Survivors bring shocking realism to Ebola treatment boot camp

A delirious man staggers through a hospital ward, banging
into walls until he is overpowered by nurses in protective
suits. Trainers are using survivors of the Ebola virus to give
frighteningly realistic courses to medical staff fighting the
disease in Liberia.
The World Health Organization has constructed a mock
Ebola Treatment Unit (ETU) in the capital Monrovia where
doctors, nurses and medical students, some sent by the
African Union, are being drilled in how to treat and deal with
the dangers of the disease.
Doctors Without Borders (MSF), the medical charity that has
been at the forefront of the fight against the epidemic, has
been insisting that training health workers is key. Trainers
constantly drum into the students that a treatment unit is
useless if it lacks competent staff — which is the case almost
everywhere.
“We tell the health workers that our role here is to protect
ourselves and save lives,” said Shevin Jacob, one of the WHO
trainers who worked on previous Ebola outbreaks in Uganda
and the DR Congo.
Training takes two weeks — three days of theory classes,
then two days in a mock ETU before working for five days in
a real unit under the beady eye of a mentor.
After the students get their certificate they are plunged into
the horror of the real ETUs, where mortality rates can reach
60 to 70 percent.
“Many are afraid, they all have lost colleagues to the
disease,” said Jacob.
Liberia is the worst hit of the three countries most affected
by the disease, with an official death toll of 2,069, according
to the latest WHO figures released on October 1.
West Africa’s nurses and doctors had never been confronted
with the virus before the latest outbreak and so did not
know how to protect themselves. They have paid dearly with
their lives, with more than 200 dying across the three
countries, whose already shaky health systems collapsed
under the strain of the epidemic.
– ‘Something needs to be done’ –
In the “red zone” of the mock unit, where the sickest patients
are treated, a woman sprawls groaning on a filthy mattress.
The six survivors of the disease who are taking part in the
programme bring a shocking realism to proceedings.
Jacob explains the scenario. “It’s a woman of 24 who has
been vomiting and who has diarrhoea, which has been
getting worse over the past 24 hours. There is no bed for her
in a medical unit. So we have to find a way to treat her in the
meantime.”
The carers, pouring with sweat inside their protective suits
dripping with disinfectant, try to calm her.
She begs for water then “vomits” all the water she was given.
Ebola passes through body fluids — so vomit cannot be
simply wiped up. Instead a health worker must slowly and
methodically douse it with disinfectant.
“And now what do you give her?” Jacob asks the students.
“An intravenous drip,” says doctor Nuah, his voice muffled
by the protective mask which hides his face. Like his
colleagues, his name and his job is written on his protective
suit in red marker pen.
And so the training section called “managing a sick patient
when a unit is full” gives way to the part on dealing with a
“confirmed case”. Then the volunteers move on to how to
cope with a patient who is so confused he is banging into
walls, and who goes into convulsions after nurses put him
down on a bed.
“I decided to be part of this training because it’s something
that needed to be done,” said Kobah, one of the fake
patients taking part in the role play.
“We need to improve the ETUs,” she added. The units are
often overcrowded and under-equipped, short of personnel
and do not reach the standards of hygiene and security
necessary to beat the disease. Some are no more than
places to die.
A medical assistant herself, Kobah knows exactly what she is
talking about. “I had Ebola in August. They took me into an
ETU on August 6 and I was discharged on August 28. I want
to help train the people who will save Liberia.”
The WHO hopes to train 400 health workers in eight or 10
weeks under the programme. Experts estimate that Liberia
needs several thousand to defeat the disease.

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