Wednesday, 15 October 2014
Not everything about Ebola is a fever, diarrhea, vomiting or abdominal pain; conversation cues for people at community level
Thomas Rogers Muyunga-Mukasa
I was fortunate to work under very experienced health workers in Uganda and Congo during the time of Ebola in those two countries. I saw how easy it was for villages to be vacated and also how people were passionately involved in containing Ebola. I later led Public Health teams in Africa. Yesterday, as we were talking with other African friends at the African Advocacy Network Centre on 938 Valencia Street, San Francisco, CA, I was asked to give tips on Ebola containment. I do follow the news since July 2014 and it was easy for me to bring them abreast of things. Before we blame we should first think harder.This write up is as a result of this experience. I had got a part time job as a home care provider. I had worked with a client for 2 weeks but when he heard about the Duncan incidence, he asked me to leave his home or else he was going to call the police. I lost my job because of this incident!
Ebolastory and America
One known case to be diagnosed in USA, was treated in Texas (SF Gate, October 9th 2014). This was Thomas Eric Duncan who had just come back to USA from Liberia on September 20th 2014. Duncan had just arrived from Liberia to visit his girlfriend and son, and probably had no insurance.He checked into the Texas Health Presbyterian Hospital on 25th September 2014. There, he was treated for a fever, vomiting and abdominal pain — all symptoms of Ebola. But he was sent home with antibiotics and was not screened for the virus. Relatives say he told hospital staff he’d come from Liberia. ‘Three days later, he was hospitalized in a worse condition and was quickly isolated. He became the first case of the deadly virus diagnosed on American soil.
Duncan received experimental medicine on October 4 — six days after admission to the hospital. He died on Wednesday, October 8th 2014. It was a far longer wait than four other Ebola patients treated in the United States. Those patients — two each at Atlanta’s Emory University Hospital and the University of Nebraska Medical Center — got experimental medicine immediately. They’re all U.S. citizens; Duncan was a Liberian ( CNN Wire, October 9th 2014).’
According to Texas Health Presbyterian Hospital, the nurse who treated Duncan during his second visit had “close contact” with him. As protocol, had to examine the patient. She also had to wear protective gear, including gloves, mask, gown and shield while treating Duncan. Physical examination is crucial and is part of the protocol. It involves looking (inspection), feeling (palpation), percussion and listening (auscultation). All these brought the nurse in contact with Duncan. They are necessary and lead to a clue and later to a diagnosis. In this scenario where urgency was crucial, other possible diagnoses must have been ruled out. Tests to confirm or exclude other likely diagnoses must have been done. This means along the line of prevention and treatment many come into contact to the biohazards materials from Duncan. Many other person come up with symptoms once they do not adhere to the protective measures required. ‘Clay Jenkins, a Dallas County judge, spoke at a news conference Wednesday morning and said more than 70 health care workers cared for Duncan while he was isolated at Dallas Presbyterian Hospital. Two of those are confirmed to have contracted Ebola.In a news conference Wednesday, CDC Director Thomas Frieden said the patient should not have traveled while in the ‘self-monitoring’ period after caring for Duncan. Frieden said the patient traveled to Ohio before it was known the first nurse, 26-year-old Nina Pham, had contracted the disease. The CDC will ensure that from now on, people who are being monitored for possible Ebola symptoms will not travel, other than “controlled movement,”(CNN Wire, October 15th 2014).’ Else where it also occurred, in Congo and in Uganda two countries that were hit by Ebola ( New Vision, December 6th 2000).
The countries recently in the news
Guinea, Sierra Leone, Liberia and Nigeria.
Red eyes, fever, diarrhea, hiccups, vomiting and abdominal pain — are symptoms of Ebola. Ebola hemorrhagic fever (alternatively Ebola Hemorrhagic Fever, EHF, or just Ebola) is a very rare, but severe, mostly fatal infectious disease occurring in humans and other primates, caused by the Ebola virus which is possibly carried by fruit bats.
Ebola can only be contracted through contact with bodily fluids of an infected person, including blood, sweat, blood, tears, saliva, feaces, semen and soiled clothing or bedding. Many Africans use scarification as a form of introducing medicinal herbs in bodies, the unsterilized cutting utensils used on many people is another cause for worry. Contact with an infected person can lead to infection.
More than 8,000 people have contracted the disease in West Africa. The CDC reports than more than 4,000 have died.
