Lisa De Bode / Al Jazeera America

A dummy run for deadly work: Bridging the Ebola care gap

In Brussels, NGO staffers are being trained to fill the shortfall of field workers in West Africa

BRUSSELS — In a mocked-up isolation unit in the back of an empty industrial lot, a plastic dummy was sprayed with disinfecting chlorine, carefully lifted and placed in a body bag. Four health care workers shouldered the burden, each dressed head to toe in protective gear and taking a limb as they disposed of the body.

Such precautions may seem out of place in the Belgian capital, but for the volunteers tasked with removing the makeshift corpse at an Ebola training session last week, the dangers could become very real very soon. While a mistake here, during a mock scenario with a mannequin, would not mean much in terms of personal danger, out in the field in West Africa it could very well lead to death.

The Ebola outbreak ravaging parts of West Africa has taken a heavy toll on medical professionals. To date, more than 120 health care workers have died, and at least 240 have contracted the disease in Guinea, Liberia, Sierra Leone and Nigeria, according to World Health Organization (WHO) figures.

Shortages of protective equipment and a lack of field-experienced medical practitioners deployed in the region have contributed to the high death rate, the United Nations' health body said. But others have blamed the international community for a response to the crisis they deem inadequate.

Brice de le Vingne, Doctors Without Borders’ (DWB) director of operations, said the WHO in particular has fallen short of fulfilling its responsibilities during the outbreak. “We need some leadership. We’re not supposed to fight the epidemic. We’re not supposed to deal with strategy,” he said of DWB’s role. “[But] we are filling the gap,” he said.

Last week’s training camp was part of that effort. A group of 36 representatives from organizations such as Save the Children, the U.N. and the U.S. Centers for Disease Control and Prevention (CDC) attended the DWB-organized session. They gathered in a tent designed to resemble field conditions in West Africa for a two-day program aimed at preparing health care workers for deployment in Ebola-stricken countries.

“As part of our response, we needed to beef up the training side and the handover of knowledge,” de le Vingne said. “In the field, the level of response is still very low, and compared to one week ago, [the epidemic] is even more out of control.”

One of the people at the training was Ali Herbert, a nurse with Samaritan’s Purse, the charity U.S. doctor Kent Brantly and Nancy Writebol worked with in Liberia when they became infected with Ebola.

Even in the cool temperature of a tent in Brussels — far from the tropical climate in West Africa — she and other volunteers were sweating inside their special protective equipment. Herbert said her experience as an operating room nurse helped her deal with the discomfort, although it wouldn’t come close to the real experience, when they will be dealing with one of the world’s deadliest viruses, which in this outbreak to date has killed 1,552 people and may have infected at as many as 20,000.

Herbert explained how learning “the sheer practicalities of how you manage a patient with Ebola, how you manage yourself,” would prove very useful in the event that Samaritan’s Purse decides to resume treating Ebola patients and she is deployed to West Africa. There she would be expected to continue her training locally and then be coached for 10 days in an Ebola clinic by an experienced professional, according to de le Vingne.

Another attendee, Robert Tauxe, deputy director at the CDC’s Center for Emerging and Zoonotic Infectious Diseases, said he was planning on setting up similar training courses in the United States after completing the two-day camp.

“[DWB’s] experience at this point is pretty much unique,” he said. “The scale [of the epidemic] is just too big. We need to have formal training like this.”

Through such programs, government, U.N. and NGO officials hope that more people will soon be deployed to West Africa to alleviate the acute shortage of field staff.

A rising toll of Ebola deaths

Local institutions are already stretched well beyond capacity. Liberia’s and Sierra Leone’s fragile health-care systems, already reeling after years of war, have strained even further under the weight of the new crisis. The WHO estimates that in the three hardest-hit countries only one to two doctors are available to treat 100,000 people. In the Liberian capital, Monrovia, DWB’s newly constructed 120-bed facility became overwhelmed with patients within hours, and the organization estimates at least another 800 beds are needed to meet the demand. 

During the crisis, the WHO has deployed about 400 people to field positions, but it is a figure that DWB says is insufficient.

Facing such criticism over its response, the U.N. health agency released a road map on Thursday that pledged to “dramatically scale up the international response."

WHO press officer Margaret Harris said, “We have already been sending plenty of people in, [but] we also recognize this outbreak needs much more. That is what the road map is all about — ramping up the response, getting more people on the ground, in the right jobs, doing what is necessary to end this outbreak.”

De le Vingne welcomed the road map but said that “it should not give a false sense of hope” over the prospect of quickly combating the outbreak. He said many questions remain, like, “Who has the correct training for the variety of tasks that are detailed? How long will it take to train organizations to set up and run an Ebola management center? How long before any new centers become operational? Who will undertake the vitally important health education, contact tracing and safe burials in the affected communities?”

He added that an uncomfortable lesson learned from this crisis is that “none of the organizations in the most affected countries — the U.N., the WHO, local governments, NGOs [including DWB] — currently have the proper setup to respond at the scale necessary to make a serious impact on the spread of the outbreak.”

Patients’ trust

A dummy at the Ebola training.
Lisa De Bode / Al Jazeera America

But getting more trained staff on the ground is only half the battle; winning the trust of the local population is also necessary.

Alongside advice on labeling decontaminant solutions and dressing safely, those attending the DWB program discussed more delicate matters regarding respectfully handling a body after death. One aid worker urged his workshop’s attendants to “avoid walking on the [body] bag.”

“We want people to trust us so that they actually come to be treated safely,” said Catherine Bachy, the DWB epidemiologist in charge of the training program.

A disconnect between public health officials and the people they serve has resulted in chaos in hard-hit areas. In West Point, a slum in Monrovia where about 75,000 residents were quarantined, an angry mob ransacked a local health facility, stealing contaminated mattresses and equipment. Some accused the government of manufacturing the crisis. Widespread panic has gripped affected communities, and people are reluctant to be separated from family members or fear the stigma that comes with Ebola, according to the WHO.

Calling steps like the quarantine an ineffective “coercive measure” that forces people into unemployment and encourages people to hide their sick or handle highly infectious corpses, Bachy urged governments to refrain from the tactic. Instead, isolation clinics where the patient remains visible to worried relatives — using transparent orange mesh fences or dedicated space in a tent from which the sick can greet visitors — are more conducive to inspiring trust among the population.

“They need to know what’s going on inside so that they voluntarily send their patients to us. That’s the only way it’s going to work to control the epidemic.”

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