What do we do when a deadly contagious disease grips a
country? On the assumption that Jack
Bauer does not have all the answers (which, as a viewer of the TV series ‘24’,
I willingly admit is tenuous), today we’re going to look at some of the
elements that are critical to containing an outbreak of Ebola Virus Disease,
which will lay the groundwork for understanding some of the problems that are
being faced in Liberia and other West African countries:
1.
Trained and equipped medical staff – It’s vital
that the cases of Ebola are managed properly.
This means barrier nursing techniques, including the wearing of
protective clothing (such as masks, gloves, gowns, and goggles), using
infection-control measures (such as complete equipment sterilisation and
routine use of disinfectant), and isolating patients with Ebola from contact
with unprotected persons. In order to
achieve this, the people need to be there in the first place, to be trained to
recognise the symptoms of Ebola, to have the facility to test and
confirm/disconfirm suspected cases, and to have the clinical environment and
equipment that they need in order to achieve the standards above in the mean
time. With no exceptions.
2.
Containment – Early detection and isolation of
cases is essential to stop Ebola spreading.
Ebola is NOT airborne (and don’t believe what you read to the contrary),
and infection relies on the direct contact with bodily fluids from infected
people who are displaying the symptoms of Ebola. The risk of contagion increases the more
advanced the disease is, so if you can identify people infected with Ebola in
the early stages, not only does this increase their personal chances of
survival, it also means you can isolate them and thus minimise the number of other
people who come into contact with infected bodily fluids.
3.
Contact tracing – Once Ebola cases are
identified, you need to list everyone who may have come into contact with
contaminated bodily fluids and thus be at risk of contagion. These ‘contacts’ must be traced, must be
provided with information and counselling, and need to monitor their
temperature and other signs of symptoms to ensure early detection. I have heard it said that about one in ten
contacts is likely to develop Ebola Virus Disease.
4.
Sensitisation – People need to know about the
risk of Ebola - in perspective with other health risks that they may encounter,
such as the much more common Malaria and Typhoid – and what to do about it if
they or someone they care for experiences symptoms. Something that was impressed upon me by the
District Chairwoman of Bushrod Island in Monrovia is how fundamental education
is to all aspects of life, peace and development in Liberia. People need to understand how to identify the
disease, how it is communicated, and what action to take if any symptoms are
exhibited. This needs to be common knowledge
for Ebola to be contained.
5.
Cooperation – Perhaps this is the hardest battle
to win. People need to cooperate, 100%. Staff need to adhere to the standards of
hygiene that barrier nursing requires.
People who are suffering from Ebola-like symptoms need to subject
themselves to the authority of medical agencies that require their
containment. Contacts need to be found,
and to comply with the monitoring of their health. Communities need to acknowledge that the
disease exists and to support measures that are put in place to protect them.
A small disclaimer: I am not a public health expert. Nevertheless, you may begin to imagine why agencies in the UK reassure us
that an outbreak on the scale we are witnessing in Liberia and beyond would
have less chance to take hold in the UK.
The world is not a fair and equal place.
