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Emergency Response to the Ebola Outbreak in DRC

by International Medical Corps
Emergency Response to the Ebola Outbreak in DRC
Emergency Response to the Ebola Outbreak in DRC
Emergency Response to the Ebola Outbreak in DRC
Emergency Response to the Ebola Outbreak in DRC
Dr. Adam Levine leads the research in May 2019.
Dr. Adam Levine leads the research in May 2019.

Throughout the West African Ebola outbreak from 2014 to 2015, the 2018 outbreak in Northwestern Democratic Republic of the Congo (DRC) and the current, second-largest outbreak in history in Northeastern DRC, International Medical Corps was there – gathering data to identify successes and extract lessons learned even as we provided care and technical training. As a result, the International Medical Corps’ Ebola Research Team has assembled one of the world’s largest — if not the largest — archive of published research on the Ebola virus and its treatment.

Two recent studies highlight the importance of collecting information to record lessons learned for the benefit of future responses: 1) the Pamoja Tulinde Maisha (PALM), or Together Save Lives, trial, which studied the effectiveness of four drugs to treat the Ebola virus; and 2) a study on prophylactic antibiotics, or the use of the antibiotics to prevent secondary infections.

With support from national, international, intergovernmental, such as the WHO, and other humanitarian organizations during the PALM trial, International Medical Corps helped test the effectiveness of four drugs in treating Ebola among more than 680 patients. After a string of disappointments in the quest for useful treatments, the results demonstrated that two of the four drugs dramatically increase patients’ chances of survival.

In the 2019 Science magazine, Kai Kupferschmidt writes, “the results [of the PALM study] should help combat the disease not only by improving patients’ chances of survival, but also by encouraging people to seek treatment early. With no effective drugs available, people with symptoms have often tried to evade detection and sought out traditional healers, which has fueled outbreaks.”

Misinformation can make the spread of diseases, such as the Ebola virus, more likely and also encourage people to be more resistant to treatment. However, results of studies like these, ones that demonstrate fewer lives lost and more effective treatments, may help convince people to seek care if they believe there is hope. 

The second study, using data gathered during the West African Ebola outbreak from 2014 to 2015, involved 360 patients diagnosed with the virus. The results found that the mortality rate among patients given the antibiotic fell to just more than half—54.7%, compared to a death rate of more than 73% among those who did not receive the drug. Our study constitutes the first evidence-based research to support the well-known practice. Evidence-based research is important because it helps transform subjective knowledge into objective data, informing not just our future responses, but also those of humanitarian agencies worldwide.

Today, our teams are again collecting data to identify the successes of our work in northeastern DRC and learn as many lessons as we can before the next emergency. Research and knowledge enhance the value of our work – and, most importantly, save lives.

We thank the GlobalGiving community of donors for supporting our efforts to inform and prevent future outbreaks.

Citations

 “Independent Monitoring Board Recommends Early Termination of Ebola Therapeutics Trial in DRC Because of Favorable Results with Two of Four Candidates.” National Institute of Allergy and Infectious Diseases, 12 Aug. 2019, Retrieved on 12 March 2020, from: www.niaid.nih.gov/news-events/independent-monitoring-board-recommends-early-termination-ebola-therapeutics-trial-drc

K. Kupferschmidt, Successful Ebola treatments promise to tame outbreaksScience, Vol. 365, p. 628, 16 August 2019, Retrieved on 12 March 2020, from: https://science.sciencemag.org/content/365/6454/628

Tyler Marshall, International Medical Corps Study Offers First Evidence That a Low-Cost Antibiotic Can Reduce Deaths in Ebola Patients, International Medical Corps, 10 February 2020, retrieved on 12 March 2020, from:https://internationalmedicalcorps.org/story/international-medical-corps-study-offers-first-evidence-that-a-low-cost-antibiotic-can-reduce-deaths-in-ebola-patients/

Ebola survivors leaving the treatment facility.
Ebola survivors leaving the treatment facility.
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Victorine with International Medical Corps staff.
Victorine with International Medical Corps staff.

With 3,348 confirmed and suspected cases of Ebola and 2,210 deaths as of December 16, 2019, the Ebola outbreak in the DRC continues unabated.

In September 2019, International Medical Corps admitted a 17-year-old pregnant woman from Biakato to its Ebola Treatment Center in Mangina. The woman was vomiting and had abdominal pains, headache, fatigue, cough and vertigo. Later that day, the woman tested positive for the Ebola virus. She passed away a few days later.

But from her death came new life. On September 29 and at an estimated 34 weeks’ gestation, a girl was born via emergency C-section at a nearby facility as her mother was dying, weighing only 4.4 pounds. The little girl required intensive care and continuous treatment for the first 24 hours of her life.

