IPAC Beyond the Borders: Ebola Relief and Beyonds/Ebola Relief and Beyond.pdf · IPAC Beyond the...
Transcript of IPAC Beyond the Borders: Ebola Relief and Beyonds/Ebola Relief and Beyond.pdf · IPAC Beyond the...
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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?