IPAC Beyond the Borders: Ebola Relief and Beyonds/Ebola Relief and Beyond.pdf · IPAC Beyond the Borders: Ebola Relief and Beyond - Madeleine Ashcroft November 2017 “I alone can’t

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IPAC Beyond the Borders: Ebola Relief and Beyond

- Madeleine Ashcroft

November 2017

“I alone can’t change the world, but I can cast a stone across the waters to create many ripples.” - Mother Theresa

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Outline

Ebola in Sierra Leone

• Background / challenges

• Phase 1: Assessments, training, mentorship

• Phase 2: The District IPC takes over

• Phase 3: Prepare for the future

• Future priorities for IPC

• Lessons learned

• Ongoing support

West Africa (Guinea, Sierra Leone, and Liberia)

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Ebola: Background

March 2014 – March 2016:

• Total cases in West Africa: 28,616 with 11,310 deaths

• Sierra Leone: 14,124 cases and 3,590 deaths

• Over 10,000 survivors, most in Sierra Leone

• Resources: West Africa had a ratio of 1-2 doctors per 100,000 population, among the lowest in the world

• High number of health care workers infected: >221 doctors, nurses and midwives died while treating Ebola patients

Sierra Leone: More Background

• Infant mortality rate - 3rd highest in the world at 87 per 1,000 live births

• Maternal mortality - 4th highest rate at 890 per 100,000 live births

• Most rural health posts lack running water and electricity, and mothers must walk through the bush for hours, babies strapped to their backs to see a nurse for malaria or diarrhea

• Malaria silently killed twice as many people as Ebola in Sierra Leone in 2014

• The World Bank has estimated the overall impact of Ebola as US$1.9 billion for a country listed as the 8th least-developed in the world

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Sierra Leone Facts

Population Approx. 6 million

Former Colony of Britain

Life Expectancy 45 years

Religion Muslim (60%), Christian (30%), secret societies

Civil War 1991-2002

Average Income $340 in 2013 (Minimum wage 3¢/hr. - raised 2280% in 2015 - now $780/year) 60% still live on less than $1.25/day

Concerns Political instability, diamonds

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Source: UNICEF

http://www.bbc.com/news/world-africa-30429360

The WHO said in a statement on Wednesday that over 11 days in Kono, "two teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor drafted into removing bodies as they piled up".

First confirmed case of Ebola in Kono July 29 2014

At the start . . .

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Nearing the end . . .

Source: WHO

Over 10,000 survivors! However . . .

https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofx155/4004818/Ebola-Virus-Ribonucleic-Acid-Detection-in-Semen

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Lack of Infrastructure

Support to Quarantine/Surrounding Areas

Aberdeen from the air

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Aberdeen – 22 new cases February 12

Coffee Wharf – some infected fisherman

Traditional Healing

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Kono – 14 chiefdoms

The fastest route

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Kono - Koidu

Kono Villages

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My lodgings

Community Care Centres

Assessments

Triage Donning Doffing

Hand hygiene

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Koidu Government Hospital

Hospital Triage and Holding Centre

Peripheral Health Unit (PHU) Screening

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Tight space in the PHU

Ebola Treatment Centre – International Federation of Red Cross (and Red Crescent)

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Well planned structures

Well practiced procedures

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Novel water systems Solar powered sink, tippy tap, and piped water and chlorine

Burial Teams

Training

Observation in the field

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Home Decontamination Team

Ambulance Decontamination Team

Ambulance Drivers

Hospital Staff

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Decontamination of CCCs on School Grounds

CCCs: Before and After Decommissioning

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School reopening – April 14

Measles at the PHUs

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A big warm Kono welcome

Sad times: The body of a dead child is removed from the ward

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Happy times: Driver’s wedding

Our Challenges

• New partners/role clarification/languages

• Lack of consistent standardized messaging

• Timing:

– Need for action before SOPs ready

– E.g., decommissioning of CCCs and creation of isolation units

• Competing priorities

– Training - decontamination - assessments - mentoring

• Transition to post-Ebola best practices for IPC

• Travel

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The bumpy road to zero?

Phase 2: National IPCs take the lead

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The new national team for Kono - Abu, Cecilia, and Augustine - at the Ebola Treatment Centre

In the community

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Moving forward – the Peripheral Health Unit screening areas

Future Priorities

• Plan move into the post-Ebola stage

• One message

• IPC as norm in all health care facilities

– Improved hospital ICP program

– Build capacity in the PHUs and Community Health Centres

– National course

• Ongoing IPC mentorship

• Balance between excess and complacency

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WHO - Phase 3

Objectives:

1. To accurately define and rapidly interrupt all remaining chains of Ebola transmission

2. To identify, manage, and respond to the consequences of residual Ebola risks

Getting back to normal . . .

• Training, improving diagnostics and supply chains, and increasing awareness

• The social fabric is healing – “handshakes are back, market stalls brim with vegetables and fruits, schools have reopened and the sound of music echoes in the streets and villages and along the wide beaches”

• “Ebola was an eye-opener. We never used to wash our hands in Sierra Leone. Now there are hand sanitizers at every health center, and people are more aware of how diseases can spread. Simple things can make a big difference.” - Dr. Lynda Foray, program manager of Sierra Leone’s National Leprosy and TB Control Program

Source: www.theglobalfund.org/en/blog/2017-02-20-rebuilding-health-care-in-the-shadow-of-ebola/

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Lessons Learned

• Communicate and collaborate

• Strength in our diversity

• Build capacity

• Social mobilization for community buy-in

• Increasing quality and standardization of training - over 8,000 health care workers were trained

• We are forever changed

Supportive supervision at checkpoint

Recently . . .

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Supportive supervision and assessment of PHU at Moyamba Junction, Southern Province

Training the trainer at Portloko, Northern Province

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Assessing the hospital burning pit

Koidu Government Hospital Gates

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World Hand Hygiene Day

Continuing to Work Together

• Assistance for IPAC leads to get places on IPAC Canada’s online course

• Mentorship during course (and beyond?)

• Covering costs:

– IPAC Canada and local chapter membership

– Online microbiology text

– Preparing abstracts and presentations

– ?Support for conference attendance

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Questions?