Responding to the Ebola Outbreak in West Africa

by International Medical Corps
Mariatu helps other survivors cope with their pain
Mariatu helps other survivors cope with their pain

“When we first heard about Ebola, we thought it was to do with politics,” says Mariatu, a psychosocial worker in Sierra Leone. “We denied it. There were those who said it was witchcraft. While others said it was a curse that had been placed on some people. When my sister, who was a nurse, got very sick, I wondered whether it was indeed a curse. I cared for her. I washed her. I hugged her. I held her. I didn’t want her to die, but she did.”

Two weeks later, Mariatu’s daughters fell ill with the same symptoms. She took them to the local hospital, but the doctor advised his staff not to touch the girls because they probably had Ebola. They were put in an empty hallway away from staff and other patients, and a few hours later, Mariatu’s eldest daughter passed away. Mariatu also became sick, and she and her youngest daughter were transferred to another hospital that was accepting Ebola patients. Miraculously, they both survived, but by the time they returned home, most of their neighbors were gone. “Our area was like a ghost town when we returned,” Mariatu says. “There are two houses nearby that are empty now. Everyone in those two houses passed away. Whole families were wiped out.”

Throughout the outbreak, some 28,600 confirmed, probable and suspected cases of Ebola were reported across West Africa, and more than 11,000 people died. Many patients who survived the disease deal with ongoing medical complications, such as vision impairment and bone and joint pain, which are associated with post-Ebola syndrome, alongside the psychological trauma. Many people were overwhelmed by the grief of losing several family members at once, and they often felt guilty for surviving the disease when so many people did not.

When International Medical Corps’ psychological coordinator asked to meet with survivors, Mariatu came forward. “I told them I was hurting and really stressed,” she said. “I told them that if they gave us jobs, survivors like me could be an example to other patients who are refusing medication and losing hope and the will to live.” Mariatu then began supporting International Medical Corps’ survivor care efforts, addressing psychosocial needs of patients and survivors. This work has helped Mariatu overcome her own despair. “It is very rewarding for me to have this opportunity because I can see the difference it makes,” she says. “I still miss my daughter, but I am learning to cope with the pain. If I had held onto that pain it would have killed me even if Ebola did not.”

We want to thank the GlobalGiving community for supporting International Medical Corps’ work with Ebola survivors.

Our teams work with local Ebola survivors
Our teams work with local Ebola survivors
The team celebrates the end of the outbreak
The team celebrates the end of the outbreak
Comfort spent 17 days in the Ebola Treatment Unit
Comfort spent 17 days in the Ebola Treatment Unit

“It was like a big cloud over my eyes,” Comfort Kollie says, describing how it felt to slowly lose her sight. Comfort spent 17 days in International Medical Corps’ Ebola Treatment Unit in Bong, Liberia before being discharged with a clean bill of health. But not long after returning home to her family, Comfort began experiencing excruciating pain in her bones and joints, and then the world began to darken. She recalls, “I cried. I thought I would never see again.”

Comfort is one of some 17,000 survivors of the recent Ebola outbreak, most of whom live in Guinea, Liberia and Sierra Leone. During the outbreak, humanitarian organizations like International Medical Corps made tremendous strides in treating and preventing the deadly disease, and in the process raised new questions about the long-term effects of Ebola, which experts call Post-Ebola Syndrome. Like Comfort, many survivors experience Post-Ebola symptoms such as body pains, psychological trauma and vision problems.

Megan Vitek, a registered nurse and program coordinator for International Medical Corps’ Post-Ebola Syndrome program says, “There is still so much unknown about what happens to a survivor’s body once their blood test is negative and they are discharged from the Ebola Treatment Unit.” Research into long-term side effects suggests that the virus can persist in bodily fluids, such as semen, and areas of the inner eye, where the virus causes blinding lesions.

International Medical Corps takes an integrated approach to survivor care. Across Guinea, Liberia and Sierra Leone, we are leveraging our experience on the frontline of the fight against Ebola to rebuild devastated health systems by training health workers, providing primary care and fostering community engagement. Our outreach programs work with survivors to rebuild lives and communities by dispelling myths, leading health promotion activities and facilitating dialogue. In Liberia in particular, our team also works with ophthalmologists to treat lesions caused by Ebola, as well as physiotherapists to combat bone and joint pain. When Comfort’s symptoms grew worse, she turned, once again, to International Medical Corps. She still experiences some pain in her bones and joints, but she has fully recovered her sight, and has returned to her career as a nurse. She says, “Because of International Medical Corps’ help, I can see clearly now.”

We want to thank the GlobalGiving community for your support as we continue to promote infection prevention and control and provide healthcare to Ebola survivors who need it the most.

A doctor performs an eye exam on an Ebola survivor
A doctor performs an eye exam on an Ebola survivor
A survivor receives treatment for his eyesight
A survivor receives treatment for his eyesight
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
 

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Organization Information

International Medical Corps

Location: Los Angeles, CA - USA
Website: https:/​/​internationalmedicalcorps.org/​
Project Leader:
Kimberly Laney
Los Angeles, CA United States
$6,262 raised of $10,000 goal
 
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