Ebola Outbreak 2014-15

Patrick is on the inside, I am on the outside.

I see him every day, and we smile and wave at each other. Patrick is just a child, but he is hanging out with guys five times his age, as if trying to make up for the fact that he is much too young to die. They play checkers and poker when they have the energy for it, and they listen to BBC Africa on the radio I brought in one day in my space invader outfit. Patrick has a shy, crooked smile and a bruise near his right eye. He has just lost his mother, but his father is with him in this horrible place. Read more..

My son is MSF’s 1000th Ebola survivor   I was out working with MSF as a health promotion officer, visiting villages and telling people about Ebola: how to protect themselves and their families, what to do if they start to develop symptoms, and making sure everyone has the MSF hotline number to call. When I was finishing up the day, I got a call from my wife’s number but it was not her. I answered the phone but nobody spoke. She was staying in the capital, Monrovia, with three of our children while I was working in Foya, in the north of Liberia. Read More.. .  On the frontline against Ebola Médecins Sans Frontières (MSF) has a strict no-guns policy. But the hygienists in the Ebola case management centre in Bo, Sierra Leone are armed against the virus. Their weapon of choice? Chlorine. ‘Our hygienists are on the frontline against Ebola,’ says Daniel Baschiera, water and sanitation manager for MSF. ‘They see themselves as combatting an invisible enemy. Using their spray tanks filled with chlorine solution they keep the rest of the staff safe.’ So what do hygienists in an Ebola case management centre do? And why is their job so important? Team leader Alpha Koroma (25), from the nearby town of Gondama, explains. ‘Our job in the high-risk zone includes waste management, changing beds, cleaning floors and watching out for the medical staff. We give our patients a clean environment, and we make sure that the medical teams have nothing else to worry about but their medical duties.’  Risk and discipline Discipline seems to be the keyword. ‘It’s absolutely essential,’ says Alpha. ‘You have to stick to the rules, to the procedures. It’s the only way to protect yourself and the people you work with. That’s everyone’s responsibility. The medics count on us. We count on the staff helping us in and out of our personal protective equipment, or PPE. And, in the end, the patients count on everyone here doing their very best to care for them. That’s what it’s about. The case management centre is a place where a lot of lives are saved.’ But is Alpha never worried about his own safety? ‘Never. I know I can rely on my co-workers. Even when I’m really exhausted after a long time in the high-risk zone, I know my sprayer will help me undress safely. Of course, sometimes there are risky situations. I remember this one patient, Ishmael. He was a big guy, but in real bad shape. He was very disoriented, and started pushing other patients. It could have been very dangerous for the staff. But we stayed calm, and managed to separate Ishmael from the others. Eventually he calmed down too. And he was even cured some time later. I was very happy to hear about that.’   Acid-bug Keeping a cool head can be difficult in full PPE, especially when confronted with the unexpected. Daniel tells the story of the nurse and the Nairobi fly. ‘This insect doesn’t bite or sting. But it does cause very painful blisters if crushed against the skin. That’s why it’s also known as the acid-bug. One of the nurses had one on the inside of her goggles while in the high-risk zone. It must have been hiding right underneath the rim. She panicked, and wanted to take her goggles off right there and then. But the hygienist who was with her said “No! Close your eyes!” He guided her to the undressing area, told her to stay cool and, together with the sprayer, made sure she undressed safely.’   ‘Everyday life has ceased’ ‘We watch each other’s backs,’ says Alpha. ‘You have to. You have to take care of each other. This is a bad time for Sierra Leone. Normal, everyday life has ceased. Kids don’t go to schools now. What happens if they can’t go to school for another year? For the next two years? That’s why it’s so important that we carry on working. We can’t stop. And we won’t. We have the faith, the strength and the responsibility to keep on fighting this disease.’ Patients’ names have been changed.

Homecoming Ebola survivors receive mixed welcome  

Moses’ family has been hard hit by Ebola. Four of his family were infected with the virus. His father and brother died, but Moses and his sister both survived. Moses was recently discharged from MSF’s Ebola management centre in Bo, Sierra Leone and made the journey back to his home village, accompanied by MSF health promoter Esmee de Jong.

“We have just started accompanying patients back home,” says Esmee. “Recovered patients sometimes have great difficulty being accepted back into their communities. It is very important that we go with them to explain to people that they are not dangerous. We also want to show people that you can survive Ebola, because this is not widely known.”

Sometimes even people involved in the Ebola response are surprised to discover that recovery from the disease is possible.

“We left early in the morning,” says Esmee, “and on our way to the small village where Moses lives, we bumped into an alert team, who follow up suspected cases of Ebola. We stopped to have a chat with the team, and they asked what we were doing so far from the treatment centre. When we told them we were taking a recovered patient home, they couldn’t believe it. One of them looked into the car and recognised Moses: ‘I brought him to you, he is alive!’ They were so happy to see him, and were flabbergasted that someone could recover from Ebola.” 

Moses is a teacher, an important man in his community, and when he arrived home, the whole village turned out to welcome him. “When we came to the village, it was a party,” says Esmee. ”All the women surrounded him and Moses really had to calm them down. I was so struck by the love and total acceptance that they showed – this is really rare.”

Two days later, Moses’ sister was declared cured, and Esmee also accompanied her home. “Everyone was singing and dancing – we could hardly could get out of the car. It was a beautiful moment,” says Esmee.

