Ebola: providing care to the care givers

With the speed of both the infection and deterioration of patients with ebola in the ongoing outbreak in the Gulu district of northern Uganda, there have been considerable safety procedures put into place to ensure the health workers and care givers working with those infected with ebola will have the highest levels of protection.

Ebola can be spread through any body fluid from the infected and can be passed on as easily as putting your hand to your face to brush a crumb from your mouth. In severe cases, the virus can be passed on through the sweat of the victim. As far as is currently known, ebola is always transmitted through body fluids.

Transmission

The disease can be transmitted through body fluids or secretions, using the same water, kissing or even sharing a cigarette. It is a brutal virus and, while inside the body, it can live easily in all
fluids such as blood, spit, sputum, vomit, faeces and sperm. Once outside these environs, Ebola is quite fragile. It can easily killed, but if nothing is done, for instance if a drop of blood is not cleaned, at least with some water and soap, then the virus can remain much longer than the HIV virus.

With such a fast spreading, fast acting fever in action, it is essential that high levels of awareness be passed on to the community and that those who work with the sufferers, whether the patients be alive or dead, have the highest level of protection.

Care givers are amongst the most vulnerable, and the point has been pressed home in this outbreak as three student nurses have already died from suspected ebola.

There is a health pamphlet that has been widely distributed through the Gulu district to all health centres and clinics. It serves as a broad gauge to identify those who have even the most remote chance of carrying Ebola.

If examined patients meet even the widest parameters, they are tested for possible infection.

The Centre for Disease Control (CDC) has set up a laboratory at the Laco hospital in Gulu District that allows for testing to happen immediately in suspect cases.

Increased awareness

Given the high state of awareness throughout the region, there is a positive tendency for people to seek medical care for any and all health concerns. What may seem excessive is actually proving beneficial as officials are more confident that people are aware of the likelihood of infection and the need for rapid access to medical care.

Although there is no cure or vaccination for Ebola infected people, the disease is not necessarily fatal. People can survive and success often happens when the person is well taken care of.

After the identification of an ebola infected case comes the necessary isolation. Before the outbreak was confirmed, cases were being held at the Gulu hospital where there was little restriction to
traffic nor an understanding of the need for careful isolation.

The facility has had dramatic alterations since the outbreak was identified. The ward has been completely fenced off. All workers in the isolation wards have to wear the protective clothing and follow the procedures for both putting on and taking off the gear. There is a one-way movement system in the hospital as well so that a worker can only move from a suspected case to a probable case, thus preventing the possibility of infecting a patient accidentally if the flow were from probable to suspected.

At the Gulu hospital, each patient is allowed one relative to care for them. This means there is a chance for the care giver to be infected if the proper safety procedures are not followed. Care givers are provided
all the necessary protective clothing and are instructed in the necessary steps required in both putting on and taking off the clothing.

Chain of responsibility

In addition, there is an organisational chart at the hospital indicating the chain of command/authority at the hospital where the care giver is at the base of the diagram. This indicates that every other person in the hospital has a fundamental responsibility for the welfare and safety of the care givers, ensuring they are watched over constantly so they do not become infected as well.

Minimising the spread of ebola has also meant a change in the customs surrounding funerals in the area. Traditionally, the body is bathed by the family and a feast is had before interment. With transmission
being so linked to fluids, the traditional cleansing is actually also a method of spreading the disease. Consequently, the Ministry of Health has asked that all bodies be buried as quickly as possible and
that the traditional ceremonies be avoided.

Should the person have died while in one of the ebola care hospitals, the body is sealed in a special body bag and transported for burial as soon as possible. However speedy burials are essential even if suspect deaths occur outside the hospitals.

Extensive care and safety procedures are in place for the transport, handling and burial of victims to prevent any chance of further contagion.

After the body has been transported, the vehicle is thoroughly cleansed. The individuals who have to handle the bodies are constantly cleaning themselves or their equipment.