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Summary of day 1: Lessons for East Africa from the Ebola outbreak

Segenet Kelemu, Michael Katende and Jackson Amone

Welcoming delegates to Kenya

The conference opened with words of welcome from Dr Segenet Kelemu, the Director General of icipe, on whose Duduville campus the conference is being held, and from Dr Michael Katende, Principal HIV and AIDS Officer/coordinator for the EAC’s Integrated Health Programme.

Commemorating painful times

Dr Jackson Amone, the Chair of the Delegation of Partner States, then made some opening remarks, in which he briefly described his own experiences of working in the UN Mission for Ebola Response in Sierra Leone, and welcomed the opportunity to meet with colleagues who had worked with him there and to meet new colleagues who had worked in other countries in West Africa.

He thanked the EAC and GIZ for organising what he described as a very important meeting. Working in West Africa during the Ebola epidemic was, he said, “painful at the time, but we need to commemorate that time.” A multi-sectoral and multilateral approach to tackling such outbreaks was very important, said Dr Amone, but above all political will and support was crucial. He wished that more politicians had been able to attend the conference to hear what the delegates had to say: “We need to appeal to our governments to prepare themselves….Ebola is still a big threat and we really need a concentrated effort across different capacities. Sharing experiences is key. We need to plan for the future.”

Opening speech by Dr Monikca Musenero

Dr MusenĀ­ero

Dr Musen­ero was WHO Field Coordinator in Bombali, Sierra Leone, and is still working with the WHO Recovery Team there. She trained as a vet, worked as an academic for 10 years and then trained as an epidemiologist, so her own background is an example of the multi-sectoral approach advocated by Dr Amone. She also co-ordinated the response to Uganda’s 2007 Ebola epidemic outside the epicentre, and of working with many different agencies.

But even this experience, said Dr Musen­ero, had not prepared her for the shock she felt when she arrived in Sierra Leone around seven weeks into the outbreak: “Never in my life did I imagine such an epidemic. It dwarfed everything that had gone before.” She knew that the response needed to be rapid but saw a situation that was spiralling out of control in the wake of Sierra Leone’s bitter civil war that had battered and destroyed its already-weak health systems.

She said a key event in the spread of Ebola was the burial of a traditional healer. Over 300 cases were subsequently traced to this one funeral. When the first urban outbreak occurred in Kenema city, Dr Musen­ero said the confusion was very frightening: 30 local nurses had been admitted and the only doctor died when shortly after she arrived. “It was very scary.”

She described the effects of Ebola on one street where 68 people lived. Only 15 people survived, and seven were not infected. An entire family of 18 people died. “It was the most scary place I have ever been – you felt Ebola was in the air”.

Dr Musen­ero said that there are many lessons to be learned from West Africa’s experiences:

  1. We need to build technical capacity to be very sure it is there – not to simply assume we have it.
  2. Case management and infection control is critical – but don’t lose trained staff.
  3. Surveillance and laboratory systems need to be established with trained people. Seven weeks into the outbreak in Kenema, there was still no system.
  4. Social mobilisation and communication are vitally important. Dr Musen­ero described a “near disaster” when what she described as a mentally disturbed woman convinced people that nurses were trying to kill people, and angry people stormed the centre.
  5. Logistics and security are key. “We lost quite a few security men because they had not been trained – when patients tried to escape they sometimes got infected when trying to restrain them.”
  6. Finance and mobilization. Dr Musen­ero said that 10-12 weeks into the outbreak there was no money to pay for responders, and a strike called by local health care workers was a major problem.
  7. Effective communication is crucial, especially in a situation where patients and their families are distressed and ill-informed and local health workers knew little about the disease.
  8. Leadership and management are absolutely vital, especially in fast-moving epidemics. If structures and systems are not established in advance, it becomes very difficult. Leadership is crucial. “I no longer take it for granted because of the experiences we had at the frontline”.
  9. Harness politics to positively impact the outcome, especially in complex situations.
  10. For three years in there was no economic activity going on – the schools and markets were shut. “We need to end an epidemic as quickly as possible so we don’t get such chaos.”

Caring for the carers

After detailing the lessons that she herself had learned in West Africa, Dr Musen­ero concluded her remarks by saying that love is a crucial component of care - Love for the patients and their families, but also love for the medical staff working in such crises: “You need to know when to stop and rest. A dead Monica is no good to anyone”.

“You put on a front that you are ok, but there’s a lot of stress. Each day you’re not sure if you’re been exposed. There was a lot of ‘psychological Ebola’ where people are constantly taking their temperature or struggling to deal with the stress of daily life.”

She described how many of the health workers who survived an Ebola outbreak had had a hard time adjusting to life at home. They felt that their experience not used or recognised or that they did not fit in. Many suffered post traumatic stress disorders on their return, “just like a soldier”. Care for the carers needs to be organised so that they are given opportunities for counselling and greater understanding of what they had gone through. Dr Musen­ero described how, after five months on the “front line” without a break, she had nightmares about dead bodies.

Dr Musen­ero concluded her speech by asking delegates to take a moment to remember their compatriots who had died and she hoped that they rest in peace.


Sharing experiences

Delegates in working group

After the opening speech, delegates then broke into small groups to introduce themselves to each other and share some initial experiences.

The conference will continue by exploring four themes on day 2:

  1. Being ready at short notice (establishing a pool of rapidly deployable experts)
  2. Taking informed decisions (effective communication to mitigate risks and crises)
  3. Working together (interdisciplinary teams working across silos an implementing the One Health approach)
  4. Organising effective logistics (what when, where, how)

A further four themes will be selected by the delegates themselves for discussion on day three, as they begin to discuss and collate the lessons learned from their shared experiences.

Ruth Evans, Nairobi


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