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Responding to the Ebola Outbreak in West Africa

by International Medical Corps
Responding to the Ebola Outbreak in West Africa
Responding to the Ebola Outbreak in West Africa
Responding to the Ebola Outbreak in West Africa
Responding to the Ebola Outbreak in West Africa
Responding to the Ebola Outbreak in West Africa
Comfort, a nurse and survivor of Ebola in Liberia
Comfort, a nurse and survivor of Ebola in Liberia

The fight against Ebola in West Africa lasted nearly two years after being announced in March 2014. The latest data from the World Health Organization reports 28,616 confirmed cases of Ebola across the three hardest-hit West African countries—Guinea, Liberia and Sierra Leone—since the start of the outbreak, with 11,310 deaths. At least 499 nurses, doctors, midwives and other health workers lost their lives to Ebola – many infected by their patients as they cared for them.

On November 7, 2015, Sierra Leone was declared to have reached a “break in transmission,” and the World Health Organization announced the same achievement for Guinea on December 29, 2015. While all three countries experienced brief resurgences of the disease in 2016, since June 9, 2016, they have all been declared and remained Ebola-free.

Despite this achievement, Ebola’s impact on the region cannot be understated. In addition to the loss of life, the disease crippled local health care systems, disrupted and destroyed livelihoods and communities, and left survivors with range of medical, social and psychological challenges. 

International Medical Corps was at the forefront of the crisis across the region, operating five Ebola Treatment Centers, training thousands of frontline health workers in infection prevention and control, collaborating with the Ministries of Health to put improved preparedness and response mechanisms in place, and supporting global efforts to prepare for future outbreaks, led by the World Health Organization and the U.S. Centers for Disease Control and Prevention.

On September 15, 2014, we opened our first Ebola Treatment Center (ETC) at one of the epicenters of the global health crisis and a regional crossroads for travelers in the region: Bong County, Liberia. During the peak of the outbreak, International Medical Corps screened some 2,600 suspected Ebola victims at our five ETCs—the second ETC in Liberia, in Margibi County, and three in Sierra Leone’s Northern Province. In total, during the crisis, these five ETCs treated 461 confirmed positive Ebola cases, about 51% of whom survived and were discharged upon recovery.

A secondary health crisis developed as communities became afraid to go to their local health centers. Many feared disappearing into an off-site ETC if they were suspected Ebola cases or being infected by the health workers themselves, and many facilities closed from lack of personnel or because they could not provide protection from infection. As a result, many services such as routine maternal care, care for infectious diseases like pneumonia, care for injuries, and immunizations for children came to a halt.

Over a period of 18 months, International Medical Corps leveraged its experience with Ebola treatment to reach more than 4,300 health workers with training in Ebola prevention, safety, screening, treatment, and case management practices; primary health care; water, sanitation, and hygiene (WASH) topics; maternal and child health; mental health; and psychosocial support services. Together with the creation of rapid response teams and screening-and-referral units in Guinea, Liberia and Sierra Leone, these trainings helped reopen health facilities and integrate safe practices into the governments’ preparedness and response protocols.

Screening-and-referral units are triage facilities located at the entrance of health facilities, where trained staff can screen all patients, visitors and staff entering the facility for possible infectious disease. International Medical Corps teams collaborated closely with governments across the region to design, develop and establish 28 screening-and-referral units at health centers and hospitals in Liberia, Sierra Leone and Guinea. By early 2016, the facilities had screened more than 653,787 patients, visitors, and staff in Liberia, 184,374 in Guinea, and 12,710 in Sierra Leone. In addition to identifying suspect cases of Ebola, these efforts aimed to restore confidence in local health systems, bring patients back to health facilities, and improve hospitals’ and clinics’ ability to implement infection prevention and control measures.

After Liberia, Guinea, and Sierra Leone were declared Ebola-free in mid-2016, new challenges emerged to complicate the road to recovery. Of the approximately 17,000 survivors, many face additional medical and psychosocial symptoms that are still not fully understood, including eye problems, chronic pain, persistence of the virus in some bodily fluids, psychological distress, and ongoing stigma in the survivors’ communities.

