LET’S ALL PREPARE FOR EBOLA
Dear Colleagues,
This discussion is a special edition responding to the current Ebola Hemorrhagic fever outbreak in West Africa.
I am writing from a hotel room in Maputo, Mozambique where I arrived yesterday to participate at the annual Medical Education Partnership Initiative (MEPI) symposium. The Ebola Hemorrhagic fever outbreak afflicting a number of West African countries has become a real African and global threat. Traveling to Maputo via Nairobi or Addis Ababa, the two major airline hubs that connect West and East Africa, I was warned to be careful and to avoid contact with crowds or to cancel air travel all
together.
Many health workers have succumbed to the infection in the affected countries and the USA is evacuating their infected health professionals using very high cost air ambulances. There is panic among communities in the affected countries. The governments and the international agencies have weighed in. However, it appears that a trust gap has developed between the health system and the general population which has made control efforts difficult in the West African countries. So how can this trust be regained?
Until the current West African Ebola outbreak, Uganda held the record for the largest epidemic with 425 recorded cases of Ebola during the year 2000. I was then Director General of Health Service’s and oversaw efforts to control this epidemic. What lessons did we learn in Uganda? The single most important lesson is that building and holding public trust by the government and health personnel is the foundation for all control efforts. Ebola evokes fear and apprehension at individual and community level which easily results in herd responses; negative or positive. We achieved public trust in Uganda through very intensive communication with the public. Epidemic status reports were issued through Press statements every morning, lunch time and evening along with a Press conference each morning. The media are critical in building and sustaining trust and their own confidence has to be won. This was not easy and required personal sessions with the leaders of the media houses on a regular basis. There were also hot lines for anyone to seek or convey information open 24 hours at the Ministry of Health Headquarters and at the District Medical office in the affected districts.
The second key intervention we made was the recruitment of the support of community or village leaders working alongside the Village Health Teams who are a cadre of community health workers that already existed in the public health system structures. Controlling the epidemic is about early detection, isolation, treatment of new infections, contact tracing, including safe handling of body fluids, and the remains of those who die.
This can only happen by staying very close to all families and households and this was achieved by building community trust of the public health system including recruiting the support and oversight by local formal and informal community leaders. Top Ministry officials moved to live in the effected districts to support and direct control efforts and the Minister and Director General visited weekly using helicopters to go to the villages addressing public meetings and inspiring local health workers.
The third key intervention was the introduction of Technology for quick field diagnosis of new infections. This enabled suspected but negative individuals to leave isolation quickly and return to normal life. It also enabled early initiation of treatment measures for those who test positive. This was the contribution of partners such the CDC who brought in the Field laboratory and WHO that came with supplies and technical expertise to support and stay with us in Uganda. This global solidarity however, can only work where there is effective local leadership that is trusted by the local population.
Finally, controlling an Ebola outbreak is about strong primary health care strategies that we have always aspired for; namely leadership from the top, integrated with routine governance of society and involving the active participation of the people themselves. Once we have controlled this outbreak, let’s institutionalize these practices because we need them anyway but also because there will be another Ebola outbreak soon enough.
Colleagues, your own thoughts, experience and words of encouragement are needed at this critical time. Please share.
Comments (16)
1. Maureen Chirwa
Please stay and travel safe.
2. John Donnelly
John
3. David Sanders
You are correct that Ebola needs a PHC approach to control it. PHC requires that,in addition to basic health care, the social determinants are addressed. The link below shows how Ebola's spread is underpinned by social, economic and political inequities.
Best regards,
David.
http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003056
4. E. Rwamasirabo
Best regars E. Rwamasirabo, MD
Kigali, Rwanda
5. Josephine Kibaru- Mbae
Thank you for your very insightful comments, I hope our colleagues in West Africa can access this platform and borrow these very practical principles.
Unless there is total confidence in the government and its local structures, all the efforts will be wasted, as the communities will engage in their own solutions which can be devastating as we have already witnessed. Regional approach is also critical in order to curb cross-border transmission and provide timely assistance. I recall the last epidemic in Uganda, ECSA
Secretariat through the East Africa Public Health laboratory project, sent both human and material resources to support the Uganda team on the ground.
Primary health care strategies are the way to go, and no amount of external support will help until we take up the mantle as Africans.
Kind Regards,
Dr. Josephine Kibaru- Mbae
Eunice Brookman-Amissah
With the current critical state of affairs is it possible to move from a discussion amongst us to initiating something concrete that than help the affected countries
Could we share the Uganda lessons ASAP perhaps through WAHO and have countries supported to implement some of these if they are not already doing so?.
I agree with Kayode that we should have a write up of the process and lessons from Uganda for sharing with all Ministries of Health.
I also agree strongly that the Primary Health Care System is best placed to deal with these kinds of issues as well as most others that we face in the region and so need to revamp and strengthen this system.
And for Ebola in West Africa I believe it is important that countries start preparing even before the first case strikes and not after!
And yes, PHC is way to go using national structures and of course supported by external aid including from other African countries like Uganda
Perhaps we should also bear in mind that with daily flights by KQ, SAA and Ethiopian between West Africa and the rest of the region no country is absolutely immune from an outbreak.
Thank you again Francis for the very insightful write –up.
Warmest Regards
Eunice Brookman-Amissah
Portia
Thanks a lot for sharing. This helps in our preparedness
8. Kayode ODUSOTE
Is the experience/lessons learnt from the Uganda epidemic documented anywhere one can access?
