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Epidemic of Fear: Treating Ebola Outbreak in Western and Central Africa

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Working in EMS on an Ebola mission means you’re the first contact with the patient and the family. What you tell them matters a lot.

When visiting a contaminated home, our team, which consists of a driver, two hygienists, one paramedic, and one psycho-social nurse, has to perform both donning (putting on) and doffing (taking off) our PPE in the field.

Before entering the house, we run through a PPE checklist: Scrubs, gum boots, gloves, Tychem suit, mask, hood, apron, goggles, gloves again.

“Ready?” I ask the hygienist assisting me. She shakes her head and grabs a small strip of duct tape, covering the space between my hood and goggles where a thin slice of skin was showing.

“Now you’re ready,” she replies. The temperature in most parts of Liberia is just over 80 degrees F. The humidity is even higher.

I feel the sweat collecting between my skin and the suit, pooling in my boots and along the bottom of my goggles as I slowly follow the one of the hygienists, who’s also dressed in full PPE, into the patient’s house (i.e., the high-risk zone).

It feels far more like we’re scuba diving in a hot spring than a conducting a normal inter-facility ambulance transfer in the city, but that’s exactly what we’re doing.

A few moments later, I meet my suspected Ebola patient, a young man who had wandered away from his bed during the night and is now lying on the ground near the edge of the bed.

He’s tired and confused. He doesn’t know where he is, or why there are two men in what look like space suits towering over him.

The hygienist with me calmly reassures him, and together we help lift him to his feet and guide him back to his thin mattress.

He’s profoundly weak, and, as we walk, I notice that his pants are soaked through with diarrhoea—a hallmark of the disease.

We lay him down and urge him to drink some water mixed with oral rehydration salts. I begin to complete a patient care report to find out if the patient meets the case definition.

I then see another patient crawling in the next room, and I assume it’s a relative of the patient I’m currently diagnosing. It seems that, by sharing their belongings, food, and living so close together, the whole household has been infected.

I start to feel exhausted from the heat, but I can’t give up because I need to finish the complete assessment and diagnosis before we load the patient into the ambulance for transfer to the Ebola treatment unit.

I minimize communications with the patients to save energy and start using hand signals to communicate with my teammate.

The rest of the team, not dressed in full PPE, remain outside the house at a distance (i.e., the green zone). However, we maintain communications if we need assistance or additional equipment.

After diagnosis, the three patients are led into the ambulance (i.e., red zone). With every step the patient takes, the hygienist sprays chlorine to kill the virus.

From a distance, the psycho-social nurse talks to the patients and explains where we’re taking them and what will happen at the destination.

He also encourages the patients to continue drinking water—an important component of Ebola care.

After finishing our transport of the three family members they’re and handed over to the awaiting ETU nurse, the ETU’s hygienist team—all of whom are dressed in full PPE.

Finally, the team cleans the ambulance and then leave it to dry, so we’re ready for the next call. The rest of the family is left behind as we start our journey back to the ETU.

EBOLA RAPID RESPONSE TEAM

In August 2014, I signed up with International Medical Corps, a U.S.-based non-governmental organization (NGO), to lead a team designated for transporting both suspected and confirmed Ebola patients and blood specimens in Liberia.

When I arrived in Liberia and became the ambulance coordinator of the first two-ambulance team on September 15, 2014, I became a pioneer in the transport of suspected Ebola patients. This was also the date that the second Ebola treatment center was opened in the country.

My team would travel via helicopter to the most remote villages to treat sick people who couldn’t otherwise get treatment.

We also used ground-modified double-cabin pick-up trucks as ambulances. Within two hours of our arrival in a village, we would set up a rapid isolation unit to isolate the suspected patients and keep the rest of the village safe from being infected.

No one knew how to transport an Ebola patient; it was trial and error. I had to make sure every one of my staff was safe.

I dressed in personal protective equipment every day, and would go out into the field to show my staff how to do the job, and show them that they could trust me to keep them safe.

We stood by our training and our policies and everyone stayed safe. Our operations were carried out only during daylight hours due to the risks of driving at night and having to put on PPE without adequate lighting.

On an average day in West Africa, we would bring as many as 25 suspected Ebola patients to the ETU within 10 hours.

HEALTHCARE PROVIDERS

For decades now, Ebola has captured the public’s imagination with its exotic name, high fatality rate, and the fear that it can cause people to bleed from odd places. Until recently, though, if you asked any global health expert about the diseases that keep them up at night, Ebola wouldn’t have made their list.

What makes Ebola different from so many other public health threats is the effect it has on healthcare providers, and, as a result, on the entire healthcare system.

