; just not enough beds, later expansion by British Army massive command centre set up, working with AGI (Tony Blair Group). overwhelming demand, patients waiting outside facilities, inability to expand further, tension with government over capacity limits, bed numbers vs how many patients you can actually see a day, throughput. Extensive media engagement by King’s to highlight urgency. Delays in large donor funded treatment centres (Kerry Town, Hastings, PTS2).[00:54:00] Stabilisation: Rapid increase in treatment beds from multiple new sites in late November–December; sudden reduction in patient load; first empty beds on Christmas day. Transition to phase of reopening closed hospitals and restoring wider health system. [00:55:20] Caseload: Approx. 1,300 suspected cases managed at Connaught, about 700–800 positive.[00:56:00] Lessons identified by OJ: Need for rapid expansion of safe isolation capacity; value of warehouse style units for fast throughput, using tents instead; importance of early command and control systems; need for operational data on bottlenecks; [00:59:00] critical role of Sierra Leone army; need for rapid funding mechanisms; need to question early expert assumptions; challenges of PPE standardisation; [01:02:00] surprise of Ebola arriving where it did, lack of early WHO leadership; importance of field driven action over remote decision making; learnings for DFID, had to nationalise Ebola response, privatisation of international aid vulnerabilities in global health architecture; need for institutions able to respond decisively, mandate of WHO [01:11:56] End of interview.
This content summary was created from the interview transcript in February 2026 using M365 Copilot Chat. The content summary was then reviewed against the audio by the cataloguer.