Foreign health workers & U.S. experts weigh in on Ebola

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Burial of ebola patient in Guinea, Africa
Staff of  a Doctors without Borders (Medecin sans Frontieres) medical team show the extent in the needed use of proper protective clothing during the burial of a person killed by Ebola viral haemorrhagic fever. This burial took place in Guekedou, Guinea on April 1, 2014. Image: Seyllou/AFP/Getty

(WNN) New York, U.S., AMERICAS: As the latest in an accelerated aggressive Ebolavirus outbreak all but shuts down public operations in Liberia, two medical response team doctors, one from the UK and the other from Brazil, work with the United Nations World Health Organization (WHO) in the neighboring region of Liberia to help slow down the disease.

Weighing in on their personal experiences and insights in the effort to stop the Ebola haemorrhagic fever in Sierra Leone, which borders Liberia, Dr. Catherine Houlihan and Dr. Mauricio Ferri are committed to face the challenges of this illness ‘head-on’ regardless of possible personal dangers.

With the latest count of 1,603 cases and 887 new deaths from the illness in West Africa, fear of the spread of the virus outbreak has been growing exponentially.

“West Africa is facing its first outbreak of Ebola virus disease,” said WHO Director-General Dr. Margaret Chan as she met last Friday with the Presidents of Cote D’Ivoire, Liberia, Sierra Leone and  Guinea. The high level meeting took place in Conakry, the capital city of Guinea.

“This is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary,” continued Dr. Chan.

“West Africa’s outbreak is caused by the most lethal strain in the family of Ebola viruses,” she added. “The outbreak is by far the largest ever in the nearly four-decade history of this disease.”

It is also been growing inside the United States as two emergency health responders working for the Christian organization Samaritan’s Purse were also stricken with the disease. Dr. Kent Brantly and Nancy Writebol became ill with the disease while working with Ebola patients in Monrovia, Liberia.

On Saturday August 2 Dr. Brantly was flown for emergency treatment to Emory University hospital. The hospital is working closely with U.S. Center for Disease Control and Prevention (CDC) infectious disease control unit in Atlanta, Georgia.

Today Nancy Writebol, who was working with Dr. Brantly, is arriving at the same hospital. Of concern to those monitoring the situation, some of the same health workers who were coming to the initial aid of Dr. Brantly when he became ill in Liberia, have also come down with the virus.

Contagion for this version of the virus, known among the international health community as the Zaïre Ebolavirus, is not airborne. It can only be passed from person-to-person through direct contact with an infected person’s blood, saliva, or any other bodily fluid.

But it’s not that simple. Their are clear challenges in containing the fatal illness that currently is showing what may be up to a 90 percent death rate.

In small rural villages where access to adequate clean water is not plentiful or easily available, challenges with personal sanitation can cause someone who may be caring for a sick family member or friend to become infected themselves.

Dr. Brantly and Nancy Writebol were both given an unreleased experimental serum before their U.S. arrival while in Liberia. While this is the first time the serum has been used on a human it is hoped that it may help them. Dr. Brantly was also given a unit of blood in Liberia that came from a 14-year-old boy who survived the disease after the doctor treated him.

Today medical workers in the field are teaching villagers, in areas where the Ebolavirus has not been contained, the importance of personal sanitation as well as isolation of those who are known to be sick. Isolation must be done as soon as possible emphasizes the medical team educators. Villages are also becoming aware that proper burial procedures is vital to containing and preventing the spread of Ebolavirus.

Washing hands properly and frequently is considered a basic and important first step in stemming the illness before it begins to take hold, outlines WHO. Immediate use of disinfectants along with proper waste management and protective isolation gear, for both those who are ill and their caretakers, is the important next step.

To date approximately 60 health workers inside Sierra Leone, Guinea, Nigeria and Liberia have died from Ebola, although it is not certain if the point of contagion was through their medical assistance work.

Other points of transmission have not been discussed as widely. It is essential to stay away from all forms of bodily fluids, which include sweat, feces, mucus as well as blood. Contact with blood can particularly arise with Ebola haemorrhagic fever which can come with extreme diarrhea, as well and bleeding lesions on the body.

Semen is also a point of contagion for Zaïre Ebolavirus.

“Men who have recovered from the disease can still transmit the virus through their semen for up to 3 months after recovery,” said a WHO – World Health Organization Risk Assessment Report on the Zaïre Ebolavirus in West Africa.

Below is a recent release by the World Health Organization outlining statements as well as the on-the-ground updates by Dr. Houlihan and Dr. Ferri in Sierra Leone.


“It was great that Mauricio and I arrived the same day; we were able to share first, very shocking, impressions and to go through the process of adapting to difficult working conditions together,” says Dr Catherine Houlihan, an infectious disease doctor from the United Kingdom deployed through WHO to help respond to the Ebola outbreak in Sierra Leone.

For Catherine this is her first deployment in an outbreak setting; “On my first day, I felt shocked by the enormity of the challenges. The day after, I started to adapt.”

Dr Mauricio Ferri, a Brazilian intensive care specialist who has worked for 7 years in various hospitals in Canada, laughs: “Before coming, I had to convince my wife to let me go”.

Both Catherine and Mauricio are mid-way through their three-week deployment to Kenema, one of the most affected areas of Sierra Leone since the outbreak was declared in late May.

They are part of a team of four internationally-deployed doctors providing clinical care inside a newly established Ebola treatment centre located in the city hospital and managed by the Ministry of Health.

They were deployed through the Global Outbreak Alert and Response Network (GOARN), a WHO-based network of experts and institutions that can assist with the international response to disease outbreaks.

In Guinea, Liberia and Sierra Leone, WHO has currently 126 experts on deployment, sourced from staff, external recruitments and partners through the GOARN.

Personal safety and patient care

“I knew it was going to be hard but I did not expect this extent of challenges, in terms of lack of equipment and gaps in infection prevention and control measures,” says Mauricio. “However, after the initial shock, I started to see those difficulties as opportunities for improvement.”

Mauricio and Catherine spend 7 hours per day inside the treatment centre, fully dressed in personal protective equipment (PPE), caring for between 40 and 50 patients a day. WHO has supplied PPE to health workers responding to this Ebola outbreak. Everybody – from security guards, ambulance drivers, cleaners and professional health workers – should be trained to properly use the PPE so that they can keep doing their job safely.

Some patients leave their mark. “On the first days I was seeing bodies being taken away; on my fourth day I saw the first patient discharged. It was my greatest moment so far,” recalls Catherine. For Mauricio, it is a story of a 4-year old boy who survived Ebola, the only one in his family that was decimated by the disease.

The issue of personal safety is another concern for response teams, especially for medical workers in direct contact with patients. “Prior to my arrival to Kenema, I was scared about my own safety but I realized later that we can be in control of the risk,” says Mauricio. “We need to strike the right balance between caring for patients and our own security.”

The infection and death of several local nurses who worked in the treatment centre has had a profound impact on all the health workers in the ward, especially national staff who had worked with them for a long time. “We need to lead by example on how to properly use the protection gear and to continue despite setbacks,” says Catherine.

Unique experience

Would the doctors return to Sierra Leone or accept a deployment elsewhere if there is a need? “Absolutely”, both reply simultaneously. “Being part of such an operation is a unique experience. Not only can we contribute to the effort to stop Ebola transmission but it is also a good personal learning experience, allowing us to be better prepared for future deployments.”

Both Catherine and Mauricio applied immediately when they received the email that WHO sent out to various medical associations asking for volunteers to help with the Ebola outbreak in West Africa. “So far, no regrets,” concludes Catherine. “I feel this is where I should be.”