The Ebola virus epidemic in West Africa is unprecedented in not only the scale of the epidemic but its spread. It has overwhelmed national health systems and left international experts wondering how to address an epidemic on such a scale. It has highlighted the frailty of global public health alert systems and not only threatened the fragile infrastructure of several nations in West Africa, but exposed countless other nations around the world to a similar risk. Addressing an Ebola epidemic of this scale has taken the international community on a journey never before walked. Previously tried and tested methods have been used as well as novel strategies, but the scale that has been required is unprecedented. It is also apparent that no 'one size fits all' approach can work - the approach must be multifactorial, addressing the problem at it's roots within the communities where the outbreaks occur, but also on a national level to provide large scale isolation of cases and interrupt transmission of the virus.
Below are nine ways in which we are beating the Ebola epidemic in West Africa:
1.Community awareness and health promotion
2.Community support and psychosocial input
3.Infection prevention and control
4.Community case identification, contact tracing and surveillance
5.Safe burial of dead bodies
6.Isolation of cases in treatment facilities
7.Improving medical treatment and survival rates in facilities
8.Using survivors to engage communities and care for patients
9.Employing rapid response strategies
Rapid response medical team outside a mobile treatment facility
Nathalie MacDermott/Samaritan's Purse International Relief
1.Community awareness and health promotion
Helping communities to understand what Ebola virus is, where it comes from and the risks it poses to the community is essential in dispelling rumours and myths about the disease. This ensures communities are open to the intervention of health care workers as opposed to hiding the sick and the dead for fear that Ebola is a hoax designed to destroy their communities.
2.Community support and psychosocial input
Ensuring badly affected communities are supported during this tragedy is again essential for the communities to trust health care and aid workers and allow them to carry out their role. Providing psychosocial support to patients, grieving families and communities as well as economical and food support to quarantined areas ensures communities are enabled to grieve appropriately and empowers them to take action should there be others in the community who are unwell. This support shows them they are not abandoned and helps them understand their loved ones are receiving the best care available in the treatment facilities.
3.Infection prevention and control
Through the distribution of kits containing hand-washing buckets, soap and chlorine and education awareness programs regarding the importance of hand washing, transmission of the virus can be interrupted within communities and within health care settings. Basic infection prevention principles such as this can have a significant impact on reducing transmission of the virus; it also encourages good practice for the future in any setting.
4.Community case identification, contact tracing and surveillance
Assisting communities in rapidly identifying potential cases through community leaders and then training community health workers in contact tracing and surveillance is essential to winning the war on this epidemic. Early identification of cases ensures improved chances of survival of the case but also significantly reduces the chances of that case spreading the virus to others in their family or community. Contact tracing ensures lists of people who have had contact with a case can be created and this group monitored for symptoms. If they become symptomatic they are isolated at a very early stage, which further helps to interrupt transmission of the virus within communities.
5.Safe burial of dead bodies
The body of a person who has died from Ebola virus disease is highly infective. The virus is present in very high quantities in the body and even just touching the body with a bare hand may result in someone becoming infected. This is why it is important to ensure teams within communities are equipped with the protective equipment they require to handle the body and safely bury them. It is important this is done in a culturally sensitive manner to ensure families are content with how their loved one has been laid to rest. This further interrupts transmission and prevents families from handling and hiding their loved ones bodies through fear that the body will not be handled in a manner appropriate to their customs or religion.
6.Isolation of cases in treatment facilities
Isolating patients suffering from Ebola virus disease reduces the risk of them infecting other people in their families and communities. It is important this is done as early as possible into symptoms, and in a treatment facility where the health care workers looking after them have access to equipment to protect themselves from the disease.
7.Improving medical treatment and survival rates in treatment facilities
This is not only an ethical and moral obligation for health care professionals, but it is also important that patients and their families feel they are receiving good medical care in treatment facilities. This helps communities to feel it is safe to bring their loved ones to a treatment facility as opposed to hiding the sick in their homes. As survival rates improve this helps communities to understand the importance of receiving early treatment and helps to dispel myths about maltreatment of patients in these facilities.
8.Using survivors to engage communities and care for patients
Survivors of Ebola are well placed to speak into resistant communities regarding the proof the disease exists and that it is possible to survive if treatment is sought early. They are also well placed to help care for patients, as they are likely to be immune to the current strain of the virus and so do not require the full protective equipment to be worn. This means they can spend more time inside the treatment facility, helping weak patients to eat and drink and providing emotional support and encouragement. They also provide hope to patients demonstrating it is possible to survive the disease they are suffering from.
9.Employing rapid response strategies
A rapid response strategy involves an urgent response to the notification of a suspect case within a community. If operating optimally it enables the rapid retrieval of the case to a treatment facility as well as incorporating the above features of contact tracing, community surveillance, health promotion, psychosocial support and infection prevention kit distribution. It also integrates the safe burial of any deceased cases. Should there not be a treatment facility in the region then the strategy includes the development of a mobile isolation and treatment facility within 48 hours of arrival on site. All of this combined helps to rapidly isolate any suspect cases as well as addressing community needs and continuing surveillance. This leads to rapid interruption in transmission and reduction in the risk of spread within a community.