Fewer Ebola cases in Liberia, surge in Sierra Leone
Health |
Although there have been some slight reported improvements in Ebola crisis in Liberia, the same cannot be said for Sierra Leone, which has seen a significant surge in reported cases in recent weeks, with every district now affected.
Following announcements made in recent weeks, deployment of international aid is slowly taking place in the three most affected countries. However, there is little indication that current efforts to increase isolation capacity and take care of suspected and confirmed Ebola cases will address needs sufficiently.
As of 29 October, Ebola has claimed 4,919 lives, with 13,698 cases registered in Guinea, Liberia, Nigeria, Sierra Leone, Senegal and Mali recently (WHO figures). On 24 October, the first case of Ebola was confirmed in Mali and that person has since died.
MSF teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation.
MSF believes the outbreak is far from over and more help is still desperately needed. Fear and stigma are still rife in communities, with many believing that Ebola is fatal and that going to a treatment centre will not help. Meanwhile, health workers, survivors and discharged patients are facing stigmatisation by families and communities.
Much more needs to be done by NGOs, governments and community leaders around community sensitisation and awareness raising to help direct sick people for treatment.
MSFs Ebola response in summary
MSF has been responding to the outbreak since March, and counts activities in Guinea, Liberia and Sierra Leone. In response to a confirmed case in Mali, an MSF team arrived in the country this week to reinforce MSFs regular mission and provide technical support to the Ministry of Health.
MSF currently employs 263 international and around 3,084 locally hired staff in Guinea, Liberia and Sierra Leone. In total there are 3,347 staff on the ground. It also operates six Ebola case management centres (CMCs), providing approximately 600 beds in isolation.
Since the response began, 23 MSF staff have been infected with Ebola, eight of whom have recovered. The vast majority of these infections were found to have occurred in the community.
Since the beginning of the outbreak, MSF has sent more than 700 international staff to the region and admitted more than 5,200 patients, among whom around 3,200 were confirmed as having Ebola. More than 1,200 patients have survived.
More than 1,019 tonnes of supplies have been shipped to the affected countries since March.
The 2014 budget for MSFs Ebola response in West Africa is 51 million. MSFs Ebola response looks set to continue into 2015, for which operational budgets are currently being calculated.
GUINEA
MSF welcomes the involvement of other actors in the response to Ebola in Guinea but these positive steps wont be sufficient to stop the epidemic. More health promotion activities and support with contact tracing and safe burials, particularly in hotspots in the east of the country, are required. At the moment, MSF is the only organization operating treatment centers.
There is an urgent need for more transit centres and treatment centres in the affected rural districts. New cases have appeared in Kerouane and Nzerekore, but existing treatment centres are difficult to access from these areas.
In Conakry, the situation has slightly stabilised, but regular small surveys show that the epidemic is not under control. MSF is clearing a new site in Koloma for the construction of a new treatment centre, where the existing Donka treatment centres activities will be moved.
With the logistical and technical support of MSF, the Ministry of Health (MOH) opened a transit centre in Forecariah (southeast of Conakry), which will transfer patients to MSFs treatment centre in Conakry.
In Macenta/Gueckedou, there has been a slight increase in confirmed patients in Guéckédou, with many coming from Kerouane.
MSF is speeding up construction of the new 30-bed treatment centre in Macenta to cope with increasing caseloads.
MSF and the French Red Cross (FRC) will start training FRC staff in November to eventually operate the Macenta CMC in November. The French Red Cross will take over in Macenta at the end of November.
LIBERIA
MSF teams in Monrovia are seeing a drop in the number of patients admitted in one of MSFs treatment centres. As of 28 October, there were around 80 patients, in the 250-bed facility. MSF teams are looking into the possible reasons: a widespread aversion to the governments mandatory cremation policy, poor ambulance and referral systems, changes in behaviour and other factors may all play a role.
Household protection kits are being distributed in in several areas of Monrovia. As of 28 October, 44,154 kits had been distributed. These kits are designed for use by the families and communities of symptomatic individuals who havent been able to make it to a treatment centres due to lack of transport, or who have died at home. They are in no way meant as a substitute for the care provided in the treatment centres.
In order to reduce malaria-related deaths, MSF is also distributing anti-malaria treatment kits in the poorest and most densely populated areas of Monrovia where access to health care is limited. MSF aims to reach 300,000 people or around 50,000 households with this distribution.
In Foya, northern Liberia, the number of admissions has been low for the past few weeks, with very few patients currently admitted. During the last 33 days, there has only been one confirmed case in the western districts of Foya, Kolahun and Vahun and this patient was infected outside of Lofa County. Most patients are coming from the east of the county, near the border of Guinea and increasingly further afield.
