MSF volunteer receives training on how to handle personal protective equipment during Ebola response courses, Brussels, Oct., 15, 2014.
MSF volunteer receives training on how to handle personal protective equipment during Ebola response courses, Brussels, Oct., 15, 2014.

BRUSSELS - By now, most of us recognize the yellow, spacesuit-like outfit of an Ebola worker.

But try putting one on — add the rubber apron and two pairs of gloves, the white hood, the strap-on goggles, the boots — and you'll find that merely donning the personal protective equipment required to battle the deadly virus is a skill set unto itself.

Inside a tent pitched here in a vast, muddy lot, however, the international group Medecins Sans Frontieres (MSF, Doctors Without Borders) is training about a dozen medical experts to do just that.

Staffers for MSF, acclaimed for its swift and massive response to the Ebola outbreak in West Africa, have been working frantically to treat victims in the hardest-hit countries. But even thousands of miles from Liberia, Sierra Leone and Guinea, the group has opened three training centers dedicated to teaching staff and humanitarian workers about how to keep themselves safe on the front lines.

Facing a virus that has killed more than 6,000 people this year, these doctors, nurses, hygienists and logisticians know that even a centimeter of exposed skin can be the difference between life and death.

Lifesaving training for lifesavers

Far from the outbreak's steamy West African epicenter, against a wintry skyline edged with factories, these lifesavers are undergoing MSF's own anti-Ebola boot camp.

"It's like preparatory training, really, to make sure that people understand what Ebola is and how they can stay safe and how they can keep other people safe," says Brett Adamson, a nurse and program facilitator. "And, of course, to understand the overall response to an Ebola outbreak and know that it requires teamwork at all levels, from day-to-day work in a center to the whole coordinated response. Without any of those parts, we won't win this outbreak."

Those attending the workshops include not only MSF staff, but also government employees and humanitarian workers from other agencies. The medical charity recently opened two other training centers, in Switzerland and the Netherlands, to handle the growing demand.

Besides getting lessons on wearing protective gear, trainees learn how to safely take blood and remove the soiled bedclothes of Ebola patients, who may have vomited or had diarrhea. The tent is equipped like a real hospital, with rooms set aside for suspect and confirmed cases. There's even an area marked "morgue" for the many who don't survive.

"In the high-risk zone, we have all the patients," says MSF trainer Mathias Kennes, who explains different zones of a typical Ebola treatment center. "We make the difference between the suspect zone, where we have patients who have just arrived and who need to be confirmed by laboratory tests. ... In the high-risk zone, we have only confirmed patients. These patients stay inside until they are cured. But a lot of people don't cure — they die."

Like all the trainers here, Kennes speaks from experience. He's worked in numerous MSF Ebola centers, first in Guinea shortly after the virus broke out earlier this year, and then in Liberia. He's witnessed many deaths but fewer recoveries.

"It's like a personal war against Ebola. It's very intensive. It's overwhelming," he says. "But still, I would like to go back just to be there, to help. To be a little stone in a big lake. But to do something."

Self-protection comes first

But fighting Ebola effectively means protecting yourself first. For Adi Nadimpalli, a physician from New Orleans who's just spent three months heading a trauma hospital in war-torn Central African Republic, the logic is almost counter-intuitive.

"I'm used to [a situation where] if I see a person with a gunshot wound, I go right away, touch, put my gloves on, set the scope on, feel what's going on," he says. "But here, no, get your suit on. Make sure you’re not at risk and not putting anybody else at risk."

Nadimpalli's next mission is Liberia, where the Ebola death toll has topped 3,000. He's been there before.

"I've always had a soft spot in my heart for Liberia and Liberians," he says. "To see the harm, the devastation ... this is happening to a whole host of populations, a whole region. It's the necessary thing for us to go."

As a medical professional, he's not alone. Ebola is exacting a profound psychological toll for patients and those who care for them. MSF staff who have been on the front lines describe the frustrations of battling the virus: the lack of any proven treatment, the high fatality rate, the inability to physically reach out and comfort suffering patients — the sheer volume of need.

"You feel compromised by what you're doing, and you question yourself and you always feel like you need to be doing more," says Adamson, the MSF facilitator. "But you're bound by all these limitations. I know for a lot of us, the first time we went into some of the Ebola management centers, you're crying as you're going around. Particularly the first couple of times."

Emotionally draining work

The emotional trauma faced by Ebola response teams is just one of the topics that workshop psychologists tackle. They also discuss how to raise awareness in affected communities about how to prevent Ebola from spreading and the need to avoid stigmatizing those touched by the disease.

While many are hopeful the outbreak will at some point be contained, the humanitarian community forced to turn its attention to other crises, for Ebola survivors, the story won't be over.

"Anyone who survives, they've lost someone. They come back to big questions and empty houses and neighbors who cross the road when they see them," says MSF psychologist Ane Bjøru Fjeldsæter. "Even when we have the last person recovering or dying, there's still a lot of work to be done."

So in Brussels and in West Africa, the war against Ebola is far from over and tougher than ever.