In an interview with Open Access Government, Dr Ibrahim Socé Fall, WHO Health Emergencies Director for the African Region tells us about the excellent work that WHO Regional Office for Africa is doing around Ebola in the Democratic Republic of Congo (DRC), near the border with Uganda
Doctor Ibrahima Socé Fall is the Regional Emergencies Director leading the newly established WHO Health Emergencies programme (WHE) at the WHO Regional Office for Africa. His background includes his work as a WHO Representative in Mali during the political and humanitarian crisis when WHO needed strong leadership and expertise to deal with complex emergencies. Dr Fall was trained as a military physician and has over 25 years’ experience in medical practice and public health.
In an interview with Open Access Government, Dr Fall details the excellent work that WHO Regional Office for Africa is doing around Ebola in the Democratic Republic of Congo (DRC), near the border with Uganda. This includes the work communication experts from the Ministry of Health, WHO and other partners are doing in terms of providing all the required information on the appropriate preventive measures to be observed in respect of Ebola. We also find out about the challenges around managing an outbreak of Ebola and why is it important to engage with key communities and raise awareness of symptoms, as well as what to do if a case is suspected.
What is WHO doing to scale-up a new front against Ebola in the Democratic Republic of Congo (DRC), near the border with Uganda?
WHO currently has about 300 specialists deployed to DRC to support the response. In Goma, the scale-up of the response team across all pillars is underway with WHO and partner staff.
Activities in North Kivu include: risk communications/ community engagement, contact tracing, safe and dignified burials, case management (patient care), provision of therapeutics, vaccinations, the survivor programme, infection prevention and control (IPC), support for laboratories, and supporting preparedness and readiness.
In DRC, preparedness activities continue in all border districts. Fifty key points of entry in affected areas have strengthened capacity to rapidly detect and respond to potential Ebola cases. Close to six million travellers have been screened at these points of entry since the beginning of screening.
Outside of DRC, WHO’s regional preparedness plan prioritises neighbouring countries based on proximity to North Kivu:
- Priority 1: Rwanda, Uganda, South Sudan, and Burundi;
- Priority 2: Angola, Congo, Central African Republic, Tanzania, and Zambia.
WHO has deployed Preparedness Support Teams to these countries.
In Uganda, WHO has provided extensive support for preparedness activities. Uganda began vaccinating health and frontline workers in high-risk areas on 7th November. As of 30 November, more than 1,500 health and frontline workers in 51 health facilities have been vaccinated. It is expected that 2,100 doses of vaccine will be administered to health workers in the country. If no Ebola case is confirmed in Uganda, these vaccinations should have been completed by late December 2018. WHO has provided the technical support and guidance to the Ugandan Ministry of Health in the areas of protocol development, development of standard operating procedures (SOPs), implementation planning, training of vaccination teams and financial support for the vaccination exercise, including the vaccine.
WHO has also supported Uganda through the hiring and deployment of technical staff in a surge capacity; through technical advice and support to all pillars of preparedness; and resource mobilisation.
WHO has set up Ebola treatment units (ETUs) in all high-risk districts; supported collection, transportation and testing of blood samples from alert cases; trained frontline health workers on surveillance and infection prevention and control (IPC); and supplied materials used at the points of entry for screening.
Other countries are also stepping up preparedness activities.
South Sudan has just completed the construction of a 24-bed ETU in Juba to isolate and treat any Ebola patients, should the need arise. WHO has deployed 15 experts to support Ebola preparedness activities in South Sudan.
In Rwanda, preparedness efforts have focused on increased community engagement, as well as support for strengthening surveillance, laboratory, epidemiology, infection prevention and control and patient care capacities. Health screening is being conducted at all high-risk border crossing points. And a health facility in Rubavu in Rugerero district (near to Goma in DRC) has been repurposed as an Ebola treatment centre.
