By Sigga Jagne
I MODERATED the CAUCUS on EBOLA for the SIERRA LEON OPEN GOVERNMENT INITIATIVE LAST WEEK in WASHINGTON, DC: Lessons I Learned through the process.
Containing the current Ebola outbreak is going to take a concept that is often foreign in Africa- training the people in the community to become a part of the public health response; particularly strengthening their ability to identify and report cases early, identify & report the contacts of infected persons so as to stop the cycle of transmission; and to raise their awareness and knowledge about how to prevent infection & what to do when they have an infected person. The success of disease intervention depends on how effectively we do this.
Over the period (about 3 weeks) that an Ebola case goes from initial infection to full blown (the point that the person is displaying late disease symptoms- vomiting, diarrhea, muscle weakness, hemorrhaging, etc), they would have infected approximately 45 people within those 3 weeks. So the key is to identify and diagnose people early and get them into the hospital very early for proper care & treatment. This would do three very important steps to stopping the epidemic: (1) Stems/stops the chain of transmission early and (2) Quickly Identifies all those who have been in contact with an infected person and get them in for diagnoses & treatment, if found necessary (3)Keeps the infected alive.
Most people diagnosed early who access care & treatment early to control the symptoms and effects of the virus to the point that they are kept alive for about 3 weeks, will survive.
We must identify community gatekeepers & opinion-leaders who are already well-entrenched crux of their local communities and who are culturally-competent trend makers. Train and use these people as the first front-line in educating & informing their communities on effective prevention measures, dispelling myths, stemming fear & panic, conducting early identification of infected persons, accessing first responders & accessing effective treatment and care. These folks are a crucial and necessary factor in stemming the tide of the outbreak
The immediate problem is the lack of good disease detection & reporting/surveillance systems in these countries coupled with the population fear & panic, stigma, and myths about how the disease is prevented, caught, transmitted, cured, etc; the mis-information, and the traditional practices on the very sick, the dying, and the dead (burial practices) that expose many to infection. We must set up very strong first layer systems within the community to detect infection early & identify contacts of the infected persons, immediately report cases, and set up first responder systems that are easily accessible by the community and are staffed with the well-trained and the well-equipped who have effective means to get the infected into care & treatment systems immediately. Those care and treatment systems themselves must be bolstered to effectively treat the infected while keeping healthcare personnel safe. Many healthcare personnel themselves are getting infected and dying at alarming rates because they are poorly trained & equipped against Ebola Virus Disease (EVD), and mis-informed about how to protect themselves and how to effectively respond. For example, we have seen images of nurses wearing the wrong PPE (Personal Protective Equipment) that might have been right for other milder Viral Hemorrhagic Fever (VHF) viruses such as Lassa fever. But Ebola belongs to the Filoviridae family and is NO JOKE. You cannot wear a dusk-mask and face shield for protection. To be adequately protected, you must wear scientifically face-fitted respirators with a HEPA filter, wrap-around safety glasses, accompanied by a face shield and overall body protection that reminisces an astronaut’s space suit. The public health systems in these countries are weak and definitely not currently equipped to respond to something like the Ebola Virus outbreak. And to be fair, many of the public health systems in some of the states in the USA would also buckle if they were to suddenly encounter an Ebola outbreak.
On Friday, August 8, 2014, I moderated a meeting of the Sierra Leon Diaspora in the Tri-state (Virginia, DC, & Maryland) and a few from NY, with their Open Government Initiative (a partnership of Civil Society organizations based in Sierra Leon & the Government- Office of the president) as a parallel event to the Obama African Leadership Summit. The key subject-matter expert and speaker at the event were renowned medical expert on hemorrhagic fevers & public health expert, Dr Austin Demby, who is the Director of the US Dept. Of Health & Human Services'(DHHS), President’s Emergency Plan for AIDS Relief (PEPFAR). He is of Sierra Leon origin and was a colleague and partner of the late renown Dr Sheik Umar Khan who has long been a medical hero in the sub-region and at the fore-front of intervention of many disease outbreaks, including this recent Ebola outbreak. Dr Khan helped save many in not only Sierra Leon but in Liberia and Guinea. He and Dr Demby had worked closely during the Lassa Fever Outbreaks in the same sub-region and during the current Ebola outbreak, before Dr Khan tragically got infected and died. Dr. Demby told heart wrenching stories of how the public health work force- especially the nurses are suffering the brunt of the outbreak with many of them dying due to lack of proper PPE, etc. He recounted how all the nurses were all ecstatic to see him when he arrived in the center of the Ebola outbreak in Kenema, Eastern Sierra Leon, all of them saying that “Thank God! Dr Demby is here now we shall all be safe.”And how he was wracked with guilt when many of them died just a couple of weeks later. He recounted the heroism of Dr Khan and how he questioned himself about what was different between him and Dr Khan. Why did he (Dr Demby) live while Dr Khan died even though they were pretty much exposed to many of the same situations. He felt that all of the healthcare infections and deaths could have been avoided if the proper PPE was available and properly used.
There are real lessons here for not only the countries currently facing an outbreak of the Ebola Virus Disease (EVD) but all surrounding countries, including Gambia and Senegal must take heed of the information shared above and implement the strategies spelled out here and many more. Because if you know how porous our borders are across Africa, how migrant our people are, and how fragile our public health systems are, you will understand that it is only a matter of time before the Ebola virus spreads across West Africa, if not across Africa. But panicking only worsens the situation. We have the information, the knowledge and the skills to properly prepare ourselves. So let’s acquire the resources and get on it NOW!