LeaderNet West African Ebola Seminar Summaries: Community-Based Preparedness, Surveillance, and Response

LeaderNet West African Ebola Seminar Summaries: Community-Based Preparedness, Surveillance, and Response

 {Photo credit: Ian Sliney/MSH.}"Let's prevent Ebola together" billboard in Liberia.Photo credit: Ian Sliney/MSH.

Management Sciences for Health (MSH) hosted an interactive, three-day, online seminar on the West African Ebola outbreak on LeaderNet.org, October 28-30, 2014. Edited summaries from seminar facilitators (MSH Global Technical Lead on Malaria and Communicable Diseases, A. Frederick Hartman, MD, MPH, Days One-Three, and co-authored by Independent Pandemic Planning Advisor, Lisa Stone, Day Two), appear below. You can access seminar archives, including resources for preparedness and response, by joining LeaderNet.org.

Day One (Oct. 28): Mobilizing community-based care

Many thanks to the 240 individuals from more than 50 countries who have signed on to participate in the LeaderNet Ebola seminar so far. I am very impressed with your interest and enthusiasm in discussing, and ultimately controlling, this massive Ebola outbreak.

One consistent theme today in the comments is the emphasis on community mobilization and involvement in the response. At Management Sciences for Health (MSH), our focus is in Liberia; so I will respond based on our current experience. The Government of Liberia, with the active support of the US Government, is building 17, 100-bed Ebola Treatment Units (ETUs). The ETUs are large and run like hospitals: with intensive care for the active Ebola cases provided in isolation units by physicians and nurses. However, only 50 percent of the ETU beds are full.

Where are the patients?

Several possible reasons have emerged: 1) The peak epidemic curve has passed and we are now on the downside. (If true, the downturn may be temporary; and we need to be ready to respond.) 2) Patients are staying home and not presenting to the ETUs. There is plenty of evidence that number two is occurring.

Either way, there is a need to move Ebola care closer to the community in a culturally appropriate setting.

Liberia is actively considering the concept of Community Care Centers (CCCs), smaller 10-20 bed units located in “hot spot” communities, managed by members of the community (including trained health workers and well-equipped family caregivers), and supported by NGOs. Community “champions” are volunteers trained to detect new suspect cases and support families and patients to enter into the CCCs and be cared for by family members with Ministry of Health and Social Work (MOHSW) staff supervision. NGOs train and support ministry staff. Family members receive appropriate Personal Protective Equipment (PPEs) and are supported in the care of their family member. In these ways, Ebola patients and their families are cared for and supported in a culturally appropriate way in the community, including safe and appropriate burial practices.

We believe that once Ebola care and isolation is located within the community, more patients will come forward and more effective contact tracing will occur, thus breaking the chain of transmission.

[Community care center for survivors, Annex 3.] {Photo credit: Fred Hartman/MSH}Community care center for survivors, Annex 3.Photo credit: Fred Hartman/MSH

Liberia has decided not to support home-based care, feeling that it is not of high quality and will perpetuate the chain of transmission through infected care givers. Even though home care kits exist, they are not officially endorsed nor being distributed. The focus is on establishing the CCCs and making them effective.

I look forward to seeing you on LeaderNet again tomorrow as we discuss the role of strengthening Integrated Disease Surveillance and Response as well at the Framework for Ebola Response and Recovery at the Local Level. Many thanks for your input, please keep the good comments and ideas coming.

Day 2 (Oct. 29): Strengthening outbreak surveillance and response

Co-authored with Lisa Stone, independent pandemic planning advisor

It’s wonderful to see the LeaderNet Ebola seminar filled today with more than 260 people from 60 countries—as far-ranging as Liberia, Australia, Pakistan, Uganda, United Arab Emirates (UAE), Kenya, Cote d’Ivoire, Belize, Cameroon, Hong Kong, and US.

A strong Integrated Disease Surveillance and Response (IDSR) is the first line of defense against introduction of Ebola, or any other novel pathogen. There is no question that a weak IDSR and overall weak health systems are important factors in the rapid spread of Ebola in affected countries. In countries with stronger health systems—e.g. Nigeria—Ebola was well controlled.

