EBOLA RESPONSE IN LIBERIA RISKY

Transcription

1 EBOLA RESPONSE IN LIBERIA RISKY Jerry F. BROWN ELWA Hospital, Liberia 4 June, 2016

2 OUTLINE Background The response Government Partners ELWA Hospital Logistics Staff recruitment Burial Social mobilization Lesson learned

3 Background Ebola Virus Disease (EVD) outbreak began in December 2013 March 22 nd Ebola Virus Disease (EVD) Emerged in Liberia Lofa County Ill and weak health system Emergencies Occupational health and safety Infection prevention and control measures Pre-existing structural vulnerabilities Insufficient and unsuitable infrastructure & equipment Very weak supply chain Poor quality of care Inadequately trained and poorly motivated health workers Inadequate and poor quality technology and diagnostic support

4 LIBERIA Area 111,369 square kilometers Population 4 million GDP per capita USD 454 in 2013 GDP growth (2014) 5.8%; % by end of 2014 Five regions and 15 counties 16 tribes or ethnic groups 14 year civil war ( )

5 Health Infrastructure Twenty nine (29%) of Liberians (1.1 million people) lack access to health facility with 5 km or a 1 hour walk 65% of households walked to health facility 26% of health facilities no comprehensive infrastructure 45% do not have a primary power source or electricity 43% do not have a functional incinerator or waste mgt system No laboratory standard Most required extension to accommodate emergency triage or isolation units Most had weak infection prevention and control systems

6 Human resources for health Critical health workforce shortage compounded with high attrition and demotivation Low and unstandardized salary structure No occupational health policy or not followed No previous experience in managing Ebola

7 MOH Approach Weekly Meeting and updates with partners Daily Meeting and update with partners Started with a few partners and up to 127 partners 51 NGOs and 25 countries with numerous multilateral international organizations, corporations and civil society groups. (HFU, MFDP, & OCHA, Jan. 2015) Incident Management System (IMS) set up to specifically address outbreak Included up to 10 pillars: CASE MANAGEMENT SOCOIAL MOBILIZATION BURIAL

8 Partners Involvement Initially delayed Factors responsible: Identifying needs Dispatching logistics WHO August US Army October German & Chinese--November

9 ELWA Hospital Response Began with what s available CHAPEL TRAINING & STAFF RECRUITMENT LOGISTICS & SUPPLIES

10 ELWA HOSPITAL RESPONSE

11 The chapel that became the first ETU in the capital(june 2014)

12 INITIAL CHALLENGES INADEQUATE SUPPLIES HOOD MASK APRON GLOVES FOOT COVER Plastic bags

13 Patients Arrival and Triage Relatives Transport vehicles Ambulance Walk in AMBULANCE ARRIVAL

14 Triage Ebola outbreak suspect and probable case definition developed and disseminated by MOH to all health facilities No Laboratory to support impression CBC Creatinine Electrolyte analysis Malaria smear No diagnostic tool or working tool X-ray Ultrasound scan Delivery kits

15 Staff Path Patient Path Ambulance Parking Entrance + Hand Washing Waiting Area Triage Changing Room Nursing Station Entrance to Suspect Ward PPE Donning Suspect 1 Green Zone Probable Doffing B Confirmed A Extension A (German tent) Extension B (German tent) Security Warehouse + Storage

16 Laboratory Studies None existent Limited facilities Laboratory testing PCR Malaria few facilities Chemistry for research purpose but not constant / ETU created by a few partners eg US Army, Chinese, Germans, Obtaining results: Weeks Days Hours

17 EMPIRICAL TREATMENT SUPPORTIVE CARE Appropriate fluid therapy Anti-emetics Anti-diarrhea Electrolyte replacement Immune boasters Antibiotics Anti-malaria

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19 Challenges in getting an ETU started Lack of logistics Community perceptions and trust Location of Construction sites Community engagement

20 Stigmatization. Medical Staff Community /society Fellow workers Survivors certificated to go home Survivors Community

21 Burial Community Cremation General burial site Challenges: Community perception rejection Inadequate burial teams Inadequate burial sites Lack of logistics

22 Community mobilization Getting an ETU started Community rejection Perception of the disease Myths Lack of trust Community involvement. Awareness Community welfare teams Hand washing stations

23 Managing None Ebola related cases Many health facilities shut down or cut down activities Increased deaths from non- Ebola related cases Medical Surgical immunization Surgical interventions at our hospital Emergencies 292 Obstetric related 75% Confirmed Ebola 4 cesarean section

24 Results of interventions: 10% survival rate 60-75% Case Fatality Rate Case Fatality Rate 49.1%

25 RESEARCH Limited research and human resource capacity Lack of enabling environment for research

26 Lessons learned Adequate preparation is key Beginning with what s available while awaiting further assistance Following protocols (especially IPC donning and doffing) is key to patient and healthcare worker safety United efforts, collaboration, coordination and communication is key to successful containment of outbreak

27 . THANKS FOR LISTENING