The decrease in the number of cases in Foya has occurred as a result of a comprehensive package of medical care, outreach activities, health promotion and contact tracing.
MSF is remaining vigilant, and is reinforcing health promotion messages and activities. In Foya, MSF has expanded health promotion activities to villages where outbreaks have not yet occurred and is also training local groups to deliver health promotion messages in remote areas that MSF has not yet reached. In Voinjama the health promotion team trained health promotion trainers for 17 NGOs and local organisations to ensure that best practices are passed on.
As local health centres begin to reopen, MSF is making donations of protective equipment and providing training to the staff working in these centres on how to use this equipment safely.
SIERRA LEONE
Every district in Sierra Leone is now affected by the epidemic. New hotspots for the disease include the capital, Freetown, and the areas of Port Loko, Bombali and Moyamba. The government has put five of the worst affected districts under quarantine, setting up checkpoints on roads to prevent people leaving the area - measures which affect between one and two million people.
The governments response is hampered by a lack of resources and coordination at both national and district level. There is no strong surveillance system in place, while up to 85 percent of calls to the national telephone helpline get no response. Transit centres are full and management is really an issue, creating the risk of cross-contamination.
With so many deaths from Ebola, we are seeing an increasing number of orphaned children in our centres, and a lack of caregivers.
The international response is beginning to get underway, but it is slow and uncoordinated. Governments (including the UK and China) and various NGOs have sent teams to construct new centres at different locations around the country, including Jiu, Port Loco and Freetown. Getting these new centres up and running is a matter of urgency. The need for more resources on the ground continues to exist. Community sensitisation is an area of increasing concern.
MSF has been conducting training for organisations interested in joining the response. So far three international organisations have been trained within MSF centres in Bo and Kailahun with more trainings planned in the coming weeks.
MSF is supporting a team of 800 health promoters who have been tasked with passing Ebola awareness messages throughout the district of 429,000 inhabitants. Social mobilisation and sensitisation activities have increased as the health promotion and medical teams reach out to public health units, community stakeholders and the community at large to raise awareness.
Our treatment centre continues to receive patients from outside of Kailahun as there are not enough treatment centres in the country. The patients are being transported from the heavily affected districts of Bombali and Tonkilili, travelling over eight hours by car which is a serious medical concern as the conditions inside the ambulances can create cross-contamination. Sometimes people travel for hours with a dead body next to them.
In Bo, MSFs new 35-bed Ebola management centre, which opened on 19 September, has now seen more than 35 people discharged since its opening.
Source: Doctors Without Borders / All Africa
As of 29 October, Ebola has claimed 4,919 lives, with 13,698 cases registered in Guinea, Liberia, Nigeria, Sierra Leone, Senegal and Mali recently (WHO figures). On 24 October, the first case of Ebola was confirmed in Mali and that person has since died.
MSF teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation.
MSF believes the outbreak is far from over and more help is still desperately needed. Fear and stigma are still rife in communities, with many believing that Ebola is fatal and that going to a treatment centre will not help. Meanwhile, health workers, survivors and discharged patients are facing stigmatisation by families and communities.
Much more needs to be done by NGOs, governments and community leaders around community sensitisation and awareness raising to help direct sick people for treatment.
MSFs Ebola response in summary
MSF has been responding to the outbreak since March, and counts activities in Guinea, Liberia and Sierra Leone. In response to a confirmed case in Mali, an MSF team arrived in the country this week to reinforce MSFs regular mission and provide technical support to the Ministry of Health.
MSF currently employs 263 international and around 3,084 locally hired staff in Guinea, Liberia and Sierra Leone. In total there are 3,347 staff on the ground. It also operates six Ebola case management centres (CMCs), providing approximately 600 beds in isolation.
Since the response began, 23 MSF staff have been infected with Ebola, eight of whom have recovered. The vast majority of these infections were found to have occurred in the community.
Since the beginning of the outbreak, MSF has sent more than 700 international staff to the region and admitted more than 5,200 patients, among whom around 3,200 were confirmed as having Ebola. More than 1,200 patients have survived.
More than 1,019 tonnes of supplies have been shipped to the affected countries since March.
The 2014 budget for MSFs Ebola response in West Africa is 51 million. MSFs Ebola response looks set to continue into 2015, for which operational budgets are currently being calculated.
GUINEA
MSF welcomes the involvement of other actors in the response to Ebola in Guinea but these positive steps wont be sufficient to stop the epidemic. More health promotion activities and support with contact tracing and safe burials, particularly in hotspots in the east of the country, are required. At the moment, MSF is the only organization operating treatment centers.
