Frontline treatment units and prevention, surveillance, and contact tracing are critical in the war on ebola, and they need to be stepped up, says Dominic MacSorley of Concern
YOU may have seen the pictures on television or in the papers, health workers in full protective equipment on the frontline of the ebola outbreak in West Africa.
They are the most instantly recognisable symbol of an epidemic that has killed nearly 3,500 people.
Less recognisable and less visible are the vitally important community health workers.
In one of the large slum areas of Monrovia, I met Denise, one of Concern’s local team on the ground. She is part of the rapidly expanding network of community volunteers who conduct social mobilisation and contact surveillance across of the county, monitoring the potential ways the disease might be transmitted through direct close contact between people.
A plucky young mother-of-one, Denise covers a regular route of 200 houses where she goes door-to door every day to give out messages on ebola prevention — her messages are simple, tough and clear: stop ebola — wash your hands, know the symptoms, if someone is sick then call the hotline.
Denise carries leaflets and a laser thermometer (which protects the health workers by avoiding the need for bodily contact) and knowledge — these are critical weapons in fighting this disease. It’s the old adage: prevention is better than cure. And in a situation where a definitive cure has not been found, this importance of this cannot be underestimated.
Denise’s husband is nervous of her work with ebola, but confronting the disease and empowering her community to halt its spread is much better from her perspective as she says she can’t just sit at home in fear. She knows the job is not without its risks. She knows, too, that often the ambulances don’t come for hours or even days.
And she has to explain to some individuals and families why, at a time when they want to care for, feed, and simply hold the hand of someone they love who is seriously ill, and possibly dying, that they can’t even go near them.
She even shows families how to prepare the oral rehydration solutions in bottles and roll them over to their loved ones to avoid contact, always reminding themselves: “Don’t go near, don’t touch, just wait and see.”
Ebola doesn’t care about love and understanding.
The frontline treatment units and the prevention, surveillance, and contact tracing are all critical in the war on ebola and need to be scaled up massively if the world is to conquer this disease.
Yet, delivering effective scaled-up responses in two of the poorest countries in the world is massively challenging. Both Liberia and Sierra Leone are countries still recovering from brutal protracted civil wars that decimated their infrastructure in the 1990s.
With only one doctor for every 33,000 people in Sierra Leone, and in Liberia even less, neither country has a health structure that is equipped to handle the crisis. And, so, international aid agencies engage in every aspect of the infection protection and containment, and it’s a race against time. The World Health Organisation admits both case and fatality figures are underestimated, warning that there could be as many as 20,000 cases by November if efforts to tackle the outbreak are not stepped up. Concerted response efforts by an international community that was initially slow to respond are now kicking in.
The US, Britain, France, China, and Cuba are now giving support, sending military personnel and medical practitioners. They are also helping to boost the capacity of the public health systems by constructing treatment centres and providing beds. Though it will take some time before these are ready, staffing these with qualified and experienced staff will be a challenge in itself. But treatment alone will never be enough to end this crisis.
We need to massively scale up prevention methods to break the transmission chain. The centres for disease control estimate that as many as 78% new cases are directly from unsafe disposal of dead bodies, and so Concern is providing training, transport, and fuel to support national burial teams to enable them to provide a safe service to families.
We are redoubling our efforts on social mobilising and contact tracing by recruiting and training more community health workers like Denise to reach more than 400,000 individuals. We are further scaling up to support 200 community health centres in Sierra Leone to ensure that the proper training and protective supplies are in place, as well as water and waste management facilities to protect the health workers. Aside from the human cost, the outbreak has seriously eroded other services such as education. Schools have been closed for six months with no reopening date in sight, and so we are working closely with governmental education departments in both Sierra Leone and Liberia to adapt curriculum lessons for radio so children can continue to learn for home. We have the opportunity to stem the rapid pace of this crisis, but it is essential that it remains a top global priority.
On this trip to the ebola-hit region, I met with Seán Sherlock, the first European minister to visit the region since the outbreak. By coming here, he sent a really important message: not only is it safe to come and visit but it is vital to see what is happening on the ground and understand the very real challenges in overcoming this crisis.
Because, unfortunately, it’s not going away any time soon.
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