But Ebola survivors do not always receive such a warm welcome. ”Unfortunately it is not always like this,” says Esmee. “Recently we took home Francis, another patient who had recovered from Ebola. In his village, people were very reluctant to receive him back into the community. He and his brother were accused of witchcraft.”

“What struck me was the fear and denial of the disease,” says Esmee. “It seemed that denial was their way of protecting themselves.”

Esmee and the health promotion team explained to the villagers that Francis was no longer infectious. “By talking and showing the community that we can touch him, I hope that we made it a bit easier for him to be accepted back. Francis was certainly very happy that we went with him, and thanked us many times.”

Talking to villagers also provides the team with the opportunity to educate people about Ebola: about how to protect themselves from the disease and what to do should they fall ill. Survivors themselves play an important role in encouraging people with Ebola symptoms to seek treatment early and give themselves the best chance of making a full recovery, which also helps prevent them infecting others.  

“We want to show people that survivors are not dangerous, and give people hope by showing that it is possible to survive Ebola,” says Esmee.

Patients’ names have been changed.

ENDS

Fighting Ebola, ending stigma: The story of an Ebola frontline fighter in Liberia

MSF’s Ebola fighter, physician assistant Jackson K.P. Naimah, tells his story:

My wife and I live a lonely life. Our neighbors have barred their children from playing with our children – our home is a ‘no go zone’ for them. Some of them have gone as far as suspending speech with me and my wife. We’ve been isolated because we are both health workers. I work as a physician’s assistant at MSF’s ELWA 3 Ebola Management Center in Paynesville, and my wife works at the John F. Kennedy Hospital as a midwife. People accused us of being carriers of the disease. If we fall victim, will they rejoice and be happy we’re dead and gone?

I lost my niece and my cousin to Ebola in July last year. But that did not discourage me from volunteering for Médecins Sans Frontières to combat the virus in Liberia over the past five months. I felt the urge as a trained physician assistant to save the vulnerable lives that have been struck. The task has not been easy. In this battle, one must always keep on the safe side or risk joining the victims. We’re not fighting Ebola blindly. We’re fighting it with our conscious minds. Safety on the frontline depends on your carefulness and straight adherence to protocols. Mistakes are not permissible here. You constantly have to remind yourself of the things you’re ought to do in order to not get infected through touching an infected person or object.

My family understands what I’m doing and supports me. Still some of our neighbors and friends do not get this. They ostracize us. It sometimes makes me wonder whether I am working for or against society.

Every day spent at the Ebola management center has been heartrending. One moment a patient survives and you celebrate and then in a split second, you see another patient whom you talked to over a couple of hours ago wrapped in body bag. You finish your day emotionally devastated and psychologically traumatized. And when you return home hoping to have some gentle conversations with your neighbors and relax your mind with friends, they give you cold-shoulder instead. This feels like an unfair punishment. The people whom we work for don’t appreciate us.  I am actually looking forward to the day some of the patients I cared for will thank me for helping to save their lives. 

A few colleagues have left their job because of stigma. But I take this as a challenge. We cannot abandon the treatment centers. There’ll be no one to care for patients if we do. It’s our responsibility. We have hope, we are proud and above all, we will remain very careful.

Before joining Medecins Sans Frontieres Ebola Emergency mission in Liberia in August last year, Jackson K.P. Naimah worked as a vaccine officer in Liberia’s ministry of health and social welfare.

MSF: Ebola decline encouraging, but critical gaps remain

Reaching zero cases difficult unless weaknesses in the response addresse

26 January 2015: A downward trend of new cases is reported in Médecins Sans Frontières (MSF) Ebola management centres across Guinea, Liberia and Sierra Leone, with just over 50 patients currently in its eight centres. While this is a promising development, the medical-humanitarian organisation cautions that loss of vigilance now would jeopardise the progress made in stemming the epidemic.

“This decline is an opportunity to focus efforts on addressing the serious weaknesses that remain in the response,” says Brice de la Vingne, MSF Director of Operations.  “We are on the right track, but reaching zero cases will be difficult unless significant improvements are made in alerting new cases and tracing those who have been in contact with them.”

The World Health Organization reported last week that only about half of new cases in both Guinea and Liberia are from known Ebola contacts, while in Sierra Leone there is no data available.  “A single new case is enough to reignite an outbreak,” continues de la Vingne. “Until everyone who has come into contact with Ebola has been identified, we cannot rest easy.”

There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. “With people moving frequently across borders, it is essential that surveillance teams based in each country collaborate immediately so that new cases are not imported into areas considered Ebola-free,” says de la Vingne. “This is a regional problem, not a country-specific one, but it is not being dealt with as such.”

Sierra Leone: cases decreasing but hotspots persist

In the past two weeks, reported cases of Ebola across Sierra Leone have declined to the lowest since August. The situation appears to be improving faster in remote, rural areas such as Kailahun district, a former Ebola hotspot where MSF began working in late June 2014. The comprehensive response with an early emphasis on health promotion, contact tracing and monitoring, and a small number of organisations working together all contributed to bringing the disease under control in this district, which has seen no new cases since 12 December.

Despite these encouraging signs, some hotspots persist, notably the capital Freetown, the Western Rural Area and Port Loko district. MSF’s busiest Ebola management centre is currently the Prince of Wales centre, in Freetown, with 30 patients as of 24 January.

