Responding to the Ebola Outbreak in West Africa

by International Medical Corps
Emergency obstetric care is critical to save lives
Emergency obstetric care is critical to save lives

A maternal and child health aide described a newborn baby as “pale and floppy” following a complex caesarean. “Previously we would have just wrapped the baby in a blanket and thought there was nothing we could do, but now we know what to do.” Because of International Medical Corps’ pilot training program, the maternal and child health aide used her newly-acquired skills and successfully resuscitated the baby. She was so proud of what she had done and she said her colleagues all thought she was a hero. Since then, the maternal and child health aide believes up to 40 babies have been saved due to the teams’ improved understanding of newborn resuscitation.

Flexible and generous funding from GlobalGiving and other donors enables International Medical Corps to make strategic investments to address gaps in Ebola preparedness and response capacity within the health system and in communities. For example, the Northern Province of Sierra Leone – where Port Loko District and our midwifery pilot project are located – has the lowest rate of births attended by skilled birth attendants and the lowest number of institutional deliveries in the country.

The health needs of its population of more than 500,000 are met by only 107 Primary Health Units and two hospitals providing secondary and tertiary care. During the Ebola outbreak, the number of cases in Port Loko District was second only to Freetown, the capital of Sierra Leone. One way our teams are addressing gaps in infection prevention and control readiness is by training maternal and child health aides, individuals who are responsible for maternal and newborn health in Sierra Leone’s health system.

Today, we have trained 50 maternal and child health aides with our midwifery mentorship program, supporting increased infection prevention control measures as well as training on emergency obstetric and maternal and newborn health practices – like newborn resuscitation – improving health workers’ ability to keep themselves and mothers and babies safe. The lives of many women and newborns have already been saved as a result of International Medical Corps’ pilot midwifery training and mentorship program for maternal and child health aides and midwives in Port Loko District of Sierra Leone.

People are regaining confidence in the safety of health facilities because of infection prevention control training, and are making greater use of their services for maternal health care and other needs. We thank you and the GlobalGiving community for your support as we continue to build health care confidence in the post-Ebola context.

Training in Port Loko District of Sierra Leone
Training in Port Loko District of Sierra Leone
Maternal and child health aides training
Maternal and child health aides training
With flare-ups, surveillance and response is vital
With flare-ups, surveillance and response is vital

It was March 18th, a regular Wednesday afternoon and everyone at the International Medical Corps office in Conakry, Guinea was involved in meetings, reports, and calls to ensure the post-Ebola program was running smoothly. Then, a call disrupted that routine at 4:23PM – three Ebola cases were confirmed. Another two were suspected. After a two-year battle with Ebola that sickened and killed thousands, it was news that would make many go silent, unsure of how to react.

“Not our staff though. We get ready to respond.” Laura Stana, International Medical Corps’ Monitoring and Evaluation Coordinator in Guinea recalled of that day in March.

Since the beginning of the epidemic, the three most-affected countries – Liberia, Sierra Leone, and Guinea – have each reached the 42-day “Ebola-transmission free” mark at least once, sometimes twice, before discovering new chains of transmission. The most recent outbreak in Guinea left five people dead and put more than 800 people in quarantine. Likely as a result of this latest outbreak in Guinea, reports surfaced on April 1 in neighboring Liberia of the first new Ebola case since early December 2015.

We need to continue to invest in surveillance efforts to ensure that new cases and chains of transmission are quickly identified and isolated.

Growing evidence suggests that bodily fluids, such as semen in men, and breast milk and potentially vaginal fluid in women, can lead to transmission for far longer than originally anticipated—leading to the possibility that most, if not all, of the new Ebola cases are a result of survivor transmission. It is important for teams to integrate surveillance for future outbreaks into care of survivors, conducting strong community engagement and the building surveillance and response networks.

Today, survivor care support, prevention of additional transmission, and the Ministry of Health’s “ring surveillance” approach, which ties ongoing survivor health care with community-based surveillance, builds upon our mission to respond to localized outbreaks, provide infection prevention control services, and safely transfer patients to facilities equipped to treat Ebola.

