Responding to the Ebola Outbreak in West Africa

 
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Lunsar Ebola Treatment Center Team, Sierra Leone
Lunsar Ebola Treatment Center Team, Sierra Leone

On Saturday, May 9, the WHO organization declared Liberia “Ebola Transmission Free”!

Thank you for your generous support -- your generous gift and your swift response helped us to stop this outbreak at the source. 

We also wanted to share a photo that our team at the Lunsar Ebola Treatment Center in Sierra Leone sent to our team in Liberia.

The hard work continues in Sierra Leone and Guinea, and much remains to be done.  But today, we wanted to take a moment to thank you – you made our response possible, you gave our First Responders the resources they needed to safely address this crisis, and ultimately, together, we saved lives. 

Korto and baby Josephine
Korto and baby Josephine

Our teams are operating four Ebola treatment centers and implementing training programs to equip frontline healthcare workers with the skills needed to stop this outbreak at the source. Through the efforts of Emergency Response Team members like Dr. Pranav Shetty as well as volunteer nurse Kelly Suter, among thousands of other First Responders, International Medical Corps will provide access to treatment for 1.5 million people in West Africa.

To date our Bong County Ebola Treatment Unit (ETU) in Liberia has discharged 78 survivors. Nurse Suter gave a firsthand account of just one survivor, baby Josephine.

“Over a week ago Korto - an Ebola survivor- and her three-month-old daughter, Josephine, came to the unit by ambulance. Josephine had developed vomiting, diarrhea and a fever hours after Korto was discharged from the confirmed unit of the ETU. Josephine tested positive for Ebola and grew weak and dehydrated quickly. Each time an IV had to be restarted, she fought a little less. Eventually, we had to hold her down and shave half of her beautiful head of hair to place a scalp IV. While not a difficult or uncommon task when caring for babies, that moment carried with it a sense of defeat. Korto had to leave the room and the medical staff were visibly grieved by the task required of them. Despite all, Josephine continued to deteriorate- her tiny little whimpers being heard less and less from the low risk side of the fence. After days of expecting Josephine to pass away, her symptoms suddenly began to disappear. Josephine gradually regained her strength and is now completely symptom free. Her blood tests are almost negative, her cheeks have filled back out and she loves to be carried around by staff in full personal protective equipment. Though not official until her blood test is completely negative - she is the youngest survivor of Ebola to date.”

* Baby Josephine did test completely negative at four-months-old and was discharged from our Bong County ETU along with her mother Korto.

With the support of GlobalGiving and other donors International Medical is able to continue operating these critically needed ETUs and has also begun efforts to repair healthcare infrastructure with long-term impact in mind.

Nurse Kelly Suter
Nurse Kelly Suter
Ebola Case Map
Ebola Case Map

Background

The World Health Organization’s December 10th Ebola Situation Report cites 17,942 total suspected, probable or confirmed Ebola cases and 6,388 deaths, mostly in West Africa. The case fatality rate across the three most-affected countries in patients is approximately 72%; in hospitalized patients the case fatality rate is lower, 60%.

International Medical Corps: Acting as First Responders

“We’re now six months into the Ebola crisis and it’s still in full throttle. We’re going to need far more manpower, expertise and resources to stem the flow and help many more patients to recover. And people must be kept aware. This virus is still raging here. People must stay informed.” – Sarata Silla, Head Nurse charged with recruiting, training and coordinating the work of nursing staff at International Medical Corps’ two Ebola Treatment Centers in Lunsar and Makeni, Sierra Leone.