Stopping transmission is particularly difficult in the overcrowded slum areas of the capital, Freetown. Elsewhere, tracing contacts of Ebola patients is still not being carried out systematically, while many contacts are being forcibly quarantined in their homes, at times experiencing shortages of food or water. These quarantine measures can discourage families from seeking early treatment for their sick relatives for fear of being locked in their homes.

“An added struggle is the paralysis of the public health system,” says Karline Kleijer, MSF Emergency Coordinator. “One in ten of the country’s health workers have died of Ebola, the medical facilities are in disarray, and people with non-Ebola illnesses struggle to get the treatment they need.”

Last week MSF teams provided 1.8 million anti-malarials in Freetown, the largest ever distribution in an Ebola outbreak.

Guinea: stigma and fear still problematic

Guinea has also seen a steep decrease in new cases; however 14 out of the 33 prefectures in the country are still considered as “active.”  New cases appear to be originating from areas of the country that were previously regarded as calm, such as Boké, Dabola and Siguiri.

Together with surveillance, health promotion and social mobilisation are inadequate and failing to make significant progress today in Guinea. “Health workers and survivors are stigmatised, people are still reluctant to seek care, and Ebola treatment centres are often regarded with suspicion and fear,” says Henry Gray, MSF Emergency Coordinator.

MSF is currently running two Ebola management centres in Guinea, as well as conducting surveillance, social mobilisation and trainings in infection control. A rapid response team is in place to address needs as they arise.

Liberia: safe reopening of the public health system an urgent priority

Liberia has seen the sharpest decline in Ebola cases, with only 5 confirmed cases currently reported in the country. On 17 January, for the first time since it opened, there were no Ebola patients in MSF’s ELWA 3 Ebola management centre in Monrovia; today there are now just two.

Liberia’s already weak public health system has been seriously damaged by the epidemic, with many hospitals shut down. Though some are beginning to reopen, infection control is crucial to mitigate the risk of Ebola and restore public confidence in the health system. In response, MSF supports thirteen health centres with infection prevention and control, and is opening a 100-bed paediatric hospital in Monrovia.

An MSF rapid response team is also running mobile clinics, training local health staff in triage and infection control, and filling gaps in primary healthcare. Between October and December, MSF distributed anti-malarials to nearly 600,000 people in Monrovia to reduce the burden of malaria infections.

-ENDS-

MSF is currently running eight Ebola Management Centres across Sierra Leone, Guinea and Liberia. Rapid response teams are in place ready to care for emerging cases, while other MSF teams are also conducting surveillance, social mobilisation, and trainings in infection control in health centres. Since the outbreak began, the organisation has cared for almost 5,000 patients, approximately 25 percent of all declared cases.  Addtionally, MSF is currently involved in two clinical trials of experimental treatments in conjunction with Oxford University in Liberia and INSERM in Guinea. More 4,000 MSF staff are working across the three countries.

MSF opens maternity for pregnant women infected with Ebola

Sierra Leone: MSF opens maternity unit for pregnant women with Ebola

A new maternity unit for pregnant women with Ebola – or those suspected of having Ebola – has been opened within an Ebola treatment centre in Sierra Leone by the international medical humanitarian organisation Médecins Sans Frontières/ Doctors Without Borders (MSF).

The new maternity unit is in Kissy, a suburb of Freetown, where MSF has been running an Ebola treatment centre since 8 January. The centre has been admitting patients for the past three weeks, but the new maternity unit for suspected and confirmed Ebola patients will enable medical teams to provide specialised care for pregnant women.

“Medical staff in the maternity unit will focus on providing specialised care to pregnant women and trying to minimise the mother’s bleeding while in labour and after delivery, to prevent her dying from a haemorrhage,” says Olivia Hill, MSF’s medical coordinator in Freetown. “The mother’s chances of survival are relatively low, but the prognosis for the fetus is much worse.”

Relatively little is known about Ebola and pregnancy, so the opening of the maternity unit will bring about increased understanding of the effects of Ebola on this vulnerable group and how obstetric care for infected women can be improved.

The maternity unit has 33 beds for confirmed and suspected cases of Ebola, while the treatment centre has another 40 beds, where some pregnant women were actually treated. The newly admitted ones will now have access to specialized care.

Since the onset of the Ebola outbreak, pregnant women have had limited access to healthcare. Fever and bleeding – both common during pregnancy – are also symptoms of Ebola, so health staff have often been reluctant to admit them to hospital or let them deliver in health facilities out of fear of being contaminated.

Sierra Leone has one of the highest maternal mortality rates in the world.

Adama

She got pregnant. It was around the time that the World Health Organization (WHO) finally woke up and declared the Ebola epidemic in West Africa an international public health emergency. A few months later, the virus sneaked into her body and latched onto her family. She was admitted to an Ebola treatment centre, and although she lost her baby, against all the odds, 18-year-old Adama Kargbo survived. This is the first day of her new life.

MSF nurse Marisa Litster gets ready to enter the high-risk area, where the patients are. Her mission is to get Adama out of there – the results of the latest test show that she has overcome the haemorrhagic fever which has killed more than 8,600 people in west Africa.

This is Kissy, a suburb of the Sierra Leonean capital, Freetown, where Médecins Sans Frontières/Doctors Without Borders (MSF) has built its newest Ebola treatment centre in the country with the highest number of cases of the disease.

“Adama is a special case. She was our first patient and she will be discharged today,” says the nurse as she puts on the yellow personal protective equipment. Adama was admitted on 8 January, on the day the centre opened its doors. Loneliness is common among Ebola patients, but Adama may have felt lonelier than most, because when she was admitted, she was the centre’s only patient.