In Guinea, this integrated approach complements post-Ebola programs implemented in partnership with the CDC, George Washington University and others. The approach includes education about how the Ebola virus is transmitted, safe semen transport and testing, counseling for those who decline testing, reproductive health education for men testing positive and their partners, distribution of prophylactics such as condoms and possible vaccination for partners and close relatives of men who test positive as a preventive measure. Teams emphasize a tracking system to ensure that men who test positive return monthly for testing until they have had two negative tests.

Laura in Guinea notes that, “As Ebola is resurfacing today, International Medical Corps remains prepared to respond to ensure the safety of the Guinean population in the most remote corners of the country. Even in what is regarded as the post-Ebola context, the Rapid Response Teams still conduct weekly simulations to remain prepared for a real intervention.”

She goes on to say that, “In the end, the deployment scenario was explored, but not enacted. At 9AM, the National Coordination for the Eradication of Ebola and humanitarian partners decided to respond via various agencies already located in immediate proximity to outbreak. We continue to make sure that we have the internal capacity to be the first there, no matter where. We are always ready to respond, as we were on March 18th.” 

International Medical Corps thanks you and the GlobalGiving community for your continued support as we continue the fight against Ebola. 

Logistical teams preparing for deployment
Logistical teams preparing for deployment
Rapid Response Team in Ratoma, Guinea
Rapid Response Team in Ratoma, Guinea
Children in Taylor-ta Village
Children in Taylor-ta Village

Nestled in the forests of north-central Liberia, Taylor-ta was a tight-knit village, home to some 1,120 people. It was this very closeness that allowed Ebola to take hold and tear them apart. The virus snuck quietly into Taylor-ta last November when a boy and his father came back from the capital, Monrovia. In a few days, the boy was sick and people from across the village came to help care for him. “When they brought the boy here no one knew about Ebola,” says Lucy Sumo, 48. “Everyone was helping him. But when he died, we got scared…Immediately after his death, those who helped him started getting sick.”

Many of these family friends were brought to the nearest Ebola Treatment Unit, which was run by International Medical Corps roughly 45 minutes away by car. Others never made it that far and died in their homes. In all, 24 people in Taylor-ta fell ill with Ebola. Only eight survived. For a community that describes itself as one family, every death was the loss of a loved one. Every new case sparked fears of who was next. As Ebola spread across Taylor-ta, people who used to share everything were driven further and further apart, their grief and anger at the relentless disease stubbornly and corrosively wedged between them.

Taylor-ta is one of the Ebola-ravaged towns where International Medical Corps is trying to help repair relationships that unraveled during the heartbreak and confusion of the outbreak. In what are called social reconnection groups, people come together to talk about what happened together with psychosocial professionals.

The current fight against Ebola is about more than treating patients and stopping the spread of the disease – it is about investing in people, fostering community recovery, training local healthcare workers in infection prevention and control, and helping rebuild healthcare systems across the region. International Medical Corps is now supporting a “durable zero” across the West Africa region because just as the World Health Organization declared an end to the current Ebola outbreak in West Africa, with Liberia the last country to get the all-clear, two new cases were confirmed in Sierra Leone. We expect that there will be flare-ups in the region for some time to come, which is why continued support for surveillance and response mechanisms is vital.

Psychosocial support is also key. “People are so sad,” says Sarah Diggen, a psychosocial staff member with International Medical Corps in Liberia. “Imagine if you lost all of your loved ones. This can create mental illness like depression.” Moreover, with an estimated 17,000 survivors, many facing not only stigma, but also health complications such as blindness, hearing loss and difficulty swallowing, continued care is critical.

International Medical Corps is extremely grateful for the unwavering support offered by GlobalGiving and other donors as we work to provide a comprehensive response against the deadly disease. Sarah says, “As long as you have life, you have hope.” As part of the global community, we work to not only offer health, but hope to those affected by Ebola in West Africa.

