© Sophie McNamara/MSF
Treatment centres alone cannot end an outbreak. We need health promotion, contact tracing and surveillance to cut the chains of transmission. Our outreach teams go into different communities to teach the public on how to prevent Ebola, find out the contacts of potential and confirmed Ebola patients and follow up the conditions of those contacts under quarantine. nd out the contacts of potential and confirmed Ebola patients and follow up the conditions of those contacts under quarantine.
These tasks can often be challenging to the teams - under large urban settings, the population is huge and the individuals are extremely mobile; in rural areas, access to the villages is extremely difficult and time consuming, let alone the distrust, myths and stigmas. In the outbreak in North Kivu, Democratic Republic of Congo, the political unrest adds extra challenges to our response.
Except patients treated under the Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) protocol, Ebola treatment is limited to supportive therapy – keeping patients hydrated, maintaining their oxygen status and treating any complications caused by the infection.
Ebola disease is not airborne so the treatment centres do not need air-tight isolation rooms. However, everyone follows a strict path along the marked routes built by barrier mesh. Neither patients nor staff are allowed to go from a zone with a high infection risk to a lower-risk zone, and at crucial intersections, there are footbaths containing disinfectant. This reduces the risk of the virus spreading within the Ebola center. Please click here see the floor plan of MSF's Ebola treatment centre.
© MSF/Louise Annaud
In May 2018, MSF started vaccinating Ebola health workers in Bikoro, Equateur Province of the Democratic Republic of Congo (DRC). This trial vaccination will also be offered to contacts of patients. All the participants receive information on the vaccine before consenting, and are carefully monitored over a period of time. Participation is voluntary and the vaccination is free.
© Yann Libessart/MSF
In 2014 to 2016, posters, banners and signs like “Ebola is real” and “Ebola is here” could be easily found on the streets of Guinea, Sierra Leone and Liberia. It’s because many people believed that Ebola is a curse instead of something caused by a viral infection. To them the idea of a deadly infection was something completely foreign. Busting the local myths about Ebola was a major challenge to control the epidemic.
© Sylvain Cherkaoui/Cosmos
This bed has a hole with a bucket beneath because seriously ill patients are unable to move from their beds to the toilet. Ebola patients could lose many litres of liquid per day through vomiting and diarrhoea.
Other than medicine for supportive treatment, nutritious meals are also important for the patients to regain strength and fight the virus.
© Fabio Basone/MSF
After disinfecting the quarantined houses of suspected Ebola patients to reduce the risk of cross contamination, the MSF outreach team removes their protective personal equipment in front of the community. The health promoters explain every single step the team is doing to help people understand our work and feel safer.
Another reason the frontline staff removes their protective suits immediately after working in the high risk zone is that these suits can be very muggy and hot under the blazing weather. Undressing is a crucial and potentially dangerous step. Each person has to remove his or her protective gear according to a very precise and meticulous procedure, in order to avoid any risk of contact with the virus. Therefore, whether in the communities or inside the treatment centres, there are hygienists to guide the often exhausted colleagues step-by-step through the undressing process to make sure they do not commit any mistakes.
© MSF/Louise Annaud
In the wake of the West Africa Ebola epidemic back in 2014 to 2015, an investigational vaccine was developed, and its early trials were led by Guinea’s Ministry of Health, the World Health Organisation, Norwegian Institute of Public Health, MSF and its epidemiological research arm Epicentre. The vaccine is currently being used in the Ebola outbreak in the Democratic Republic of Congo (DRC), as part of the overall strategy to control the epidemic.
© Sylvain Cherkaoui/Cosmos
MSF hygienists put aside the bodies of patients who passed away. They were washed with chlorine solution and put in a disinfected, sealed, and air tight bag before leaving the high-risk zone. The corpses will either be given back to the family for funerals after the decontamination, or incinerated in a crematorium by MSF staff.