Likewise, Uganda remains on high alert and is implementing a series of activities to ensure preparedness. These activities include border screening, community-based and health facility surveillance, collection and testing of blood samples from alert cases, and capacity building for infection, prevention and control. Other efforts are focused on clinical management, psychosocial care, safe and dignified burials, risk communication and community engagement, and cross-border surveillance.
Tell us about the work communication experts from the Ministry of Health, WHO and other partners are doing in terms of providing all the required information on the appropriate preventive measures to be observed in respect of Ebola
Risk communications and community engagement experts are working across all areas of the response. Experienced staff are embedded in contact tracing teams, in safe and dignified burial teams, inpatient care teams, and in infection prevention and control work. These experts are also actively involving formal community leaders, religious leaders and informal influential community groups, and private sector workers (including those in the transport sector, pharmacists, and formal and informal health care workers, including traditional healers).
In this vein, what are the key issues when it comes to surveillance and vaccination?
Most communities support the response. The Ministry of Health, WHO and partners continue to work closely with communities and are able to provide vaccines to contacts and treatment to those who are sick. However, faced with rumours and misinformation, some families have chosen to care for sick relatives at home; some patients leave health care centres to find alternatives or actively avoid follow up. This increases the risk to themselves, their relatives and health workers, and contributes to the spread of the outbreak.
How are cases of Ebola controlled? What are the challenges around managing an outbreak of Ebola?
Managing the current Ebola outbreak in the difficult and dangerous operating environment of Kivu is particularly challenging. There have been numerous security incidents, particularly in Beni and Butembo. The majority of these have targeted UN peacekeepers but incidents have at times impeded the response or temporarily shut it down altogether. There have also been incidents of community resistance. Community violence has at times also impeded the ability of burial teams to conduct safe and dignified burials.
One of the other challenges in this outbreak is the number of health workers infected. Health workers are particularly vulnerable to being infected by Ebola as they are one of the first points of contact. They can also amplify spread as they have contact with many patients. In order to protect themselves and others, health workers need training, supplies and facilities that permit them to practice infection prevention and control. WHO and partners such as the International Rescue Committee are working with health centres in the Ebola-affected areas to provide training and supplies (181 health centres decontaminated, and over 400 health workers trained). It is an uphill battle considering the sheer number of centres and the lack of adequate infrastructure (often no electricity and no piped water). Over 8,700 frontline and health workers have also been vaccinated, which is another line of defence for them.
Finally, why is it important to engage with key communities and raise awareness regarding the symptoms of Ebola and how to prevent it, as well as what to do if a case is suspected?
Community engagement is an essential part of any disease outbreak response. In the context of Ebola, it is particularly critical as the severity of symptoms and the rapid deterioration of health can lead to fear and misunderstanding of the cause of illness and death. Some of the recommendations to stop the spread of Ebola may interfere with local beliefs and practices and cause disruption to the lives of local communities.
The control of Ebola is resource intensive and requires adequate early detection of people suspected of being infected with Ebola, rapid laboratory testing, treatment of patients who are confirmed of Ebola infection and follow up of their contacts for at least 21 days so that those who develop signs and symptoms of the illness are quickly identified and provided with early treatment. The funerals of Ebola victims should be performed in a safe and dignified manner, with respect for grieving families.
Early communication of Ebola risk and engagement with local communities and health workers is pivotal to the prevention and control of an Ebola outbreak. To communicate effectively with communities, response teams must approach community leaders and members in a way that seeks first to understand their perspectives, solicits their inputs, shares information, and engages them in the response to the outbreak.
In addition, information must be shared in a manner that allows individuals and communities to learn (receive information and ask questions) and to make informed decisions about how to protect themselves, their families, and communities. Community leaders and members must be a part of, and have an influence on, response efforts. Effective engagement involves on-going interactions that include adjusting risk communication strategies in response to community signals.
Dr Ibrahima Socé Fall
WHO Health Emergencies Director for the African Region
WHO Regional Office for Africa
Tel: +(47 241) 39402