Need #1: Treatment – 4 Ebola Treatment Centers

The global community has been very responsive to the Ebola crisis in West Africa. Thanks to the generosity of government and private donors, International Medical Corps operates three Ebola Treatment Centers in Bong and Margibi Counties in Liberia, and in Lunsar, Sierra Leone. Our first Center opened in Bong County on September 15th and our fourth will open in Sierra Leone in the town of Makeni, in mid-December. They are strategically located for maximum impact, and at full capacity they can offer a total of 320 beds to admit, diagnose and treat suspected, probable and confirmed Ebola cases—meeting about 10% of the total need in the region. With 1,250 beds available, Liberia has been able to meet more than 70% of its identified need, but Sierra Leone, with only 406 beds, is still short 1,094 beds. Our Centers provide access to care for 1.5 million people around the clock, and each employ about 200 clinical, logistics and technical personnel, 90% of whom are local. We have also provided Ambulances to safely transport patients to and from the Centers; help us reach patients in remote communities; enhance our capacity to trace and collect suspected and confirmed cases; support burial teams; and provide additional capacity to the Ministry of Health’s District Medical Teams as we work side by side to thwart the spread of this disease.

The situation requires a fast, but also a flexible approach. We are basing our response to the outbreak in each country not only on epidemiology, but also on its unique context and specific needs.

Comfort, a Liberian scrub nurse, was lucky. When she got infected with the “nurse killer” where she worked at Phebe Hospital in Bong County, she was terrified. Five of her fellow nurses had already died of Ebola. When she arrived at International Medical Corps’ Ebola Treatment Center, just a couple of kilometers away, Comfort was certain she too wouldn’t survive. She kept thinking, “Ebola kills and there is no medicine for it.” She was right. But Treatment Centers can save about 40% of their patients by controlling blood pressure and with hydration and nourishment. Today, Comfort is one of our many success stories. She is working for International Medical Corps as a nurse, at the Center that saved her.

“When I enter a place with people with Ebola, I know I cannot get it again. I’m free now—I’m happy. I can help patients, talk to them, counsel them, tell them how to be safe.”

Need #2: Training – 7-10 Day Course Offered at 2 Centers

Staff safety and competence are of primary importance in this outbreak, as out of 620 health workers infected with Ebola in West Africa, 345 have died. In Liberia, Ebola is called “nurse killer” because of the number of doctors and nurses who have died from the disease. The region can ill afford this loss. Liberia and Sierra Leone, with only 187 doctors in 2012 for a combined population of 10.2 million, have a critically small health workforce. (By way of comparison, Croatia and Denmark together, with the same population, had 31,287 doctors in 2012.) Training is key. To rapidly scale up the number of frontline health workers with the skills equipped to fight this disease, in early November we began offering our standardized Ebola training course, the Multi-Agency Training Collaborative Curriculum (MATCO), to members of International Medical Corps and partner organizations. This 7-10 day course draws on expertise and technical content provided by the World Health Organization, Centers for Disease Control and Prevention, and Doctors Without Borders (MSF). Topics include the use of personal protective equipment, patient transport, admission, triage, psychosocial support for staff and patients, quality assurance, infection protection and control, case management, and management of the dead. To date, we have trained more than 250 frontline healthcare workers, 130 workers in Bong County, Liberia and 120 in Lunsar, Sierra Leone. Certification requires an additional four weeks of hands-on training in an Ebola Treatment Center for non-clinical trainees. International Medical Corps has plans to make this curriculum and materials available online, with open access.

International Medical Corps’ goal is to train 3,500 clinical and technical staff to help in the fight against Ebola in the next months, ensuring their safety even as they work to save the lives of others. Liberia’s Ministry of Health and Social Welfare and Sierra Leone’s Ministry of Health and Sanitation create the participant lists in collaboration with international organizations. Many of these organizations are operating or are in the process of launching their own Ebola Treatment Centers in other parts of Liberia and Sierra Leone, and include: Liberia’s Ministry of Public Works, the U.S. Public Health Service, the International Rescue Committee, Heart to Heart International, Partners in Health, the German Red Cross, the German Armed Forces, the Swedish Civil Contingencies Agency, AmeriCares, Save the Children International, the International Organization for Migration, the American Refugee Committee, and the Women and Health Alliance. In addition to clinical and psychosocial support staff, the MATCO curriculum is used to train the technical staff who ensure proper sanitation and hygiene, and the ambulance drivers who ensure safe transport throughout the community.

