An overview:

It really was fascinating to hear the experiences of the two epidemiologists, Dr Kathryn Stinson from the UCT School of Public Health and Family Medicine’s Centre for Infectious Disease Epidemiology and Research (CIDER) and Dr Gem Patten from Medicines sans Frontiers (MSF), who have both recently spent time in the Kailahun District of Sierra Leone, the epicentre of the epidemic in Sierra Leone specifically, where MSF has set up a testing and treatment centre for suspected and confirmed Ebola cases.

Sarah Crawford-Browne, from the PHC Directorate (who spent time in Kailahun a few years back helping set up a trauma counselling centre after the war), was also present to provide us with a socio-economic and geo-political overview of the country for a better understanding of this particular context in which this epidemic has taken hold.

Ms Crawford-Browne’s input was most revealing: she reminded us that Sierra Leone is still recovering from its eleven-year war (1991 – 2002), which did considerable damage to an already unstable healthcare system. All three ladies, in fact, referred to the healthcare in the country as either being “damaged”, “fragile” or “brought to its knees”, which does not paint a very promising picture for the country minus the assistance from the global community and global organisations such as MSF, the WHO, UNICEF etc.

The country has incredibly high rates of child and maternal mortality, so much so that women fear pregnancy and children are not given names until they are 5 years old because so many of them die before then.

All three ladies painted a picture of a people who experience high sickness levels in general and a complexity of multiple, co-existent epidemics  (malaria + Ebola + etc.); locals have a poor sense of trust towards Western medicines and interventions, lean strongly on traditional medicine and beliefs, and do not seem to trust their government much at all either. Ms Crawford-Browne called this a “perfect storm” for an Ebola epidemic.

Responses/interventions:

The following systems/resources/activities are in place in the Kailahun District (and I would imagine in the other districts too) and are being covered/organised by MSF, the local Department of Health, UNICEF, WHO and other organisations.

• 1 MSF treatment centre (with high risk and low risk patient holding areas)

• Other holding centres (for those who have not been confirmed as Ebola positive, but are waiting for their blood results and need to be quarantined)

• Labs (for blood tests)

• Ambulances (patient transportation)

• Phone hot lines

• Food assistance (quarantined villagers are not able to access food supplies as easily)

• Training for healthcare workers and volunteers

• Logistical support for orphans and displaced people

• Contact tracing (to locate family members and people that confirmed patients may have been in touch with)

• Teams for safe burials

• Communication: MSF and other volunteers visit villages to distribute soap, hand out information leaflets, and make announcements through loudhailers etc., all in an effort to break some of the denial around the virus and its spread.

Working conditions and infection control at the MSF Treatment centre:

Staff: According to Dr Patten and Dr Stinson, the MSF treatment centre in Kailahun is mostly nationally-staffed; local healthcare workers are assisted by a smaller number of MSF volunteers (i.e. international healthcare professionals).

The centre is divided into low and high risk zones. Only specific healthcare workers are allowed into the high risk zones (where confirmed or suspected Ebola patients are cared for) and both epidemiologists shared that nothing comes out of or goes into high risk other than staff or patients - dead or alive; it is a ‘one-way’ zone (I think they said that only boots from high care are ‘recycled’: everything else is burnt.)  Patient records, food and stock are kept in low risk zones and patient information and blood results are shouted across divides if need be.

Healthcare workers in the high risk zones wear scrubs under hazmat suits, while those working in the low risk zones wear scrubs and boots only.

Dr Stinson shared that infection control procedures are simple: 1.) Don't touch anyone, 2.) Never touch your face, 3.) and wash your hands after every activity. She pointed out that it is very difficult for local healthcare workers to maintain these protocols ‘24/7’ due to the realities of their village living conditions: large and extended families share very small living spaces; water is collected from shared well points etc.

In contrast, international MSF volunteers in Kailahun are accommodated in a local hotel, which MSF has taken over. Each volunteer has their own room and therefore contact with a potentially infected colleague and the fear of infection is reduced.

UCT’s response:

While the exact way forward for the Faculty of Health Sciences remains unclear, a number of needs were identified and suggestions for involvement made by those present. Among these was a register sent around for all interested individuals to sign up for further communications and to indicate potential availability for involvement in a trip to West Africa.

The national response:

The Ministerial Advisory Committee for Ebola had their first meeting last week with the South African Health Minister, Aaron Motsoaledi. The committee is working towards formulating and finalising the country’s domestic response to Ebola, as well as its response to West Africa. Communication strategies and response guidelines for South Africa are being developed.

Keep informed:

1. National Institute for Communicable Diseases: http://www.nicd.ac.za/
2. South African National Department of Health Facebook Page: https://www.facebook.com/HealthZA
3. The World Health Organisation Facebook Page: https://www.facebook.com/WHO