Social Reconnection Group in Taylor-ta Village
Social Reconnection Group in Taylor-ta Village
Triage center in Sierra Leone
Triage center in Sierra Leone
Adama and her nephew, Alhaji
Adama and her nephew, Alhaji

In late July, a young man returned to his home village of Massesebe in northern Sierra Leone to celebrate the Eid festival with his family. Within days the man was dead from Ebola. His death brought to an end a period of 150 days during which Tonkolili district had been Ebola free. As so often throughout this crisis, it was his closest family who had cared for him through his illness that were now at the greatest risk.

On July 31, the International Medical Corps Ebola Treatment Center near Makeni, received two new patients, Alhaji, the 36-year-old cousin of the man from Massesebe and 24 hours later, Adama, 35 the dead man’s mother. Both patients responded well to treatment and soon Alhaji received his second negative Ebola test result which meant he could go home. His aunt still tested positive and so had to join in the celebrations of her nephew's release watching across the fence from the Red Zone.

This story was in many ways unremarkable. It has been repeated hundreds of times at the ETU in Makeni and across Sierra Leone. Yet Adama’s story was momentous at that time. With her discharge on August 24, Sierra Leone reached the milestone of having zero confirmed Ebola cases at that time anywhere in the country for the first time since the crisis began in May 2014.

"This is not the end of the fight against Ebola. We have seen many setbacks before, and nobody should be complacent about the challenge that lies ahead for the people of Sierra Leone. But today is without doubt a day for celebration and reflection on the thousands of lives lost during this devastating crisis," said Sean Casey, International Medical Corps Regional Director for West Africa Ebola Response, "Across West Africa, in Liberia, Guinea and Sierra Leone, International Medical Corps is working with communities and governments to ensure that we can, in the near future, genuinely declare this Ebola outbreak over and help people to rebuild. Just as important are our efforts to build the resilience of communities against future outbreaks so the whole region, including in Mali and Guinea-Bissau are better prepared for outbreaks in the future."

Adama celebrates her nephew
Adama celebrates her nephew's release
Ebola worker celebrates Adama
Ebola worker celebrates Adama's release
Adama as she leaves the treatment center
Adama as she leaves the treatment center
Adama with the President of Sierra Leone
Adama with the President of Sierra Leone
Nurses in training at Kabala, Koinadugu
Nurses in training at Kabala, Koinadugu

Over the last 14 months, the Ebola crisis has created a regional and international public health emergency which has stubbornly persisted much longer in Sierra Leone than in neighboring Liberia, a country that faced a comparable epidemic at the outset. The World Health Organization reports a total of 13,290 suspected, probable and confirmed cases in Sierra Leone as of July 29, 2015, close to half of the total of 27,748 confirmed, probable and suspected cases of Ebola across West Africa. A total of 11,279 have died across the region. The crisis has taken a devastating toll on health systems in particular: 510 health workers have perished and only recently have most health facilities reopened to the public.

While much work remains to be done, and despite this evidence of tremendous suffering, there is reason to hope for an ending when looking at virus transmission rates in Sierra Leone over the last six months: on January 14, 2015, the World Health Organization reported 769 new Ebola cases in Sierra Leone in the preceding 21 days; on July 29, only 20.

International Medical Corps is currently working to end the Ebola crisis in Guinea, Guinea-Bissau, Liberia, Mali and Sierra Leone, and is one of a handful of international NGOs that is treating Ebola patients in West Africa. We are committed to getting to zero cases, and to rebuilding and strengthening the local and regional health systems; engaging community members in recovery through outreach and education programs; and bolstering local, regional and national preparedness. In total, we have nearly 1,550 staff working on the ground in West Africa for the Ebola response, including 1,390 local staff. International Medical Corps manages five Ebola treatment centers – two in Liberia and three in Sierra Leone – which can provide not only isolation and care for Ebola patients, but also psychosocial support; to date, we have screened more than 2,130 patients through these centers.

With the rapid and generous support of GlobalGiving and other donors, International Medical Corps led a community-based initiative to reactivate primary health care services in Sierra Leone, helping to bring patients back to health facilities and strengthen the health system for the future. The project took an integrated approach, including capacity-building and infrastructure development at the health facility level; improvements to community and household water, sanitation and hygiene infrastructure and hygiene education; and prevention messaging for families, among other activities. Combined, these activities helped respond to Ebola and build capacity for future outbreaks, and brought families back to the health facilities.