Now there are around ten patients, and Adama has made a full recovery. “I’m excited for her, but also a little bit nervous, because I can see that there is lot of fear,” says Marisa. “This is just one part of the journey, but a big step will be going home and dealing with the aftermath of everything that comes with Ebola.”

After the ritual of preparing to enter the high-risk area (adjust the protective glasses; make sure there are no gaps for the virus to sneak in), the medical staff go inside. Adama is sitting on a plastic chair, waiting. She gets up and walks towards the chlorine disinfectant shower. She is no longer infectious, but her clothes and personal items might be contaminated, and all traces of the virus need to be liquidated.

When Adama crosses the gap in the wooden fence that signals the separation of patients and the outside world, there is timid applause. On the other side of the fence, two people wait for her: MSF health promotion manager Roberto Wright Reis, who has been providing Adama with psychosocial support for the past two weeks; and Javiera Puentes, the medical team leader. Now they are free to do so, they immediately embrace her, hold her hand, put their arms around her.

As the group walk along the aisle to the exit, between two orange fences, louder applause breaks out from the Sierra Leonean logisticians. Adama smiles and greets them. Roberto raises her hand in the air in a gesture of victory. In Ebola versus Adama, Adama is the clear winner. The next emotional moment takes place when the 18-year-old leaves a handprint on the ‘survivors’ wall’, as has become a tradition in Ebola treatment centres. The wall is a blank rectangle, touched by a single person – Adama’s handprint is the first blue stain on it.

Ebola and pregnant women

Outside her home of the past two weeks, Adama sits down with Javiera, the medical team leader, to receive some medical advice. “Ebola gets into you and sucks all your energy, all your vitamins,” says Javiera. “Now that the virus is gone, you will feel weak for one or two months. This is normal. Don’t think that you are not better – all Ebola survivors feel weak for weeks.”

Javiera advises Adama not to have sexual relationships without protection for three months, because the virus remains active for a while in vaginal and seminal fluids. “Do not get pregnant now, you are very weak,” says Javiera. “A new chapter of your life is opening in which you will need to take care of yourself. Sleep and eat well.”

The death rate for pregnant women infected with the virus is a matter for discussion. A study in Democratic Republic of Congo showed that 95 percent died, but the sample was too small to draw conclusions from.  

While it is clear that the chances for the mother’s survival are lower than in other cases, the prognosis for the fetus is much worse. The virus appears to concentrate itself in the fetus.

Medical staff in the newly opened MSF maternity unit cannot do routine procedures because of the risk of high exposure to body fluids, but they do use intravenous therapy, oral medication and, most importantly, they try to minimise the mother’s bleeding while in labour and after the delivery, to prevent the risk of her haemorrhaging and dying from blood loss.

After Javiera has finished giving Adama medical advice, staff crowd around, keen to find out how Adama feels. She’s a bit overwhelmed. She thanks everyone and says: “I’m feeling fine. I’m happy because I’m discharged, so I pray to God for the others to be discharged.” During her stay, the team has put a lot of effort into making her as comfortable as possible. They brought Adama her favourite pepper soup, even though it was not on the regular menu. “I don’t know yet what food I will prepare now,” she says. Over the two weeks she was here, MSF staff chatted with her for hours from the low-risk area, which is separated from the high-risk area by an orange plastic fence. “I like being outside to take fresh air,” Adama whispers.

Adama is wearing a green T-shirt and skirt, the clothes she was given on discharge. She combs her hair and says that she prefers red to green, then gets ready to leave for home. How will your new life be? “I imagine it to be good,” she says. “When I get better, I want to go to university, study accounting and work in a bank.”

Life after Ebola

But Adama won’t be able to go home yet, because it is still under quarantine, surrounded by tape. Most of her family came down with Ebola. Her mother, sister and brother are currently in a holding centre. Her brother Abu Bakar, who didn’t get the virus, was the only person to visit her while she was battling the disease. A decision is made that she will go to stay with one of her aunts in Waterloo, half an hour’s drive from the treatment centre. Stigma will be the first hurdle that Adama will need to face. 

Accompanying Adama to her aunt’s house is someone very special: Hawa Turay, one of her former teachers. Fate saw them meet again in the Ebola treatment centre, where Hawa works as a health promotion officer. “When I met Adama in the centre, I couldn’t believe she was the one, with a pregnancy of several months,” says Hawa, as the MSF car negotiates the potholed roads of Sierra Leone. “I didn’t think she was going to survive, so I was very sad when I saw her. The time she got here she was weak, unable to talk. Now she is the first pregnant woman to survive in our centre. She looks good, she’s happy, but she has lost many things.”

When they arrive in Waterloo, the neighbours look on, unfazed. The MSF staff members hug Adama to demonstrate to the community that she is not longer infectious, but nobody pays much attention. Soon Adama’s brother, Abu Bakar, arrives on a motorbike. In the coming days, he hopes she can come and stay with him. “I’m happy for my sister. As of now she’s going to stay here,” he says.

While everyone discusses her future, Adama sits down on a plastic chair outside the house. Chickens and goats roam around clothes drying on lines. She sits, just as she did for hours outside the tent for Ebola-confirmed patients in the centre; just as she did as she regained her energy after losing her baby; just as she did when she gazed at the landscape while the other patients chatted away next to her. She sits, just as she did when she was beating Ebola in silence, stealing minutes, hours and days away from the virus. She sits, just as she did when she was seeking peace in the fresh air – the fresh air that she likes so much.

