By David Lewis and James Harding Giahyue
With the number of Ebola cases spiralling in West Africa and weeks remaining until treatment units promised by Western governments are built, health workers fighting one of the world’s deadliest diseases are being forced to improvise.
In the “hot zones” of Liberia, where Ebola patients are being turned away from overflowing clinics, aid agencies are distributing tens of thousands of protection kits, made up of buckets, chlorine, soap, gloves, a gown and instructions on how to look after the infected in their own homes.
In neighbouring Sierra Leone, authorities advise those waiting for an ambulance to isolate the patient in a room, designate someone to treat them and ensure this person uses gloves or a towel soaked in chlorine when they are in contact.
As experts ponder how nurses treating Ebola even in Western hospitals contracted the disease, such efforts in West Africa highlight the steps being taken to bridge the gap between the care available and what is needed in the epicentre of the crisis.
Aid organisations acknowledge that getting people with Ebola into a professionally-manned treatment units is the only way to halt the worst outbreak on record, which has already killed over 4,500 people and risks claiming thousands more lives.
But with ambulances overloaded and an insufficient number of beds in treatment centres, getting the sick quickly out of their homes to avoid infecting others is a major challenge.
“Sometimes that’s just not possible. When someone gets sick overnight, we have to ensure that they don’t infect others,” Sheldon Yett, the head of UN child agency UNICEF in Liberia, told Reuters.
“People really want to give help to people who are sick, but we need to ensure that when they give help to people who are sick, they don’t get sick too. These kits are designed to do just that – to break the circle of transmission.”
There is no known cure for Ebola and the limited stocks of experimental drugs have been exhausted. In treatment centres in West Africa, care involves preventing dehydration and helping treat other infections, with those who are diagnosed soonest faring the best.
UNICEF is supporting efforts to roll out 65 community care centres across Liberia. Units of 6-20 beds will be set up and manned by trained members of the community to look after people until they can be taken to an Ebola treatment unit.
Other organisations, like Medecins sans Frontieres (MSF) and Samaritan’s Purse, are handing protection kits directly to families living in communities most at risk.
Yet the high toll the outbreak has taken on health staff – 236 dead from a total of 427 infected in West Africa – highlights how dangerous the disease is even for professionals with training and equipment.
“It’s a very fine balance to try to provide adequate and efficient protection without providing full safety,” said Jens Pedersen, a South African who led MSF teams in Monrovia.
“If you aren’t sufficiently trained, regardless of what protective gear you use, if you don’t know how to use it or know how to look after yourself and an infected patient, there’s very little that protective gear can do for you.”
MSF says 16 of its staff have contracted Ebola, of whom 9 have died.
Some, but not all Ebola patients evacuated to Europe and the United States for better care in western medical facilities have survived. Those evacuated were mainly aid workers.
Drug firms are fast-tracking vaccine research and GlaxoSmithKline says if current trials are successful frontline health workers in West Africa would be vaccinated early next year.
First confirmed in Guinea’s remote southeast in March, Ebola spread across the country and into neighbouring Liberia and Sierra Leone, where it has torn through ill-equipped health systems in nations recovering from years of conflict.
Medics in Liberia, home to the world’s largest natural rubber operation, lacked rubber gloves to treat patients.
The global response has accelerated as cases reached the West. Hundreds of millions of dollars in aid has been pledged, the US and British militaries are deploying and volunteers from across the globe are signing up to help.
Yet the effects on the ground have been slow to materialise. So far, Liberia has 620 of 2,930 planned beds for Ebola cases. In Sierra Leone, there are 346 of 1,198 planned beds.
UN officials say the turning point for rolling back Ebola will be when 70 per cent of cases are hospitalised and 70 percent of those Ebola kills are buried properly.
Nigeria was declared Ebola-free on Monday after it successfully traced and isolated 300 people who had come into contact with an Ebola patient who brought the disease to Lagos in July.
Manuel Fontaine, UNICEF’s director for West and Central Africa, said providing care in community centres was an example of the ways in which an overstretched aid community was being forced to innovate to tackle an unprecedented epidemic.
“We’ve worked in wars or against malnutrition where we have pretty clear protocols. But here it is about adapting,” he said, adding that training and supervision, especially on how to dispose of used kits, was essential to ensuring they did not spread infection.
In Ebola units, medics follow a laborious 15-step procedure to undress without infecting themselves. Underscoring the risks even in highly-controlled environments, authorities in Spain said a nurse looking after an infected patient appeared to have contracted the disease after making a mistake.
MSF, which has led much of the medical response, says the epidemic’s scale demanded “unprecedented and imperfect measures”. It plans to distribute over 50,000 kits to patients turned away from hospitals and to those living in communities vulnerable to further infection.
MSF says the equipment should be for short-term use until an ambulance arrives and the kits are not intended for longer-term care. “It is just too dangerous. It is about just giving food and water,” said Thomas Curbillon, head of MSF’s mission in Liberia.
Samaritan’s Purse, a US-based charity handing out 3,000 kits and training to community members, said home care was not ideal but the lack of beds and extent of unreported cases meant it was already happening on the ground.
“Good, bad or ugly, it has been happening,” Ken Isaacs, vice president of programmes, told Reuters. “We believe we can give care givers knowledge and basic equipment to take care of their loved ones and take care of themselves.”
Latest estimates from the WHO warn that there could be 5,000-10,000 new cases of Ebola per week by December.
“I will acknowledge this is the least desirable option but there is no other option. We are dealing with is the reality of the situation,” he said.