Need #3: Support – Mobile Teams

International Medical Corps makes available extensive experience and expertise to our many partner organizations across Liberia and Sierra Leone in order to have the greatest impact possible. In addition to our formal training program using the MATCO curriculum, our Mobile Support Teams bring invaluable and much-needed assistance to the staff and managers of the new Ebola Treatment Centers opening throughout Liberia and Sierra Leone, especially in the rural areas. Our Teams consist of 4-8 professionals, with a training and quality assurance director, doctors, nurses, epidemiologists, psychosocial workers, water and sanitation engineers, and logisticians. Their primary role is to assist MATCO-trained managers after they open Ebola Treatment Centers operated by partner organizations, helping to ensure compliance with protocols that keep staff and communities safe, and provide surge support as needed. In the first few weeks after a new Center opens, a Mobile Support Team works with its senior frontline staff, both national and international, for quality assurance and quality improvement in the areas most needed.

Need #4: Community Outreach – Triage-and-Referral Centers

To re-establish trust in health systems that have been badly battered by the Ebola outbreak, to build their capacity to identify and refer suspected Ebola patients to nearby Treatment Centers, and to begin the process of building the health system forward, International Medical Corps has launched a new initiative: establishing triage-and-referral centers in strategic communities. Our first partners in this outreach are Phebe and C. B. Dunbar Hospitals in Bong County, Liberia, and 28 primary care clinics in four health districts in Sierra Leone. Many health facilities closed following the outbreak from a combination of sickened and dying doctors and nurses, and fear among the populace that they also could contract the virus. The result has been a secondary crisis in access to health care for common ailments and for emergencies. With a network in place of safe, isolated spaces and a specially trained local workforce at community health facilities, the most isolated Ebola cases can be identified and referred to a nearby Ebola Treatment Center—bringing an end to this devastating epidemic.

The Global Community: Making a Long-Term Commitment

“I’ve always worked to develop local capacity, which is what attracted me most to International Medical Corps. In addition to treating Ebola patients in Sierra Leone, my work here centers on training local health care workers in infection prevention and control in an incredibly challenging setting. [International Medical Corps] will leave behind a group of skilled and talented staff who will strengthen the health system here and improve the country’s ability to respond to future outbreaks. Their contribution is already extraordinary.” – Dr. Ramona Sunderwirth, International Medical Corps Volunteer and Director of the Global Health Division of Emergency Medicine at Mount Sinai St. Luke’s Hospital, New York City

The global community—the United Nations, the Food and Agriculture Organization, the World Bank—agrees. Getting Ebola under control in West Africa will require a sustained investment of time and resources. We must not lose sight of the continued need to increase access to primary and secondary health care in the region so that fewer people die of Ebola, but also from malaria, complications in childbirth, and other preventable diseases, now and in the future. We must think beyond the present, and begin to rebuild the decimated healthcare system forward better by bolstering faltering infrastructure. In the meantime, we must ensure that local health workers continue to be adequately trained to identify Ebola patients, have adequate supplies and resources to isolate patients and also protect themselves, and have access to referral networks to nearby Ebola Treatment Centers to effectively treat patients and stop this outbreak as quickly as possible. In an analogy put forward by others, the wounds of the civil wars are still fresh and deep, and the countries’ immune systems, represented by their scant 187 doctors at the beginning of the Ebola crisis, have been hit hard—just like the victims of Ebola themselves. The international community needs to come to their aid.

With generous support from GlobalGiving as well as other donors, International Medical Corps and our partners from around the world aim to restore self-reliance to Liberia and Sierra Leone.