© Martin Zinggl/MSF
A logistician gets his shoes disinfected with chlorine solution as he enters the Ebola case management centre. He is holding a box of protective equipment.
© MSF/Louise Annaud
© Sylvain Cherkaoui/Cosmos
After exposure inside the isolation zone, health workers’ clothing, goggles, rubber gloves and boots were disinfected with 0.5% chlorine solution.
© Malin Lager/MSF
At MSF’s Ebola centre in Monrovia, Liberia during the 2014-2015 West Africa outbreak in West Africa, the team set up this “survivors’ wall” where patients who survived the ordeal were free to put their hand prints in different colors. It reminded everyone that amidst the darkness, there is always hope.
Ebola patients suffer from physical pain all over the body. Even after being discharged from the treatment centres, the pain might continue or come back. Survivors may face stigma and unfair treatment from their community, including their closest family and friends. Getting the fatal disease and losing family members or friends during the outbreak are traumatising, too. MSF has dedicated teams to follow up the physical and mental well-being of these survivors and educate the community about Ebola.
Photo source: CDC/Cynthia Goldsmith
The Ebola virus is initially transmitted to people from wild animals, such as fruit bats. It spreads in the human population through direct contact with body fluids of those infected with the virus. The incubation period for this deadly disease is two to 21 days. Depending on the strain, the chances of survival varies from 75% to only 10%. Currently, a trial vaccine is now being used to manage the Ebola outbreak in the Democratic Republic of Congo. It is available to health workers, patient contacts and to those who are at high-risk of exposure due to their work as part of the safe burial team, ambulance drivers, etc. The vaccine is considered highly effective.
The early symptoms of Ebola are also often seen in patients with other more common diseases. For example, fever, muscle pain, headache and sore throat from flu; and vomiting, diarrhoea, and abdominal pain from malaria. This makes early diagnosis challenging and leads to more people catching the deadly virus. An Ebola patient should be cared for and isolated as soon as possible to prevent the risk of infecting others – usually caretakers, family members and neighbours. A laboratory test is carried out to confirm a diagnosis.revent further risk of infection to relatives and care takers. A laboratory test must be carried out to confirm a diagnosis.
© Sylvain Cherkaoui/Cosmos
Despite their protective gear, the medical team tries to ensure human interaction with patients by talking with them at length and getting as close as possible to maintain eye contact.
Ebola first appeared in 1976 in simultaneous outbreaks in Nzara of Sudan and in Yambuku of Zaire (currently Democratic Republic of Congo). The latter was in a village situated near the Ebola River, from which the disease takes its name. Since then, 41 known outbreaks have been recorded.
MSF has intervened in almost all reported outbreaks since the mid-1990s. From Ebola’s discovery in 1976 until 2014, most outbreaks were in isolated rural areas with fewer than 100 cases.
The 2014-2016 West African epidemic reached urban areas and killed over 11,300 people, and MSF launched one of the largest emergency operations in its 44-year history. At the peak of the epidemic, MSF employed nearly 4,000 national staff and more than 325 international staff. MSF admitted 10,310 patients to its Ebola management centres of which 5,201 were confirmed Ebola cases, representing one-third of all WHO-confirmed cases.
The Ebola epidemic in Equateur province declared on 8 May 2018 came to an end on 24 July, 38 confirmed cases and 17 deaths were recorded. It was the 9th outbreak in the country’s history.
Just days after, the 10th Ebola outbreak of the country was declared in North Kivu province on 1 August 2018. This outbreak in the northeast of DRC has recorded a total of 3,317 patients and 2,287 deaths. It lasted for 11 months and ended in 25 June 2020. It is known as the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.
Meanwhile, the disease is back to the Equateur province only less than two years since the 9th outbreak ended. DRC declared its 11th Ebola outbreak last June 2020.. As of 25 June 2020, there were 25 confirmed cases and 13 deaths.
MSF has been working with the country’s Ministry of Health in responding to all these three Ebola outbreaks.
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