Factors affecting the delivery of healthcare on a humanitarian operation in West Africa: A qualitative study.

INTRODUCTION: Medical personnel in the UK Armed Forces are highly trained to deploy in support of military operations that assist humanitarian, peacekeeping, counter-terrorism and environmental catastrophes anywhere in the world. Such environments are often austere and successful outcomes demand an individual is highly resilient and able to adapt quickly to any situation. This qualitative study aimed to determine the factors that affect healthcare delivery on such missions by capturing the personal experiences of the first military personnel deployed on a humanitarian operation in support of the Ebola outbreak in West Africa between October 2014 and January 2015.

METHODS: A grounded theory methodology was utilised to probe the personal accounts of these experiences. Semi-structured interviews were conducted on 14 multi-disciplinary personnel 3-6 months following their return to the UK and were transcribed verbatim. Data were analysed and a framework generated that had been further refined by discussion with military personnel independent of the study but with the contextual understanding and experience of this particular deployment.

FINDINGS: The resultant theoretical framework was underpinned by participants framing their experience by "just getting on with it". Stressors such as a poor flow of information, a fear of the unknown, strict patient admission criteria, environmental constraints and transcultural boundaries to care were mitigated by strong leadership, teamwork, peer support and the positive impact of having made a difference.

CONCLUSION: Collective pre-deployment training generated competence, confidence and team cohesiveness providing a firm foundation for coping with the challenges of this humanitarian mission, which continued to be strengthened throughout the deployment. These factors helped to build personnel's resilience to the stressors associated with the mission and may help to protect their mental health outcomes in the longer-term.