“In all of my years with MSF, this has been the hardest but also the best thing that I have done.”

Midwife Ruth Kauffman is pioneering MSF’s work with pregnant Ebola patients, and proving that – despite everything that was previously thought – pregnant women can survive the disease. She describes how she helped Kumba and Musa, in Sierra Leone, to give birth safely and survive Ebola.

“Before this outbreak, all we really knew about pregnancy and Ebola was that usually the women die either while pregnant or else during the birth. As Ebola is a haemorrhagic fever, once a woman goes into labour, she will most likely bleed to death.

We also knew that unborn babies don’t survive, as the virus appears to concentrate itself in the placenta and in the amniotic fluid which surrounds the fetus.

As the number of people infected in other outbreaks was low – too low to gain an understanding of how Ebola impacted pregnancy – little research had been done. 

But as we’re seeing so many more people infected with the disease in this outbreak, we are learning a lot more about Ebola.

We were surprised that two pregnant women at MSF’s centre in Gueckedou, Guinea, and two more across the border in Foya, Liberia had managed to recover from Ebola, give birth and survive.

Once a woman is better, it seems that the best thing for her to do is birth the fetus, as it has become a ball of concentrated virus in her body. So we began to look at how to do this in a controlled way, that is safe for the people assisting the birth and that will ultimately help the woman survive.

I was working as a midwife at an MSF-run community health centre in Bo, Sierra Leone, when I got a call from our Ebola management centre in Kailahun, in the remote northwest of the country. They said they had one pregnant woman who had almost recovered from Ebola, and asked if I could come and help with the birth. Almost immediately a second pregnant woman was admitted to the same centre. I packed my bags and got a lift up to Kailahun.

There I met Kumba, who was seven months’ pregnant with her third child. She had arrived at the centre with a high viral load, and had been there for about a month.

Kumba knew that her baby was going to be born dead; she had felt no movement for some time.

We wanted to induce Kumba’s labour in as controlled a way as possible. We didn’t want her to go into labour in the middle of the tent. Not only would it be undignified for her, but if there was a lot of infected blood and amniotic fluid around, then it would be risky for everyone.

Kenema hospital, in central Sierra Leone, lost a number of its nurses to Ebola after they attended the birth of an Ebola-positive colleague. Strict infection control is vital.

We needed a place that would be clean and afford some protection – both for Kumba and for those attending her. Luckily the team had just finished constructing a small building for people who needed extra privacy, so we were able to use it for the birth.

We were wearing the standard protective clothing for Ebola, but with extra-long gynaecological gloves on top of the three other layers of gloves. When you are attending a birth, you move around a lot and you really need to make sure that your mask doesn’t slip and that your headgear doesn’t ride up.

You can’t stay inside the high-risk zone, in all your protective gear, for more than an hour at a time. So you also need someone on standby who can come in to relieve you. We had two nurses waiting outside who, even though they didn’t have much experience of birth, were able to monitor Kumba’s vital signs and reassure her.

Before inducing labour, we gave Kumba antibiotics, on the assumption that she would have an infection from carrying around a dead fetus for some time. We also assumed that she would bleed during labour, so we had a lot of anti-haemorrhagic medication ready for after the birth.

Kumba’s labour took about a day and a half, and it went as well as we could have hoped. With Ebola, you don’t want to touch the baby and you don’t want to pull the placenta out; you leave all of that to happen on its own.

What was really amazing about this birth was that, by the next morning, Kumba was stable. She wasn’t bleeding much, and we were able to take out the IVs and the catheter.

The other pregnant woman at the centre was Musa. She had arrived with her two-year-old child, who also had Ebola, and both were now on the way to recovery.

We told Musa that we weren’t going to be able to help her with the birth too much, and she would need to do it herself. This was hard, but with limited time inside the high-risk zone, you have to decide when you’re going to be most useful.

The biggest risk for the mother is right after the birth. If you’re in there for 30 minutes of pushing time, then you don’t have a lot of time or energy left for the next stage ­– making sure the placenta comes out properly and that she doesn’t bleed.

The birth went really well and within a couple of hours Musa was ready to get up.

Birth is so special, even in these circumstances. Whatever the culture, you are immediately intimate with the woman. To be a part of this intimacy is so rewarding – and even more so in the context of Ebola.

Kumba and Musa’s experiences really confirmed to me that, with the resources and with specialised care, pregnant women can be helped to survive Ebola. We may not be able to save the lives of their unborn children, but we can save theirs. In all of my years with MSF, this has been the hardest but also the best thing that I have done.”

Fighting Ebola, Ending Stigma

Ebola survivor Amie Subah tells her story:

I contracted Ebola through midwifing a pregnant woman.  Unfortunately, the woman was infected and she died of the virus as well as her baby.

Eight staff members from the clinic where I worked, including myself, got infected through that delivery.  Only two of us survived after being admitted at the Ebola management center.

I returned home, but no one would welcome me back into the community. Neighbors barred my children from fetching water from their wells. Often, they would point at them because they are related to an Ebola survivor; the same with my husband. He decided to leave.