There is an urgent need for more transit centres and treatment centres in the affected rural districts. New cases have appeared in Kerouane and Nzerekore, but existing treatment centres are difficult to access from these areas.
In Conakry, the situation has slightly stabilised, but regular small surveys show that the epidemic is not under control. MSF is clearing a new site in Koloma for the construction of a new treatment centre, where the existing Donka treatment centres activities will be moved.
With the logistical and technical support of MSF, the Ministry of Health (MOH) opened a transit centre in Forecariah (southeast of Conakry), which will transfer patients to MSFs treatment centre in Conakry.
In Macenta/Gueckedou, there has been a slight increase in confirmed patients in Guéckédou, with many coming from Kerouane.
MSF is speeding up construction of the new 30-bed treatment centre in Macenta to cope with increasing caseloads.
MSF and the French Red Cross (FRC) will start training FRC staff in November to eventually operate the Macenta CMC in November. The French Red Cross will take over in Macenta at the end of November.
LIBERIA
MSF teams in Monrovia are seeing a drop in the number of patients admitted in one of MSFs treatment centres. As of 28 October, there were around 80 patients, in the 250-bed facility. MSF teams are looking into the possible reasons: a widespread aversion to the governments mandatory cremation policy, poor ambulance and referral systems, changes in behaviour and other factors may all play a role.
Household protection kits are being distributed in in several areas of Monrovia. As of 28 October, 44,154 kits had been distributed. These kits are designed for use by the families and communities of symptomatic individuals who havent been able to make it to a treatment centres due to lack of transport, or who have died at home. They are in no way meant as a substitute for the care provided in the treatment centres.
In order to reduce malaria-related deaths, MSF is also distributing anti-malaria treatment kits in the poorest and most densely populated areas of Monrovia where access to health care is limited. MSF aims to reach 300,000 people or around 50,000 households with this distribution.
In Foya, northern Liberia, the number of admissions has been low for the past few weeks, with very few patients currently admitted. During the last 33 days, there has only been one confirmed case in the western districts of Foya, Kolahun and Vahun and this patient was infected outside of Lofa County. Most patients are coming from the east of the county, near the border of Guinea and increasingly further afield.
The decrease in the number of cases in Foya has occurred as a result of a comprehensive package of medical care, outreach activities, health promotion and contact tracing.
MSF is remaining vigilant, and is reinforcing health promotion messages and activities. In Foya, MSF has expanded health promotion activities to villages where outbreaks have not yet occurred and is also training local groups to deliver health promotion messages in remote areas that MSF has not yet reached. In Voinjama the health promotion team trained health promotion trainers for 17 NGOs and local organisations to ensure that best practices are passed on.
As local health centres begin to reopen, MSF is making donations of protective equipment and providing training to the staff working in these centres on how to use this equipment safely.
SIERRA LEONE
Every district in Sierra Leone is now affected by the epidemic. New hotspots for the disease include the capital, Freetown, and the areas of Port Loko, Bombali and Moyamba. The government has put five of the worst affected districts under quarantine, setting up checkpoints on roads to prevent people leaving the area - measures which affect between one and two million people.
The governments response is hampered by a lack of resources and coordination at both national and district level. There is no strong surveillance system in place, while up to 85 percent of calls to the national telephone helpline get no response. Transit centres are full and management is really an issue, creating the risk of cross-contamination.
With so many deaths from Ebola, we are seeing an increasing number of orphaned children in our centres, and a lack of caregivers.
The international response is beginning to get underway, but it is slow and uncoordinated. Governments (including the UK and China) and various NGOs have sent teams to construct new centres at different locations around the country, including Jiu, Port Loco and Freetown. Getting these new centres up and running is a matter of urgency. The need for more resources on the ground continues to exist. Community sensitisation is an area of increasing concern.
MSF has been conducting training for organisations interested in joining the response. So far three international organisations have been trained within MSF centres in Bo and Kailahun with more trainings planned in the coming weeks.
MSF is supporting a team of 800 health promoters who have been tasked with passing Ebola awareness messages throughout the district of 429,000 inhabitants. Social mobilisation and sensitisation activities have increased as the health promotion and medical teams reach out to public health units, community stakeholders and the community at large to raise awareness.
Our treatment centre continues to receive patients from outside of Kailahun as there are not enough treatment centres in the country. The patients are being transported from the heavily affected districts of Bombali and Tonkilili, travelling over eight hours by car which is a serious medical concern as the conditions inside the ambulances can create cross-contamination. Sometimes people travel for hours with a dead body next to them.
In Bo, MSFs new 35-bed Ebola management centre, which opened on 19 September, has now seen more than 35 people discharged since its opening.
Source: Doctors Without Borders / All Africa