Ambulance support for Ebola Treatment Centers
Ambulance support for Ebola Treatment Centers
Comfort, Bong County, Liberia nurse
Comfort, Bong County, Liberia nurse
Personal Protective Equipment training
Personal Protective Equipment training
Ebola Treatment Center burial area
Ebola Treatment Center burial area
Frontline health worker
Frontline health worker
Ebola Treatment Center patient
Ebola Treatment Center patient
Ebola Treatment Unit, Bong County, Liberia
Ebola Treatment Unit, Bong County, Liberia

International Medical Corps is taking a two-pronged approach, treatment and training, to address the most immediate, critical needs of the Ebola outbreak and build the capacity of the national health care system to address this epidemic and meet the challenges of future outbreaks as well. 

With a 70-bed Ebola Treatment Unit up and running in Bong County, Liberia and a 50-bed unit soon scheduled to open in Lunsar, Sierra Leone, International Medical Corps is currently in discussions to open two additional units in the region over the next several weeks.  Once open, units will operate for a minimum of 6 months.  Each unit will require 200+ trained staff working in 24/7 shifts to provide treatment and training for patients.  In both Liberia and Sierra Leone, 90% of treatment unit staff will be local healthcare workers trained in Ebola treatment and prevention. 

To meet the critical staffing needs on the ground – the UN Development Program in Liberia estimated that it needs 40,000 trained community healthcare workers in that country alone --  International Medical Corps has developed a broad-based training strategy that will provide training to local communities and community-based organizations;  international healthcare workers and volunteers;  local, national staff; and partner organizations. 

Training will be delivered through Ebola Training Centers, adjacent to treatment units, allowing for classroom education and monitored, hands-on experience in treatment units for new staff and partner organizations – equipping additional organizations with the skills needed to open their own units. International Medical Corps is also deploying mobile support teams which will provide ongoing training and support to treatment unit staff and partner organizations – training thousands of new frontline healthcare workers in the next six months.

Ebola Treatment Unit, Bong County, Liberia
Ebola Treatment Unit, Bong County, Liberia

Links:

Personal protection equipment training
Personal protection equipment training

September 15, 2014 - Los Angeles, Calif.A new Ebola Treatment Unit was opened today in Bong County, Liberia, bringing the total number of facilities capable of treating the disease in the country to six. The facility was opened by International Medical Corps at the site about 120 miles north of Monrovia - only the second location in the country, outside of the capital, capable of treating patients with suspected or confirmed Ebola virus. With the opening of this facility, International Medical Corps is one of only two international NGOs in the world to be treating Ebola patients.

International Medical Corps will operate the facility, beginning with 10 patients and gradually scaling up to 70 beds within weeks. Once at full capacity, the facility will employ more than 200 specially-trained medical staff, 90% of whom will be Liberians.

“We greatly appreciate the United States Agency for International Development’s (USAID) and Office for Foreign Disaster Assistance’s (ODFA) swift and generous support that enables International Medical Corps to open this critically needed facility in Bong County,” said Nancy A. Aossey, President & CEO, International Medical Corps. “Ebola is one of the most virulent diseases in the world and continues to claim lives on a daily basis. The treatment of suspected and confirmed Ebola patients is hugely challenging, and requires extensive infection control measures. The Bong County Ebola Treatment Unit is equipped to provide quality, dignified care to patients, while also ensuring that families and communities are protected from potential exposure. This is the only way to effectively prevent new infections and eventually turn the tide on this outbreak.”

At least 1,700 people in Liberia have been infected with the Ebola virus and more than 870 have died during the recent outbreak. Of Liberia’s 15 counties, 10 have reported confirmed Ebola cases, while three other counties have reported suspected Ebola cases.

Sean Casey, International Medical Corps’ Emergency Response Team Leader in Liberia commented, “Last week, in one day alone, ten new suspected Ebola cases were identified in Bong County. This is a crisis that is growing in scale and intensity. Everybody living in this part of Liberia is waiting for this facility to open and we will be working day and night to treat patients and to get the facility up to full capacity as quickly as possible.”

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Development

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