Everyone at the Ebola Treatment Center waited to see if she would survive these critical moments and wondered whether she would have Ebola. The Ebola virus has long been known to be passed through bodily fluids for long after a patient has recovered, but more research is needed to know the probability of passing the infection from a mother to her newborn child.

Happily, the little girl made it through the first few days without advanced breathing assistance and was soon declared “Ebola-free” by the team of International Medical Corps’ doctors. Fitting the challenging circumstances of her birth, the little girl was named Victorine — meaning “Victory” in English.

Victorine was discharged from intensive care at the nearby facility, and was placed in the Mangina Ebola Treatment Center's nursery to be monitored over the next month. The nursery at the Ebola Treatment Center provides a child-friendly space for the children of people diagnosed with Ebola, with an isolated section for children who have the disease themselves. The intent of the nursery is to mitigate the long-term psychological impact of the disease while providing appropriate developmental and play activities.

Victorine is currently thriving and will remain in the care of the Congolese nuns who help run the nursery until she is strong enough to return to her family.

In addition to Victorine and the Mangina Ebola Treatment Center, International Medical Corps supports 74 facilities that screen for Ebola and refer patients to more advanced care in Ebola Treatment Centers as needed. As of October 31, 2019, International Medical Corps’ supported facilities had screened more than 1.09 million people for Ebola.

International Medical Corps sincerely thanks all of you in the GlobalGiving community for your continued support of our efforts to also be victorious over the Ebola virus.

Victorine, born on September 29, 2019.
Victorine, born on September 29, 2019.
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Six of eight new survivors in traditional outfits
Six of eight new survivors in traditional outfits

In December 2013, a young boy was infected with Ebola in Guinea from bats. Over two years later, the largest outbreak in history was declared over with an accumulated 28,616 confirmed cases and 11,320 deaths across ten countries, including the United States.

International Medical Corps was in West Africa from the very beginning of that outbreak, just like we have been responding from the very beginning of the ongoing outbreak in the Democratic Republic of the Congo. Now the second largest outbreak in history, according to the World Health Organization Regional Office for Africa’s September 18, 2019 report, there have already been 3,145 confirmed or suspected cases of Ebola and 2,098 deaths across two countries and 37 health zones.

During the 2014-2016 West Africa Ebola Outbreak, International Medical Corps trained more than 5,000 health and technical workers in Ebola case management and infection prevention and control. We supported five Ebola Treatment Centers that cared for 2,678 patients, including 460 Ebola-positive patients. Finally, we constructed 27 screening and referral units that had conducted more than 670,000 screenings by mid-2016.

Since August 2018, in this current outbreak in the Democratic Republic of the Congo, International Medical Corps has already trained more than 1,700 health and technical workers on infection prevention and control and other topics related to Ebola response. We have staffed two Ebola Treatment Centers that have cared for 1,407 patients, including more than 260 confirmed cases, and our teams have constructed 48 screening and referral units that have conducted more than 1 million screenings. While it is difficult to compare responses, one of the differences is reduced media attention on the current outbreak. Public interest is often tied directly to funding availability, impacting nonprofit organizations, such as International Medical Corps.

What’s Going on This Time?

Treatments. Though cases continue to rise, preliminary data from the clinical trial in which our team in DRC is participating are very positive and signal potential game-changing Ebola treatments that will be used in this and future outbreaks. Two of the experimental Ebola treatments that were trialed appear to greatly increase survival rates. These two therapies will now be offered to all patients in the DRC.

International Medical Corps was one of three humanitarian non-governmental organizations that were part of this trial. Dr. Adam Levine, International Medical Corps’ Director of the Ebola Research Project, said, “This Ebola therapeutics trial is the largest ever conducted and the first to be run in the middle of a conflict zone. International Medical Corps is proud to be one of the few organizations participating in this groundbreaking trial, which will not only help us find better treatments for this deadly disease but also likely alter the humanitarian community’s approach to research for decades to come.”

Psychosocial Support. International Medical Corps is collaborating with the Ministry of Health to provide psychosocial support to patients and their families at our Mangina treatment center, and to survivors as they rejoin their communities.

Community Engagement. International Medical Corps is engaging the community in Ebola surveillance through networks of Community Health Workers. Because of the widespread fear and misinformation related to Ebola, these healthcare workers are conducting household visits, hosting educational talks and leading mass sensitization sessions to spread awareness of the realities of the disease. Trained to recognize Ebola signs and symptoms, they play a key role in discovering new cases and tracing contacts. International Medical Corps’ community engagement activities have reached nearly 64,000 people.

Vaccinations. Healthcare professionals are using what is called a “vaccination ring,” or vaccinating everyone who has come in contact with an infected person, to prevent the spread of the disease. However, misinformation and fear of the government have often prevented healthcare professionals from being completely effective.

