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 In the "hot zones" of Liberia, where Ebola patients are being turned
away from overflowing clinics, aid agencies are distributing tens of
thousands of protection kits, made up of buckets, chlorine, soap,
gloves, a gown and instructions on how to look after the infected in
their own homes.
In neighboring Sierra Leone, authorities advise those waiting for an
ambulance to isolate the patient in a room, designate someone to
treat them and ensure this person uses gloves or a towel soaked in
chlorine when they are in contact.
As experts ponder how nurses treating Ebola even in Western
hospitals contracted the disease, such efforts in West Africa
highlight the steps being taken to bridge the gap between the care
available and what is needed in the epicenter of the crisis.
Aid organizations acknowledge that getting people with Ebola into a
professionally-manned treatment units is the only way to halt the
worst outbreak on record, which has already killed over 4,500 people
and risks claiming thousands more lives.
But with ambulances overloaded and an insufficient number of beds in
treatment centers, getting the sick quickly out of their homes to
avoid infecting others is a major challenge.
"Sometimes that's just not possible. When someone gets sick
overnight, we have to ensure that they don’t infect others," Sheldon
Yett, the head of U.N. child agency UNICEF in Liberia, told Reuters.
"People really want to give help to people who are sick, but we need
to ensure that when they give help to people who are sick, they
don’t get sick too. These kits are designed to do just that — to
break the circle of transmission."
There is no known cure for Ebola and the limited stocks of
experimental drugs have been exhausted. In treatment centers in West
Africa, care involves preventing dehydration and helping treat other
infections, with those who are diagnosed soonest faring the best.
UNICEF is supporting efforts to roll out 65 community care centers
across Liberia. Units of 6-20 beds will be set up and manned by
trained members of the community to look after people until they can
be taken to an Ebola treatment unit.
Other organizations, like Medecins sans Frontieres (MSF) and
Samaritan's Purse, are handing protection kits directly to families
living in communities most at risk.
Yet the high toll the outbreak has taken on health staff - 236 dead
from a total of 427 infected in West Africa - highlights how
dangerous the disease is even for professionals with training and
equipment.
"It’s a very fine balance to try to provide adequate and efficient
protection without providing full safety," said Jens Pedersen, a
South African who led MSF teams in Monrovia.
"If you aren't sufficiently trained, regardless of what protective
gear you use, if you don’t know how to use it or know how to look
after yourself and an infected patient, there’s very little that
protective gear can do for you."
MSF says 16 of its staff have contracted Ebola, of whom 9 have died.
Some, but not all Ebola patients evacuated to Europe and the United
States for better care in western medical facilities have survived.
Those evacuated were mainly aid workers.
Drug firms are fast-tracking vaccine research and GlaxoSmithKline
says if current trials are successful frontline health workers in
West Africa would be vaccinated early next year.
"ADAPTING"
First confirmed in Guinea's remote southeast in March, Ebola spread
across the country and into neighboring Liberia and Sierra Leone,
where it has torn through ill-equipped health systems in nations
recovering from years of conflict.
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Medics in Liberia, home to the world's largest natural rubber
operation, lacked rubber gloves to treat patients.
The global response has accelerated as cases reached the West.
Hundreds of millions of dollars in aid has been pledged, the U.S.
and British militaries are deploying and volunteers from across the
globe are signing up to help.
Yet the effects on the ground have been slow to materialize. So far,
Liberia has 620 of 2,930 planned beds for Ebola cases. In Sierra
Leone, there are 346 of 1,198 planned beds.
U.N. officials say the turning point for rolling back Ebola will be
when 70 percent of cases are hospitalized and 70 percent of those
Ebola kills are buried properly.
Nigeria was declared Ebola-free on Monday after it successfully
traced and isolated 300 people who had come into contact with an
Ebola patient who brought the disease to Lagos in July.
Manuel Fontaine, UNICEF's director for West and Central Africa, said
providing care in community centers was an example of the ways in
which an overstretched aid community was being forced to innovate to
tackle an unprecedented epidemic.
"We’ve worked in wars or against malnutrition where we have pretty
clear protocols. But here it is about adapting," he said, adding
that training and supervision, especially on how to dispose of used
kits, was essential to ensuring they did not spread infection.
In Ebola units, medics follow a laborious 15-step procedure to
undress without infecting themselves. Underscoring the risks even in
highly-controlled environments, authorities in Spain said a nurse
looking after an infected patient appeared to have contracted the
disease after making a mistake.
MSF, which has led much of the medical response, says the epidemic's
scale demanded "unprecedented and imperfect measures". It plans to
distribute over 50,000 kits to patients turned away from hospitals
and to those living in communities vulnerable to further infection.
MSF says the equipment should be for short-term use until an
ambulance arrives and the kits are not intended for longer-term
care. "It is just too dangerous. It is about just giving food and
water," said Thomas Curbillon, head of MSF's mission in Liberia.
Samaritan's Purse, a U.S.-based charity handing out 3,000 kits and
training to community members, said home care was not ideal but the
lack of beds and extent of unreported cases meant it was already
happening on the ground.
"Good, bad or ugly, it has been happening," Ken Isaacs, vice
president of programs, told Reuters. "We believe we can give care
givers knowledge and basic equipment to take care of their loved
ones and take care of themselves."
Latest estimates from the WHO warn that there could be 5,000-10,000
new cases of Ebola per week by December.
"I will acknowledge this is the least desirable option but there is
no other option. We are dealing with is the reality of the
situation," he said.
(Additional reporting by Ed Cropley in Johannesburg; Editing by
Daniel Flynn and Anna Willard)
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