Ebola alone didn’t cause catastrophe in West Africa. Fear played a part in it as well.

Every day in Liberia, I heard stories about people dying of perfectly treatable diseases, since many hospitals and clinics had shut their doors: A woman in labor who bled to death; a baby half-delivered due to the lack of a midwife; a driver who crashed his truck and was left to die because there was no functioning trauma centre; a young child who seized and died from malaria—after his mother had visited multiple hospitals and clinics, all of which were closed.

To put it bluntly, Ebola kills EMTs, paramedics (referred to in most African countries as “ambulance attendants”), nurses and doctors, almost preferentially.

This shouldn’t be surprising; Ebola is spread by contact with the body fluids of symptomatic patients—and nobody has more contact with the body fluids of sick people than medical personnel.

The toll that Ebola has taken on clinicians and public health professionals alike means that the very people who once calmed their patients’ fears, who assured us that everything was going to be okay if we only kept calm and did as directed, were now running scared themselves, and that’s frightening indeed.

Ebola, though, isn’t all that frightening. It can be destroyed with weapons as simple as chlorine, alcohol, soap, detergent and sunshine.

With the right precautions in place, including protective equipment and triage protocols to identify those most likely to have the disease, healthcare workers can safely treat patients of all types without the fear of dying themselves.

Ultimately, the local EMTs, paramedics, nurses and doctors bore the brunt of this epidemic, working long hours responding and caring for desperate patients without the proper protection, watching as their colleagues fell ill around them.

The vast majority of them were more than willing to come back to work once their safety was ensured by the introduction of protective equipment and protocols.

When the public saw healthcare providers saving lives, unafraid to treat Ebola patients, they were suddenly more willing to bring themselves and their loved ones to the hospital early, before the disease had a chance to spread. When transmission stopped, the epidemic stopped, and life in West Africa returned to normal.

As brave and heroic as they are, there simply weren’t enough trained EMTs, paramedic, doctors and nurses in West Africa to stem the tide of this epidemic on their own.

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And because the necessary protective equipment is expensive, the impoverished countries of West Africa couldn’t afford it on their own and sought support from NGOs like ours.

ELIJAH

When the Ebola outbreak was at its height in Liberia, I met a 12-year-old boy named Elijah. A call had come into the ETU around 4 p.m. regarding a sick boy who’d been waiting for an ambulance for more than a day.

Despite the fact that the call had come in past the daylight curfew for deploying ambulance teams, my team decided it was important to pick up the young patient immediately.

After a five-hour drive to the small village, we arrived to find that Elijah was displaying the classic symptoms of Ebola.

After dressing in PPE, I diagnosed him, completed the PCR and loaded the patient in

the ambulance. We arrived back to the ETU around 1 a.m., where Elijah later tested positive for Ebola.

I felt a special responsibility for the young boy. Every day, I would dress up in full PPE and enter the ETU to make sure he was eating and taking his medications. If he hadn’t eaten that day, I sat with him and helped him eat.

I was impressed by Elijah’s steady improvement; it gave me more motivation to go out and help the needy every day. Within a few days, he started to sit outside in the sun, and a few days after that, he was running around in the yard.

After three weeks, we did another test, which came back negative. Elijah was a survivor. He was soon discharged to go back home.

On the day he was discharged, he told me that he had heard that a person infected with Ebola could receive the blood of an Ebola survivor and be cured.

I explained the science behind this process to him. He told me, ‘If you ever get Ebola, I’ll volunteer to give my blood to save your life. ’It was the most memorable moment for me throughout the entire outbreak.

NO CONDITION IS PERMANENT

There was a dire need for the international community to stop treating this crisis like a horror movie—closing its eyes tightly until the scary part is over—and instead treat it like a real humanitarian disaster that required an adequate input of monetary, logistical and human resources.

A sufficient supply of experienced international aid workers, including EMTs, paramedics, nurses, doctors, epidemiologists, sanitation engineers, lab technicians and logisticians, provided with the proper protection and resources, could have brought this particular crisis to a halt in a matter of months.

It’s true that most humanitarian emergencies can’t be solved by humanitarians alone, but the Ebola crisis in West Africa was an exception to the rule.

New Cluster – August 2018 Nord Kivu, Beni -Congo DR

I arrived in Goma, Congo beginning of July with good news that we are going down to zero for the cluster that happened in Mbandaka but our joy was short lived when a new cluster started in Nord Kivu

A cluster of Ebola cases in the Democratic Republic of Congo — just one week after it declared an end to an outbreak on the other side of the country

This was worrying because the new infections are in a war zone.