To serve survivors and help prevent future outbreaks in Sierra Leone and Guinea, International Medical Corps has been providing consultations, running community-based survivor support and Ebola surveillance groups, supporting bodily fluid testing, distributing pharmaceuticals and medical equipment, and spreading awareness about survivor stigma and Ebola prevention. In 2016, International Medical Corps established Lumley Survivor Clinic in Freetown, Sierra Leone, which has provided 625 general consultations to Ebola survivors. Most recently, we launched a project in Conakry, Kindia and Nzérékoré in Guinea to provide 952 Ebola survivors with access to health care specialists like rheumatologists, ophthalmologists and mental health professionals.

International Medical Corps’ work fighting the Ebola outbreak focused on the most affected countries — Liberia, Sierra Leone and Guinea, but we also worked with the Ministries of Health in Guinea-Bissau and Mali to provide training and implement preparedness efforts to help prevent the spread of the disease into both those countries.

Throughout our entire response, International Corps has remained committed to four key tenets: getting to and maintaining zero Ebola cases; rebuilding and strengthening health-care systems; engaging communities in health promotion and behavior change to mitigate the risk of future outbreaks; and strengthening preparedness efforts at the local, regional and global levels by sharing best practices and lessons learned.

We want thank the GlobalGiving community for their loyal support over the past three years as we worked to stop the spread and resurgence of Ebola in West Africa and support the wellbeing of its survivors.  

Training health workers on infection prevention
Training health workers on infection prevention
Disinfection station at an Ebola Treatment Center
Disinfection station at an Ebola Treatment Center
Celebrating the end of the outbreak in Lunsar
Celebrating the end of the outbreak in Lunsar
Screening patients at a Guinea hospital
Screening patients at a Guinea hospital

Fatoumata arrived in Conakry, Guinea from Labé on a Tuesday for her grandson’s baptism. By the time she returned, two weeks had passed and her brother, a television crew and the Governor of Labé stood by the road, waiting to greet and escort her home. Fatoumata had survived Ebola. "I lost my children but I am here. I didn't die, so don't cry," Fatoumata told her crying brother as she stepped off the bus, beginning the harrowing journey that many Ebola survivors must face – reintegrating into society and recovering after losing those closest to them.

Fatoumata’s eldest daughter, Aissatou, was first misdiagnosed with malaria after her headaches and vomiting started to worsen, three days after her son’s baptism. As Aissatou’s symptoms accelerated, Fatoumata was determined to save her daughter, staying by Aissatou’s side in Conakry for a week seeking treatment at the Donka Hospital. Unfortunately, it was too late by the time it was discovered that Aissatou did not have malaria, but Ebola. Aissatou died in her mother’s arms at the door of the Taouyah Hospital, where they had gone as Aissatou’s state quickly deteriorated.

Over the next six days, Fatoumata went on to lose her granddaughter and her two-year-old daughter to Ebola just as she and her son-in-law were diagnosed with the disease and began treatment. Ultimately, Fatoumata and Aissatou’s husband recuperated but the wounds that Ebola left on their family will remain deep, painful and permanent.

In February 2015, International Medical Corps was one of the first international organizations to respond to the Ebola outbreak in Guinea by treating Ebola patients and training health workers. Now we are helping the country’s health system and communities recover, preventing new Ebola infections to maintain its status of zero cases, and supporting survivors like Fatoumata with health care and psychosocial support.

Over the next year we will provide 952 Ebola survivors in Conakry, Kindia and Nzérékoré with access to health care with specialists like rheumatologists, ophthalmologists and mental health professionals. Many of these survivors are experiencing both post-Ebola syndrome and social stigmas which affect their mental health.

Our mental health and psychosocial services specifically will fill a critical healthcare gap as Guinea currently has no mental health outpatient facilities, no psychiatric hospitals, no psychologists, and approximately only 1 psychiatrist per 3,300,000 persons. International Medical Corps is also strengthening care over time for chronic conditions, monitoring survivors and their immediate contacts, and assisting in disease surveillance to ensure that suspect illnesses and deaths are rapidly and systematically reported and investigated.