In the market, sellers refused to serve me. One told me one day that she could not risk accepting money from an Ebola survivor. I tried to convince her that Ebola survivors are no longer infectious but she wouldn’t listen. Commercial bike riders and taxi cabs refused to pick me up. I tried to sell cookies but no one could buy from me. My children and I ate all the cookies.

In a desperate attempt to convince people, I posted in public places copies of the medical certificate issued by the Ebola treatment center that officially declare me cured of Ebola. But some residents still could not believe that I was free of the virus and continued stigmatizing me. Instead of using my name, they were calling me “Ebola survivor”.

Once I visited one of my aunts in the Duport Road Community, a Monrovia suburb. She welcomed me warmly, offered me a seat and served me a bowl of rice. I ate and gave the left over rice to her daughter. My aunt suddenly took the food away the girl and dumped it right on the floor in front of me. It feels even worse when it comes from your own family.

Then, my landlord issued an eviction notice. She was blaming me because the authorities had imposed quarantine on her house I was living in after burning all my belongings. I asked elders in my community for help but she would not listen to them and increased the rental fee so I could not afford the place anymore.

I was feeling very depressed when a longtime girlfriend finally called to invite me over. She gave me clothes and some household stuff. Then my youngest sister took me in, along with my kids. We slept in her dining room until I could rent a new place. Later a psychosocial team from MSF went to talk to my husband and he has now returned home.

I was so desperate I came really close to killing myself. But I survive. I am a survivor after all.

Amie Subah is now psychosocial assistant at the ELWA 3 Ebola Management Center in Monrovia which is being managed by the international medical charity Médecins Sans Frontières. Before contracting and overcoming Ebola, Amie worked as a midwife at MASCO Health Center in the New Hope Community, eastern Monrovia.

Dr Joanne Liu speech to the high-level meeting of the European Union on Ebola

3 March

Excellencies, distinguished guests, esteemed colleagues:

We cannot overstate the human cost of the Ebola epidemic in West Africa: the death, the fear, and the impact on local communities and on national health systems.

 

At a time when Ebola case numbers are notably lower, we—collectively—continue to fail patients and those who remain at risk of contracting the virus. The mortality rate in our treatment units is at a staggering 50 percent.  This is unacceptable. A practical plan to sustain research for vaccines, treatments, and diagnostic tools must be developed. The outcome of this research belongs first and foremost to the affected communities, so we must ensure that results are geared primarily towards their benefit.  

 

Fear has been a dominant factor in the Ebola epidemic. This is a normal reaction to an unprecedented and lethal outbreak. Yet, we must recognize that after a full year, community sensitization efforts have failed to counter misinformation.  The level of response there requires urgent improvement.  In some cases, Ebola is being used as a political instrument, contributing to confusion and mistrust among communities.

 

In Guinea, where misinformation and fear appear strongest, aid workers and medical teams are still suspected of introducing the virus to communities, and are violently attacked.  And yet, we have seen in this same country that when people receive accurate information, they do build trust.  However, coercive measures, such as armed escorts for outreach activities, which are being considered today in Guinea, will likely compound the fear and suspicion.

 

Ebola is not over until there are zero cases over a period of 42 days. One undetected case can lead to a surge.  To reach zero, every single person who has been in contact with someone infected with Ebola must be identified. Yet, today there is still almost no cross-border information sharing on contact tracing. Surveillance teams lack basic resources for active case finding.

 

While we pursue zero cases, we also need to adapt to Ebola’s broader devastation by ensuring safe access to healthcare for non-Ebola cases.  We must not overlook that Ebola has decimated the healthcare work force in the affected countries. The emergence of measles in Liberia underscores the immediate need to restore health systems and public confidence.  Public health threats loom, perhaps even more devastating than Ebola. 

 

Guineans, Sierra Leonians and Liberians continue to face the devastating direct and indirect consequences of Ebola. We should not declare an early victory.  We cannot be satisfied and content. We must remain engaged, responsive, and determined.  

 

Thank you

Patrick is on the inside, I am on the outside.

I see him every day, and we smile and wave at each other. Patrick is just a child, but he is hanging out with guys five times his age, as if trying to make up for the fact that he is much too young to die. They play checkers and poker when they have the energy for it, and they listen to BBC Africa on the radio I brought in one day in my space invader outfit. Patrick has a shy, crooked smile and a bruise near his right eye. He has just lost his mother, but his father is with him in this horrible place. Read more..