Drug Trials and the fears to allay; lessons for those in USA and Africa
The National Institutes of Health will start the first human safety trials of an experimental Ebola vaccine next week, amid a grave estimate from the World Health Organization that Ebola cases in West Africa could top 20,000. (AP, Aug. 28)
The Standard Operating Procedures, Perceived Stigma and Discrimination, Insurance cover affect attendance at hospitals for routine check ups. The others could be one’s attitude and inclination to make medical check ups a regular every day practice.
The approach to the Duncan case will be a lesson to many hospitals in USA from now on. A recent history of travel will be crucial."It's so easy to forget to ask about travel," said Dr. Emily Landon director of a University of Chicago infection control program. "That's our one vulnerability.” ( SF Gate, october 9th 2014).
‘The patient, a man, walked into an emergency room at Texas Health Presbyterian Hospital in Dallas on September 26. A nurse asked him for his travel history while he was in the emergency room, and the patient said he had traveled to Africa, said Dr. Mark Lester, executive vice president of Texas Health Resources. But that information was not “fully communicated” to the medical team, Lester said. The man, who had just flown from Liberia to the United States, underwent basic blood tests, but not an Ebola screening, and was sent home with antibiotics, said Dr. Edward Goodman with Texas Health Presbyterian Hospital.( CNN Wire, October 1st, 2014).’
In Africa, ten things can help prevent deaths from Ebola and also contribute to containment. These are: bleach; electrolyte fluids; IV lines; gumboots; basins; water containers; masks, gloves, disposable bed pads; antibiotics; trained/motivated community health volunteers who knock on all doors with messages. These can be linked to health facilities and that way it is possible to get reports or feedback from remote areas.
There is need to involve government, Faith based organizations, community leaders, Civil Society organizations, and youths in all interventions. As far as drug trials are concerned, adverse reactions that may arise need to be prepared for. Short of this there is bound to be a backlash that will interfere with Ebola eradication. Information, Education and Communication on Ebola vaccines or drugs should be such that they allay fears. The IEC should emphasize the strict and rigorous preparations trial medicines go through. (http://articles.latimes.com/keyword/ebola-virus)
The preparedness and Test Drugs
Families, communities, hospitals and governments invest so much time and money in containing infectious diseases. In the case of Duncan, a hazardous materials team arrived at the Dallas apartment where four contacts of U.S. Ebola patient Thomas Eric Duncan were put under quarantine. The family members — Duncan’s partner, Louise, along with her son and two nephews in their 20s — have been ordered to stay there until October 19. The sheets, clothes and towels Duncan used are in plastic bags in one of the apartment’s rooms, health officials say. Ebola can live outside the body on those kinds of materials, says CNN’s Dr. Sanjay Gupta. The length of time it remains active depends on the environment — from hours to days — but it is possible for someone to contract the disease from touching those materials. There are nuanced factors that stand in the way of accessing medicines easily in USA, in case of Ebola treatment. Food and Drug Administration permission to use experimental drugs in over 4200 different hospitals around USA, that have emergency and intensive care units with over 100 beds; and efficacy of the drugs are some of those. These lie between survival or death. Thomas Eric Duncan got the experimental drug Brincidofovir. A Spanish priest infected with Ebola died after taking it earlier in August. NBC cameraman Ashoka Mukpo, who got infected in Liberia and was airlifted to Nebraska on Sunday, got the same drug as Duncan but survived. Two of four patients who survived after treatment in the U.S. received a different drug, ZMapp. Experts say there’s no proof that ZMapp or any drug is effective in treating Ebola. The Centers for Disease Control and Prevention said ZMapp stocks have since been depleted. A third American patient received TKM-Ebola — another experimental drug approved by the FDA recently for wider use.
Africans, socialization and other factors
Established African communities in USA still act as a magnet for those who are new and recently from Africa. It is necessary to key members in these communities trained in readiness skills. The skills include: peer to peer counseling so that they are able to demystify or allay any fears as well as refer cases for immediate management; telling signs and symptoms; conducting first response activities such calling for 911 or knowledge of referral points and maintaining links with the support mechanisms in USA.
Ebola has opened so many other social issues around relations; preparedness and infection control. Both Africans and Americans need to work together in containing Ebola. This means a range of things. This write up was an attempt to highlight the issues.