A year after the outbreak, Fatoumata remarried and gave birth to a new daughter, also named Aissatou in remembrance of her sister. Today, Fatoumata feels happy and hopeful. “I am here and I’m alive,” she said smiling, reflecting on the past two years. Still, Fatoumata knows the road ahead will be challenging and thanks us for our support, “International Medical Corps helped me a lot: not just financially, but also—and also most importantly—they took care of me. I would sometimes call International Medical Corps officers to say I needed help because I felt sick, and there was always an answer straight away. I trust International Medical Corps and respect them. I still ask for help because I still need it. I want things to get better and I know they will, and I also know that I need the continued support of International Medical Corps.”

We thank you and the GlobalGiving community for your support as we continue to serve survivors of Ebola in Guinea and work to prevent future outbreaks.

Note: A photo of Fatoumata is not available

A Guinean learns about Ebola safety at home
A Guinean learns about Ebola safety at home
Women
Women's association discussing causes of Ebola
Mariama speaks with our team
Mariama speaks with our team

As we were leaving her village, we assured Mariama that her name would not appear in any publication, but in a determined voice she replied, “I want my name to be written down. I want people to know my story is real.”

Mariama is a 40-year-old Ebola survivor and mother of four who lost her husband to Ebola after the disease first reached N'Zérékoré, Guinea in March 2014. Her husband was a community health worker who was exposed to Ebola while administering vaccines to a sick family. “In only three days he was gone. He left our place on a Friday and he passed away that very Sunday,” Mariama remembered. “I could not accompany him. The people who took him away told me that there was not enough room for me in their ambulance.”

Shortly after Mariama’s husband contracted Ebola, she too fell ill with the virus. Despite the superstitions surrounding the treatment and neighbors telling her, “go there, and you will never come back,” Mariama chose to fight by seeking medical support and was admitted into the hospital in Kindia – the same day her husband passed.

Over the next three weeks, Mariama recovered but bore witness to many who did not. “I thought about a lot of things. People were dying around me – mothers and children, brothers and sisters, the young and the elderly. Every day people were dying around me. The disease was ruthlessly killing everyone. I was grateful to have survived.”  

The Ebola outbreak aroused a great deal of fear throughout West Africa for close to two years, and while since June 2016 Guinea has been declared Ebola-free, its reverberations continue to complicate the road to recovery. Survivors face medical issues like eye problems, chronic pain and extreme fatigue, in addition to the psychological burden of being unable to continue their livelihoods and care for their families. Many just feel alone — often ostracized by their communities when they need them most. Mariama recalls, “In the beginning I was frail. I was unable to carry out any of the activities that had been part of my daily life prior to Ebola, such as walking outside, cooking, taking care of my children, or even sitting in the sun. This made me feel small…like my life had shrunk to a small universe.”

Mariama is one of the more than 17,000 Ebola survivors with a story to tell. With your support and the support of the entire GlobalGiving community, International Medical Corps is reaching many of these survivors in Guinea and Sierra Leone. Our teams established the Lumley Survivor Clinic in Freetown, Sierra Leone, which provided 625 consultations in five months and supported bodily fluid testing for 249 survivors within the past year. Our efforts also reached nearly 10,000 people in communities across Sierra Leone and Guinea with Ebola prevention messaging and psychosocial support.

In Guinea specifically, International Medical Corps initiated “platforms” that provided survivors, including Mariama, with an opportunity for open dialogue where people voice their concerns, discuss and disabuse rumors, and recognize the importance of reintegrating survivors into the daily life of the community. Djoumande, a member of International Medical Corps’ Mental Health and Psychosocial Support team notes, “We come often and ask them how they are. They know their suffering is ours. We’re with them every day, accompanying them in their journey to recovery.”

Today, Mariama is back in the markets and providing for her family. “International Medical Corps changed my life…I am extremely grateful for this initiative. Without International Medical Corps, I would have continued to suffer. No one else could have helped me. International Medical Corps helped us survive.”

We thank you and the GlobalGiving community for your continued support of our comprehensive health care response in the fight against Ebola as we address the needs of Ebola survivors across Guinea and Sierra Leone.

Discussing Ebola  in Coyah, Guinea
Discussing Ebola in Coyah, Guinea
Treatment at the height of the outbreak
Treatment at the height of the outbreak
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
 

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International Medical Corps

Location: Los Angeles, CA - USA
Website:
Project Leader:
Davis Nordeen
Los Angeles, CA United States

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