My son is MSF’s 1000th Ebola survivor   I was out working with MSF as a health promotion officer, visiting villages and telling people about Ebola: how to protect themselves and their families, what to do if they start to develop symptoms, and making sure everyone has the MSF hotline number to call. When I was finishing up the day, I got a call from my wife’s number but it was not her. I answered the phone but nobody spoke. She was staying in the capital, Monrovia, with three of our children while I was working in Foya, in the north of Liberia. Read More.. .  On the frontline against Ebola Médecins Sans Frontières (MSF) has a strict no-guns policy. But the hygienists in the Ebola case management centre in Bo, Sierra Leone are armed against the virus. Their weapon of choice? Chlorine. ‘Our hygienists are on the frontline against Ebola,’ says Daniel Baschiera, water and sanitation manager for MSF. ‘They see themselves as combatting an invisible enemy. Using their spray tanks filled with chlorine solution they keep the rest of the staff safe.’ So what do hygienists in an Ebola case management centre do? And why is their job so important? Team leader Alpha Koroma (25), from the nearby town of Gondama, explains. ‘Our job in the high-risk zone includes waste management, changing beds, cleaning floors and watching out for the medical staff. We give our patients a clean environment, and we make sure that the medical teams have nothing else to worry about but their medical duties.’  Risk and discipline Discipline seems to be the keyword. ‘It’s absolutely essential,’ says Alpha. ‘You have to stick to the rules, to the procedures. It’s the only way to protect yourself and the people you work with. That’s everyone’s responsibility. The medics count on us. We count on the staff helping us in and out of our personal protective equipment, or PPE. And, in the end, the patients count on everyone here doing their very best to care for them. That’s what it’s about. The case management centre is a place where a lot of lives are saved.’ But is Alpha never worried about his own safety? ‘Never. I know I can rely on my co-workers. Even when I’m really exhausted after a long time in the high-risk zone, I know my sprayer will help me undress safely. Of course, sometimes there are risky situations. I remember this one patient, Ishmael. He was a big guy, but in real bad shape. He was very disoriented, and started pushing other patients. It could have been very dangerous for the staff. But we stayed calm, and managed to separate Ishmael from the others. Eventually he calmed down too. And he was even cured some time later. I was very happy to hear about that.’   Acid-bug Keeping a cool head can be difficult in full PPE, especially when confronted with the unexpected. Daniel tells the story of the nurse and the Nairobi fly. ‘This insect doesn’t bite or sting. But it does cause very painful blisters if crushed against the skin. That’s why it’s also known as the acid-bug. One of the nurses had one on the inside of her goggles while in the high-risk zone. It must have been hiding right underneath the rim. She panicked, and wanted to take her goggles off right there and then. But the hygienist who was with her said “No! Close your eyes!” He guided her to the undressing area, told her to stay cool and, together with the sprayer, made sure she undressed safely.’   ‘Everyday life has ceased’ ‘We watch each other’s backs,’ says Alpha. ‘You have to. You have to take care of each other. This is a bad time for Sierra Leone. Normal, everyday life has ceased. Kids don’t go to schools now. What happens if they can’t go to school for another year? For the next two years? That’s why it’s so important that we carry on working. We can’t stop. And we won’t. We have the faith, the strength and the responsibility to keep on fighting this disease.’ Patients’ names have been changed.

Homecoming Ebola survivors receive mixed welcome  

Moses’ family has been hard hit by Ebola. Four of his family were infected with the virus. His father and brother died, but Moses and his sister both survived. Moses was recently discharged from MSF’s Ebola management centre in Bo, Sierra Leone and made the journey back to his home village, accompanied by MSF health promoter Esmee de Jong.

“We have just started accompanying patients back home,” says Esmee. “Recovered patients sometimes have great difficulty being accepted back into their communities. It is very important that we go with them to explain to people that they are not dangerous. We also want to show people that you can survive Ebola, because this is not widely known.”

Sometimes even people involved in the Ebola response are surprised to discover that recovery from the disease is possible.

“We left early in the morning,” says Esmee, “and on our way to the small village where Moses lives, we bumped into an alert team, who follow up suspected cases of Ebola. We stopped to have a chat with the team, and they asked what we were doing so far from the treatment centre. When we told them we were taking a recovered patient home, they couldn’t believe it. One of them looked into the car and recognised Moses: ‘I brought him to you, he is alive!’ They were so happy to see him, and were flabbergasted that someone could recover from Ebola.” 

Moses is a teacher, an important man in his community, and when he arrived home, the whole village turned out to welcome him. “When we came to the village, it was a party,” says Esmee. ”All the women surrounded him and Moses really had to calm them down. I was so struck by the love and total acceptance that they showed – this is really rare.”

Two days later, Moses’ sister was declared cured, and Esmee also accompanied her home. “Everyone was singing and dancing – we could hardly could get out of the car. It was a beautiful moment,” says Esmee.

But Ebola survivors do not always receive such a warm welcome. ”Unfortunately it is not always like this,” says Esmee. “Recently we took home Francis, another patient who had recovered from Ebola. In his village, people were very reluctant to receive him back into the community. He and his brother were accused of witchcraft.”

“What struck me was the fear and denial of the disease,” says Esmee. “It seemed that denial was their way of protecting themselves.”

Esmee and the health promotion team explained to the villagers that Francis was no longer infectious. “By talking and showing the community that we can touch him, I hope that we made it a bit easier for him to be accepted back. Francis was certainly very happy that we went with him, and thanked us many times.”

Talking to villagers also provides the team with the opportunity to educate people about Ebola: about how to protect themselves from the disease and what to do should they fall ill. Survivors themselves play an important role in encouraging people with Ebola symptoms to seek treatment early and give themselves the best chance of making a full recovery, which also helps prevent them infecting others.  

“We want to show people that survivors are not dangerous, and give people hope by showing that it is possible to survive Ebola,” says Esmee.

Patients’ names have been changed.

ENDS

Fighting Ebola, ending stigma: The story of an Ebola frontline fighter in Liberia

MSF’s Ebola fighter, physician assistant Jackson K.P. Naimah, tells his story:

My wife and I live a lonely life. Our neighbors have barred their children from playing with our children – our home is a ‘no go zone’ for them. Some of them have gone as far as suspending speech with me and my wife. We’ve been isolated because we are both health workers. I work as a physician’s assistant at MSF’s ELWA 3 Ebola Management Center in Paynesville, and my wife works at the John F. Kennedy Hospital as a midwife. People accused us of being carriers of the disease. If we fall victim, will they rejoice and be happy we’re dead and gone?