I was in Liberia recently and now back in Nigeria. I cannot agree more with your points 1 - 3 as being essential to fighting the epidemic. What I saw in Liberia was fear, anger and denial as well as lack of trust in government. There was negative reaction from communities with significant disruption in epidemic control plans of government. In Nigeria, one case imported from Liberia is causing panick and what I would call communication disarray.
I wish the lessons of Uganda can be circulated to all Ministries of Health in Africa, especially West Africa, as soon as possible and if possible translated into the official languages of Africa.
Thanks for sharing.
Kayode ODUSOTE
9. Francis Omaswa
Here is the publication with a report of the Uganda outbreak published in
2002.
Okware S I, Omaswa F G et al “An Outbreak of Ebola in Uganda” Trop Med Int
Health, Dec 7(12): 1068.
This blog reaches Technical leaders at the African Union Commission, WHO
African Regional Office and WHO Headquarters, the World Bank, AfDB as well
as the government of Uganda etc.
I suggest that these leaders circulate this information to the
governments. On top of this, these leaders together with our international
partners should convene a major consultation on Ebola as soon as possible
where we can all share experience and develop and disseminate guidelines
as well as mobilize resources for implementation of agreed actions.
Thank you all for your wise contributions. I have been informed that this
blog on this virus has "gone viral". This is good! I hope it triggers the
actions that are needed.
Francis.
10. Patrick Kadama
The lessons are quite well set out and very relevant especially the regarding the emerging difference in approach and engaging communities which in the current epidemic are moving toward a command and control approach that may have negative or costly results on communities involved.
One aspect that you could comment upon is the significantly high in facility infection rates especially to health workers in the current West African epidemic. The experience in Uganda could shed some light on possible direction to get this under control.
I hope the symposium has kicked off well.
Regards
11. Florence.
Thanks for sharing your thoughts. Because of the vigorous public health approach to prevention of the outbreak in Uganda, the epidemic was successfully contained and did not spread to the neighboring countries all of which have very porous borders with Uganda. Yes lets share ideas – the community is central to winning the war.
Cheers,
Florence.
12. Grace Kalimugogo
The epidemics were quickly contained because each stakeholder played their role, lead by and coordinated through the Ministry of Health. Public awareness was high and thus, communities were vigilant and assisted with contact tracing and other interventions.
It is important therefore, that all countries note the lessons from Uganda as outlined by Prof. Omaswa, especially since the West African epidemic is another proof that diseases do not recognize borders.
Grace Kalimugogo
maureen lchirwa
Please stay and travel safe.
14. OKELLO, David O.
Great discussions on Ebola preparedness. But I must add my voice and concern. West Africans have been battling the spread of Ebola for the past few months, in the worst epidemic of the disease ever seen. Then, last week, two U.S. aid workers were infected, and the American media exploded with Ebola news. Kent Brantly, a doctor who was infected while working at a hospital in Liberia, was flown to Atlanta’s Emory University on Saturday, and the media closely reported on his whereabouts, down to the very moment that he exited the ambulance. Nancy Writebolsumder, an American missionary who was also infected in Liberia, is expected to arrive at Emory sometimes this week. Now that Ebola appears to have the potential to affect Americans, the world seems to be truly awake. The Internet has been teeming with misinformation, advising people to stay away from keyboards and money. Others have even suggested a doomsday scenario of Ebola being brought to the U.S. and spread via passengers on airplanes. We are clearly confronted with the risk that the ripples of fears across communities and towns will evolve into panic and result into insecurity and possibly riots. This is what I see as a new dimension to the disease outbreaks, an epidemic of FEAR and PANIC. With no vaccine or drugs to fend Ebola, it is understandable to have widespread panic. Part of effective response to bring a halt to the spread of Ebola should indeed be managing and assuaging the fears of the populations. We should do more to educate the public on the basics of Ebola - the virus is spread only through bodily fluids from an infected person, or from objects such as needles that have been in contact with infected bodily fluids. Ebola is not spread through air, food, water, or by touching computer keyboards.
Thank you.
Dr David OKELLO
Francis.
Here is the publication with a report of the Uganda outbreak published in 2002.
Okware S I, Omaswa F G et al “An Outbreak of Ebola in Uganda” Trop Med Int Health, Dec 7(12): 1068.
This blog reaches Technical leaders at the African Union Commission, WHO African Regional Office and WHO Headquarters, the World Bank, AfDB as well as the government of Uganda etc.
I suggest that these leaders circulate this information to the governments. On top of this, these leaders together with our international partners should convene a major consultation on Ebola as soon as possible where we can all share experience and develop and disseminate guidelines as well as mobilize resources for implementation of agreed actions.
Thank you all for your wise contributions. I have been informed that this blog on this virus has "gone viral". This is good! I hope it triggers the actions that are needed.
Francis.
16. Prof L Gwanzura
Lovemore
Hi Prof Omaswa!
indeed a great discussion you sparked. The beauty of your presentation is your gave a solution on the basis of your last experience in Uganda. I watched on CNN the first and second plane land ,load and fly out of Liberia. No thing was off loaded which could at least help Liberian EBOLA patients or the health staff. Prof Okello has also raised an interesting aspect of ALARM and despondence that Africa and the rest of the world would face. I wonder how the Liberians felt when the special plane landed picked and flew out of Liberia with only one American. couldn't it have taken one African child? or better still say try this which we going to try on these two American? Alarm and fear ais all we have besides the assurance from Prof Omaswa. GOD WILLING the current Ebola epidemic has reached its peak and can now slow down and save the African souls. Hope and perseverance are also a powerful tool especially when you see others treating their own. Ethics......
Prof Gwanzura