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Stopping Ebola: A View From the Trenches

By Dr. Tessie San Martin
Stopping Ebola, a View From the Trenches

From Thompson Reuters Foundation, this is the second of three blogs written by Plan International USA CEO Tessie San Martin following her trip to the front lines of the Ebola outbreak in West Africa.

We arrived at the Community Care Center (CCC) in Sierra Leone’s Foredugu village in the Port Loko District on the morning of January 15. It was an unusual day at the CCC. They had not had a confirmed case of Ebola for almost 2 days.

The last patient was discharged the previous day after the test came back negative (testing for Ebola takes 3 days, down from 10 just a few weeks ago - allowing for confirmed patients to be segregated and treated much quicker).

Because it was a mercifully quiet morning, the CCC's clinical staff was able to spare a few minutes to meet with our group. The Supervisory Nurse (herself a Ministry of Health professional who had been serving in the district's maternal and child clinic until the summer of 2014) introduced us to her team from the morning shift, which included half a dozen nurse trainees and a young technician responsible for drawing the blood samples to be sent for testing.

They had seen a lot over the last 3 months.

None of them had been able to go home for some time (their families had asked them to stay away until they were sure they were not infectious). Many of them had not had a single day off since they came to the CCC. Even when they are off, they find that the community would prefer they stayed in the CCC "Green Zone" - such is the stigma attached to Ebola work. 

Despite the hardship associated with working at the CCC, all the nurses and staff were firmly committed to their work. They saw the difference the facility had made. As the Supervisory Nurse told us, before the CCC was in place, anyone with symptoms (fever, nausea, diarrhea, vomiting, bleeding, in some combination - but anyone with a fever is immediately suspect) was coming to the maternal and child clinic in the district for treatment.

Segregating patients effectively was difficult at the clinic. As a result, patients who did have Ebola ended up contaminating patients who did not have it and the disease spread. People feared going for treatment, creating more possibilities for contaminating households.

To illustrate the benefits of the CCCs, the nursing staff in Foredugu introduced us to two very young former patients, aged 4 and 6. Their father was infected with Ebola and died. Their brother had also been infected. They were all transported to the CCC, treated for the symptoms, tested and, when the EVD infection was confirmed, transported to an ETU.

The father and older brother died. But these two little boys survived. Had the CCC not existed, not only might they have infected more people, but they themselves may not have survived.

Combating the spread of Ebola requires more than CCCs. For CCCs like the one we visited in Foredugu to work well you need effective community-based social mobilization, a network of community volunteers doing contact tracing, and teams taking care of disinfection and replacement of all affected households.

Social mobilization is the work Plan is doing with the support of community leaders and volunteers informing and educating every household member about hygiene protocols. It is also the very sensitive work being done to raise awareness about how traditional burial practices contribute to the spread of the EVD. Contact tracers track who might be sick and call immediately for specialized transport to the CCC.

The work has at times been uncomfortably stressful, if not downright dangerous. Volunteers doing contact tracing have from time to time faced hostility, as community members fear that being made to go to a CCC or an ETU may mean you never come back. Ebola plays on everyone's most basic fears.

LOCAL HEROES ON THE GROUND

Time Magazine declared the men and women who worked to help stop the transmission of the Ebola epidemic their Person of the Year for 2014. The article referred mostly to the expat staff from INGOs that went into all the affected countries to provide medical care. But in fact, the group that needs to be recognized is much broader than that.

It includes not just the medical and clinical staff testing and treating patients but also the army of community workers doing contact tracing, disinfection and replacement, under sometimes very difficult environments. It also includes chiefs and community leaders who have taken unpopular stances to convince, cajole and at times force community members to support all the hygiene and patient segregation protocols.

And it seems to be working. As recently reported by the BBC, UN figures show that new Ebola cases are declining, in some cases dramatically, In Sierra Leone, as well as in Liberia and Guinea.

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