I lost my niece and my cousin to Ebola in July last year. But that did not discourage me from volunteering for Médecins Sans Frontières to combat the virus in Liberia over the past five months. I felt the urge as a trained physician assistant to save the vulnerable lives that have been struck. The task has not been easy. In this battle, one must always keep on the safe side or risk joining the victims. We’re not fighting Ebola blindly. We’re fighting it with our conscious minds. Safety on the frontline depends on your carefulness and straight adherence to protocols. Mistakes are not permissible here. You constantly have to remind yourself of the things you’re ought to do in order to not get infected through touching an infected person or object.

My family understands what I’m doing and supports me. Still some of our neighbors and friends do not get this. They ostracize us. It sometimes makes me wonder whether I am working for or against society.

Every day spent at the Ebola management center has been heartrending. One moment a patient survives and you celebrate and then in a split second, you see another patient whom you talked to over a couple of hours ago wrapped in body bag. You finish your day emotionally devastated and psychologically traumatized. And when you return home hoping to have some gentle conversations with your neighbors and relax your mind with friends, they give you cold-shoulder instead. This feels like an unfair punishment. The people whom we work for don’t appreciate us.  I am actually looking forward to the day some of the patients I cared for will thank me for helping to save their lives. 

A few colleagues have left their job because of stigma. But I take this as a challenge. We cannot abandon the treatment centers. There’ll be no one to care for patients if we do. It’s our responsibility. We have hope, we are proud and above all, we will remain very careful.

Before joining Medecins Sans Frontieres Ebola Emergency mission in Liberia in August last year, Jackson K.P. Naimah worked as a vaccine officer in Liberia’s ministry of health and social welfare.

MSF: Ebola decline encouraging, but critical gaps remain

Reaching zero cases difficult unless weaknesses in the response addresse

26 January 2015: A downward trend of new cases is reported in Médecins Sans Frontières (MSF) Ebola management centres across Guinea, Liberia and Sierra Leone, with just over 50 patients currently in its eight centres. While this is a promising development, the medical-humanitarian organisation cautions that loss of vigilance now would jeopardise the progress made in stemming the epidemic.

“This decline is an opportunity to focus efforts on addressing the serious weaknesses that remain in the response,” says Brice de la Vingne, MSF Director of Operations.  “We are on the right track, but reaching zero cases will be difficult unless significant improvements are made in alerting new cases and tracing those who have been in contact with them.”

The World Health Organization reported last week that only about half of new cases in both Guinea and Liberia are from known Ebola contacts, while in Sierra Leone there is no data available.  “A single new case is enough to reignite an outbreak,” continues de la Vingne. “Until everyone who has come into contact with Ebola has been identified, we cannot rest easy.”

There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. “With people moving frequently across borders, it is essential that surveillance teams based in each country collaborate immediately so that new cases are not imported into areas considered Ebola-free,” says de la Vingne. “This is a regional problem, not a country-specific one, but it is not being dealt with as such.”

Sierra Leone: cases decreasing but hotspots persist

In the past two weeks, reported cases of Ebola across Sierra Leone have declined to the lowest since August. The situation appears to be improving faster in remote, rural areas such as Kailahun district, a former Ebola hotspot where MSF began working in late June 2014. The comprehensive response with an early emphasis on health promotion, contact tracing and monitoring, and a small number of organisations working together all contributed to bringing the disease under control in this district, which has seen no new cases since 12 December.

Despite these encouraging signs, some hotspots persist, notably the capital Freetown, the Western Rural Area and Port Loko district. MSF’s busiest Ebola management centre is currently the Prince of Wales centre, in Freetown, with 30 patients as of 24 January.

Stopping transmission is particularly difficult in the overcrowded slum areas of the capital, Freetown. Elsewhere, tracing contacts of Ebola patients is still not being carried out systematically, while many contacts are being forcibly quarantined in their homes, at times experiencing shortages of food or water. These quarantine measures can discourage families from seeking early treatment for their sick relatives for fear of being locked in their homes.

“An added struggle is the paralysis of the public health system,” says Karline Kleijer, MSF Emergency Coordinator. “One in ten of the country’s health workers have died of Ebola, the medical facilities are in disarray, and people with non-Ebola illnesses struggle to get the treatment they need.”

Last week MSF teams provided 1.8 million anti-malarials in Freetown, the largest ever distribution in an Ebola outbreak.

Guinea: stigma and fear still problematic

Guinea has also seen a steep decrease in new cases; however 14 out of the 33 prefectures in the country are still considered as “active.”  New cases appear to be originating from areas of the country that were previously regarded as calm, such as Boké, Dabola and Siguiri.

Together with surveillance, health promotion and social mobilisation are inadequate and failing to make significant progress today in Guinea. “Health workers and survivors are stigmatised, people are still reluctant to seek care, and Ebola treatment centres are often regarded with suspicion and fear,” says Henry Gray, MSF Emergency Coordinator.

MSF is currently running two Ebola management centres in Guinea, as well as conducting surveillance, social mobilisation and trainings in infection control. A rapid response team is in place to address needs as they arise.

Liberia: safe reopening of the public health system an urgent priority

Liberia has seen the sharpest decline in Ebola cases, with only 5 confirmed cases currently reported in the country. On 17 January, for the first time since it opened, there were no Ebola patients in MSF’s ELWA 3 Ebola management centre in Monrovia; today there ar