Table 4 Challenges in health protection for medial team in China ETC in Liberia

1. The capability of emergency command system (CS) needs improvement

I think it is very important to establish a command system (CS) to command the battle to fight against EVD. This CS might promote effectiveness of all ETCs. For example, the CS could coordinate all ETCs to work effectively and consider interests of all ETCs. CS could coordinate all resources among ETCs in order to ensure all ETCs could run. CS could coordinate local transportation for materials for ETCs. For example, due to the different procedures required by customs in different countries, our materials were delayed to ETC when arrived in Liberia. For example, in order to treat that child who infected with EVD and was very severe, we need oxygen cylinder, our director of China ETC took a lot of time to get one for the child. Another example is the incinerator, we take a lot of time to coordinate it. (Leader of foreign affairs office in ETC)

We got support from many Chinese enterprises in Liberia. We coordinated the materials through Embassy of the Chinese people’s Republic of China in Liberia. We also asked Ministry of Health in Liberia, UN. We also coordinated with custom and Foreign Office in Liberia for the transportation of materials for our ETC. (Leader of logistics support group in ETC)

2. International guidelines on how to respond to Ebola were not readily available

Up to deployment of our medical team, there is no standard or protocol for our medical team to refer to. In WHO website, there is only a special website to publish and update EVD epidemic, but no special website to publish any standard or protocol for international medical team to respond to EVD. We prepared our medical team with the experience from fighting SARS in China in 2003. But there are substantial differences between these two diseases, working and living environment in China and in Liberia. We found shortage of supplies and HCWs when we arrived in Liberia just because of no guidelines for preparations. (Deputy director of ETC)

3. No prepared medical teams for emergent infectious diseases and inadequate equipment deposit was another kind of challenge.

There need internationally prepared medical team for this emergent infectious diseases. The Global Foreign Medical Teams Registry has minimum standards for international health workers. Those standards also facilitate coordination between aid providers and recipients. The temporarily established medical teams are often unfamiliar with the international emergency response systems and standards and they might not know the usual coordination mechanisms. Besides, there lacked of registered factories to produce and deliver adequate PPE for HCWs. It is difficult to get PPE of high quality. (Deputy director of ETC)

The prepared medical team should have a standard training camp. The training camp should simulate the living and work environment of the location they would be deployed to. If medical teams receive training in a similar environment they would have a better health when we arrive in field. (Senior medical technicians)

4. Participating in meeting for communication between ETCs increased risk to infection.

In affected countries, there should be a website for HCWs to communicate on experiences or lessons in responding to EVD in order to prevent medical team from infection with Ebola. But participating in meeting by NECC or visiting ETCs were the only approach for ETCs to communicate. In this case, this approach resulted in increasing contact with staffs from ETCs which might increase risk for contact and is not appropriate.(Deputy director of ETC)

5. Shortage of professionals who familiarize with health diplomacy challenged the medical team.

We lacked of diplomatic experience though we have experience to participating UN peacekeeping in Africa. Peacekeeping is different from anti-Ebola. We need more training for health diplomacy and we should cultivate more professionals (Psychological experts).