Thanks to the GlobalGiving community and other donors, for continually enabling access to cutting-edge services for Ebola patients and survivors and their family members.

One of five cured Ebola patients from June 2019
One of five cured Ebola patients from June 2019
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Sanitizing all the equipment, even the boots.
Sanitizing all the equipment, even the boots.

On June 11, 2019, the first Ebola case was confirmed in Uganda, making this the first case linked to the outbreak outside of the Democratic Republic of the Congo (DRC) in the second largest outbreak in history. As of June 23, 2019, there were 2,269 suspected cases of Ebola with 2,145 confirmed and 1,506 fatalities in 24 health zones of the North Kivu and Ituri provinces of the DRC, according to the Ministry of Health.

Our team currently provides services to prevent and treat cases of Ebola in the DRC. To date, International Medical Corps has provided care to 186 confirmed and 571 suspected Ebola patients at our Ebola Treatment Centers; conducted more than 990,000 screenings for Ebola; trained over 1,300 health staff on proper infection prevention and control; and reached nearly 63,000 people through community engagement on prevention and treatment.

As our teams continue to care for those infected with the highly contagious virus, one of the many “must-have” items needed before the facility could accept its first patients presents a special logistical challenge: clean water. Water’s role in Ebola treatment goes beyond the task of keeping the patients hydrated as they endure vomiting and diarrhea triggered by the hemorrhagic virus.

Water is essential for the safe handling and disposal of Ebola-contaminated human waste, and for adhering to the strict procedures essential to maintaining safe hygiene. Water, sanitation and hygiene specialists estimate that the daily clean water needs for an Ebola treatment center today are as high as 400 liters per bed to treat patients and maintain the level of infection prevention needed to keep all staff and areas of the treatment facility safe.

Chlorinated water plays an important role in enabling the staff to keep the facility itself clean, and — more important still — themselves safe from exposure to the deadly virus. Healthcare staff must be followed by infection prevention and control teams who use spray wands connected to canisters of chlorinated water from boreholes to disinfect every footstep taken until every piece of equipment are removed, sprayed and quarantined to dry, right down to the boots.

Thank you to our GlobalGiving community and other donors, who help us continue to promote clean water, sanitation and hygiene in every response wherever and whenever it is needed most.

Preventing transmission starts with the staff.
Preventing transmission starts with the staff.
Preparing to treat an Ebola patient.
Preparing to treat an Ebola patient.
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Community health workers learning about Ebola
Community health workers learning about Ebola

According to the latest Ministry of Health report, as of March 24, 2019, the number of cumulative cases official rises to a total of 1009, with 944 confirmed cases and 65 probable cases of Ebola, and 629 fatalities. Ebola has now spread across more than 20 health zones and two provinces. Never before have Ebola response teams faced active insecurity, community resistance and urban transmission simultaneously, all of which are weakening the effectiveness and reach of critical surveillance and prevention activities in North Kivu and Ituri provinces.

With misinformation and fear of Ebola, communities have been highly resistant to response efforts, contributing to the rapid and ongoing spread of the disease. Many individuals and families keep loved ones at home when they become symptomatic, flee from health facilities and checkpoints after presenting with a fever, and refuse vaccinations and follow-up. These actions leave communities and health workers extremely vulnerable to undocumented transmissions of the virus.

In order to address these concerns, we are conducting community engagement through community health workers (CHW) and community-based organizations. He goes on to explain that these CHWs and CBOs visit households in vulnerable areas, lead educational talks on Ebola, and facilitate awareness sessions about the disease. Trained to detect and raise alerts on potential cases, CHWs also play a key role in discovering new cases and contacts in their communities.

“Identifying a case early is extremely important,” explains Dr. Cimanuka, the medical coordinator of the International Medical Corps Ebola response program in the DRC and one of our program’s trainers. It’s also important to break down resistance to the presence of health workers involved with the Ebola response, he says, and he is proud that staff members have been able to use their newly gained knowledge to engage leaders of communities. To date, International Medical Corps’ community engagement activities have reached more than 54,010 people.

“Those who had initial doubts if Ebola was dangerous came to understand quickly just how real and how serious the Ebola Virus Disease is,” says Dr. Nzanzu, a chief physician of Luotu in North Kivu province. The training provided by International Medical Corps “was great timing for .”

We thank the GlobalGiving community for your continuing support of our efforts to bring an end to this dangerous Ebola outbreak.

Healthcare workers at one of our Ebola facilities
Healthcare workers at one of our Ebola facilities
Our team engaging with communities on outreach
Our team engaging with communities on outreach
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International Medical Corps

Location: Los Angeles, CA - USA
Website:
Project Leader:
Kelli Maddock
Los Angeles, CA United States
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