North Kivu Province, is a volatile region in the Democratic Republic of Congo where the new outbreak is centered, creates security complications that health officials did not confront in the outbreak they just defeated in northwest Équateur Province, 1,550 miles away. The World Health Organization is worried about the safety of medical workers in North Kivu and their access to areas controlled by militants.

The new cases are in and around the remote village of Mangina, near the city of Beni and the border with Uganda. The area has been chronically plagued by fighting between government forces and armed rebel groups. Last year, 15 United Nations peacekeepers were killed in an attack on a compound in North Kivu.

The region also hosts more than one million people displaced by conflict throughout the country and shares porous borders with Rwanda and Uganda.

The cases are increasing but we keep on fighting hard till we bring it at zero.

MYTHS ABOUT EBOLA

Myth #1: Ebola is universally fatal.

Ebola can certainly be fatal, but not universally so. The case fatality ratio for Ebola and its close cousin, the Marburg virus, varies greatly depending on the setting.

The first recorded outbreak of these diseases, which occurred in Germany and Yugoslavia in 1967, had a mortality rate of 23%. This is high by any standard, but far lower than the 53–88% mortality seen in subsequent outbreaks in sub-Saharan

Africa over the next 40 years.2, 3 This first outbreak also occurred before anything was known about the disease, and before the widespread availability of EDs in Europe. When it comes to the likelihood of dying from any disease in this world, geography matters.

Myth #2: Ebola isn’t treatable.

There are actually several effective treatments for Ebola that can help support individuals through the worst phases of the disease and increase their chance of survival.

These treatments include early and careful resuscitation with IV fluids; blood products such as packed red blood cells (PRBCs), platelets, concentrations of clotting factors to prevent bleeding; antibiotics to treat common bacterial coinfections, respiratory support with oxygen (in severe cases, via a ventilator), and powerful vasoactive medications to counter the effects of shock.

Modern diagnostic equipment can help doctors and nurses continuously track vital signs to rapidly detect and manage new complications of the disease and stay one step ahead of the virus. Access to emergency and critical care services could help save patients with Ebola, as well as those affected by these and many other more common killers.

Myth #3: Ebola is the most contagious

Ebola is the most contagious disease and will spread rapidly across the U.S. if it enters the country. Ebola isn’t the most contagious disease known. It’s not airborne and it’s not spread by aerosols (small droplets that float through the air). This makes it less contagious than a host of other diseases, such as measles, chicken pox, tuberculosis, or even the seasonal flu.

To the best of our knowledge, Ebola is spread only by close physical contact, especially with bodily fluids. So, unless someone on the subway vomits, defecates, or bleeds on you, they aren’t going to be passing Ebola onto you.

In a medical setting, all that’s required to prevent the spread of Ebola from patient to healthcare provider to patient is the use of “contact precautions,” which include gowns, gloves and regular hand-washing after every patient contact.

These precautions are already the standard in the intensive care units of all U.S. hospitals where patients with Ebola would be treated.

Myth #4: We need to give experimental

Ebola drugs to as many Africans as possible to help stem the outbreak. Any human being given an experimental treatment that hasn’t yet been proven safe and effective in humans is, by definition, being experimented upon. Experimenting on humans, even those in poor countries, isn’t necessarily a bad thing.

Conducting research in resource-limited settings is part of what I do for Partners in Health. However, every person enrolled in a medical research study, whether they are American or African, is entitled to the same basic international ethical protections—and people in poor countries actually deserve special protections.

Myth #5: Nothing can be done to help

Africa—it’s just too poor. The true tragedy of the Ebola outbreak is that most Africans lack access to the very same medications, equipment, and skilled physicians and nurses that have been available in the U.S. and Europe for several decades.

Access to these things could have prevented the current epidemic from raging out of control.

These very same measures could also be used to reduce mortality from the variety of other diseases, aside from Ebola, currently killing Africans each day.

(Elvis Ogweno is a Public Health Specialist with vast of experience in Emergency Epidemics).

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Public officers above 58 years and with pre-existing conditions told to work from home: The Standard

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Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.

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However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.

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Uhuru convenes summit to review rising Covid-19 cases: The Standard

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President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow

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Drastic life changes affecting mental health

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Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.

KBC Radio_KICD Timetable

Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.

Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.

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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.

In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020.  It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.

A study by Dr. Habil Otanga,  a Lecturer at the University of Nairobi, Department of Psychology says  that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.

The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.

KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.

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Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.

As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.

“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”

Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.

“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.

Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.

“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”

Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.

“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.

Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.

Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.

She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.

Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.

“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added

Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.

“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and  also engage in   reading that would  help expand their knowledge.

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