International Medical Corps’ primary health care reactivation project targeted health workers and communities in four districts of Sierra Leone, and was part of a larger effort in coordination with the Ministry of Health and Sanitation (MoHS) to combat Ebola and prepare communities for future outbreaks.

Communities continue to be devastated by the crisis. Many lost confidence in the health system with the death of health workers, and a secondary health crisis emerged with the closing of health facilities in the wake of the Ebola outbreak. Even as they reopened, the injured, pregnant women and people ill with common diseases like malaria, pneumonia and diabetes still didn’t seek treatment for fear of infection, eliminating the public health gains achieved in these countries over the past decade.

The goal of International Medical Corps’ project was to restore confidence in Sierra Leone’s community-based primary health care facilities by building health worker capacity to treat common illnesses and to identify and refer potential Ebola cases, and by providing training and equipment for their protection. The project included a concerted effort to reach out to communities to sensitize them on the importance of good hygiene and of infection prevention and control behaviors, and of utilizing government health services. Rebuilding trust in the health system with comprehensive projects such as this one is a powerful tool for ending the ongoing transmission of the Ebola virus.

International Medical Corps and the MoHS chose to reactivate 37 Peripheral Health Units (PHUs) located in some of the districts hardest hit by the Ebola crisis – exceeding the initial target of 27 PHUs by nearly 40 percent. In total, this project reached 171,482 direct beneficiaries and 1.5 million indirect beneficiaries in Bomboli, Tokolili, Koinadugu and Kailahun Districts, and achieved the following targeted outcomes:

    • 148 PHU staff received training on health and infection protection and control and use of personal protective equipment
    • Using a Training-the-Trainer model, PHU staff trained 37 Village Health Committees on key aspects of infection prevention and control, with a focus on sanitation, referral for suspected cases and psychological first aid
    • 100 Mother-to-Mother (M2M) groups were established and 1,000 mothers were trained on health, infection protection and control and nutrition to help prevent transmission
    • 37 PHUs stocked with 3 months of personal protective equipment and related infection prevention control supplies. This included 640 gallons of disinfectant liquid; 33,000 bars of soap; 1,285 pairs of reusable elbow gloves; 78,700 pairs of disposable gloves; 39,250 disposable facemasks; 685 plastic aprons; 435 of heavy duty reusable gloves; and 20 chlorine power drums for disinfection.
    • 37 handwashing stations, 16 latrines and 17 incinerators were constructed at PHUs and waste managers were trained on proper sanitation and hygiene procedures to improve sanitation and help stop the spread of disease
    • As a result of community outreach and education on sanitation and hygiene, 10,000 tippy tap and 640 Veronica bucket handwashing stations were constructed in homes and common community areas.
  • Over the course of the project, patients visiting the PHUs increased from an average of 3-5 five daily, to 20; clinics for pregnant women now welcome 25 or more patients daily

The support of GlobalGiving and other generous donors made it possible for International Medical Corps to train staff and communities, rehabilitate and supply facilities, and conduct outreach activities that are restoring confidence in Sierra Leone’s community-based health system. As a result, this intervention helped fight the Ebola outbreak -- while stemming the impact of the secondary health crisis it caused.

Tippy tap demonstration at Magburaka, Tonkolili
Tippy tap demonstration at Magburaka, Tonkolili
Personal sanitation and hygiene training
Personal sanitation and hygiene training
Newly constructed incinerator at Gbenikoro PHU
Newly constructed incinerator at Gbenikoro PHU
Tippy tap in use at Yataya PHU in Koinadugu
Tippy tap in use at Yataya PHU in Koinadugu

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International Medical Corps

Location: Los Angeles, CA - USA
Website: https:/​/​​
Project Leader:
Los Angeles, CA United States
$6,131 raised of $10,000 goal
57 donations
$3,869 to go
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