Perhaps the greatest lesson learned from this tragic outbreak is the need to be eternally vigilant and not get complacent, to constantly challenge our IDSR with “test” cases, and to ensure they work well. Our surveillance and response systems need to be constantly challenged to stay sharp.

Along with the discussion on IDSR, we also introduced the Framework for Ebola Response and Recovery at the Local Level. There was interest in using the Framework in both affected and non-affected countries. It was good to hear agreement that even taking Step 1, establishing a Local Coordinating Committee, would be helpful. There is such a value in preparedness!

We also appreciate the difficulty of using the Excel-based tool at the local level; there is a pen and paper method that accompanies it where computers are not available.

Thank you for this great discussion! Tomorrow, the final day of this seminar, we will discuss the role medical stores can play in prevention, detection and access to routine care. We will also talk about ideas for next steps and how we can best work to overcome the threat of Ebola.

[Ebola outbreak response: Regional confirmed and probable cases, 20 Oct. 2014.] {World Health Organization (WHO) map}Ebola outbreak response: Regional confirmed and probable cases, 20 Oct. 2014.World Health Organization (WHO) map

Day 3 (Oct. 30): Preparedness, Response, and Next Steps

Many thanks to the large number of participants (over 260) on day three of the exciting Ebola LeaderNet seminar! Many people commented on ways in which we can respond to the current Ebola epidemic in West Africa, and also prevent Ebola from gaining traction in other countries.

Liberia continues to show encouraging news of a decline in Ebola deaths and new cases that we hope continues as a trend. However, we all agree that we need to be vigilant, since undetected cases in urban neighborhoods or in rural communities could continue the chain of transmission and lead to an upsurge in new cases in another wave of the epidemic.

We discussed how moving case detection, isolation and contact tracing closer to the community is an evolving strategy designed to locate culturally appropriate community care centers (CCCs) in “hot spot” neighborhoods and communities. This strategy, combined with effective community mobilization, will hopefully identify more new cases and isolate them in the CCCs, where the bulk of the care is provided by family members, appropriately protected and trained. This will interrupt the chain of transmission in West Africa.

The potential introduction of new cases of Ebola into new countries is very real. Mali is now experiencing an outbreak after family members brought a two year old girl into the country from neighboring Guinea after her mother died of Ebola. That outbreak is now being aggressively contained, and, hopefully, Mali will follow the model established in the control of new outbreaks in Nigeria and Senegal.

We agree that strengthening existing Integrated Disease Surveillance and Response (IDSR) systems in non-affected countries is the best defense to the spread of the epidemic. In addition, utilizing the Framework for Ebola Response and Recovery at the Local Level developed by MSH can strengthen the capabilities of local IDSR teams to detect, respond, and contain any new outbreak quickly. It can also be used to respond effectively if Ebola breaks out of the local response and containment efforts and spreads to other geographic areas.

[Accredited drug shop in Liberia.] {Photo credit: MSH staff.]Accredited drug shop in Liberia.] {Photo credit: MSH staff.

We described a novel approach to improving Ebola surveillance and education through private medicine vendors: using laser thermometers and Android phones equipped with the KoBo toolkit to report new cases of fever that could be Ebola. We know from experience and community-based surveys that 50 percent of people with fever will first consult the private medicine vendors. We need to train and equip these medicine sellers to contribute to the Ebola control activities—not just sell medications.

Many of you commented positively on the potential of harnessing the private sector for Ebola control, and we need to think creatively of other ways to achieve this objective.

Finally, we outlined a planned set of activities to train staff worldwide, to address the emergency Ebola situation in Liberia and other West African countries, and to support and strengthen case detection, response, and containment in non-Ebola countries.

You had many creative comments on how you could support your own country programs, and we hope this seminar has stimulated you to become more actively involved. No country is immune to imported Ebola. Many thanks for your input, it has been enlightening and educational, as well as an honor to work with you.

The three-day, interactive seminar concluded October 30. You can access seminar archives, including comments, summaries, and resources, by joining LeaderNet.org. Learn more about the Framework for Ebola Response and Recovery at the Local Level here.