Shoe-Leather Epidemiologist Blogging About Ebola In Sierra Leone
Gives Picture Of Situation On The Front Lines
Explains Why She
Volunteered To Go
A vivid account of the many faces of Ebola has been
provided by Kathryn Stinson, a University of Cape Town
epidemiologist who volunteered with Doctors Without Borders in Sierra
Leone. The shoe-leather epidemiologist was involved in contact tracing
investigations and, according to her latest October 29 blog, came to
see that “life and death in the context of Ebola is a health systems
issue.” She makes very clear why this is so by tracing the path of a
typical Ebola patient in her area of Sierra Leone and noting that
death can happen at any point in time along this chain of events.
Why Volunteer?
In her first post on October 26 on Ground Up, a
community journalism project website in South Africa, Stinson, who is
married with three children, explained why she was volunteering to go
to West Africa. “Perhaps I am crazy, but I have the tools of the trade
and I need to help…We are sharing a continent with others who are
bearing the consequence of a foundering health system that is in turn
betraying its own people. While fully understanding the risks, it’s
time to put my money where my mouth is. I need to plot that epidemic
curve for real. Hence the question isn’t about whether I should be
doing this, but rather how can I not do this?”
Patient Journeys
Below are the excerpts tracing the journeys of patients
in Sierra Leone.
“…The
identification of an Ebola suspect in the community to a large extent
depends on a well-functioning surveillance and alert system. There is
a national toll free Ebola number, and these calls are taken by
Freetown and then distributed accordingly at district level…
Suspects Identified
…Once a
suspect is identified, a surveillance or health officer will visit to
verify the case. If thought to be Ebola, an ambulance will be called,
and contact tracing is initiated. Given that there are only two
operational ambulances to cover the district, waiting for an ambulance
is a grim reality. Holding centres also operate out of previously
functioning primary health care clinics where suspects are sent to
wait for the ambulance. Regardless, there are often too many suspects
waiting, and since the ambulance can transport only six patients,
during my time in Kailahun, there was speculation that the sickest
were most likely to be left behind...
Ambulance Journey
***After boarding the ambulance, the sick passengers
endure a torturous journey of up to four to eight hours to the
treatment centre. While these ambulances are 4x4 land cruisers, there
is no space to lie down no matter how sick one is feeling. One is
lucky to make it at all, and ambulances have suffered the misfortune
of many other vehicles on Sierra Leone roads - that of getting stuck
for hours on a stretch of road that has been reduced to soft,
meringue-like mud after the rains...
...Infrastructure for laboratory testing of Ebola is limited. Tests
are done at one hospital referring to the treatment centre. While a
majority of the patients arriving at the treatment centre result in a
laboratory-confirmed case, there are those who get on board who are
negative. One only has to think of models of TB transmission in South
African taxis to consider that the opportunity for transmission after
such a long and bumpy ride (including contact with body fluids) is
considerable...
Triage
...Identification of patients at triage is crucial and our staff have
a high rate of getting it right. This means identifying those who suit
the clinical criteria as a suspect versus those who are probably
infected. A blood test is needed, this taking several hours –often the
next day given the late arrival of the ambulances– for the result to
confirm the diagnosis. There is a need for an accurate rapid test,
preferably an oral swab which minimises the risk of exposure to health
providers, and allows for patients to be triaged before they start the
long journey to the treatment centre...
Deaths
...Death
can happen anytime along this chain of events. Given that days five to
nine are the most critical days, much rests on the ability of the
health system to identify a case and deliver them timeously to care.
Those who die in the ambulances or soon after probably had to wait too
long. There is speculation about those who arrive with low viremia
(amount of virus in their body) that perhaps they are in recovery.
Again, this is dependent on an optimized surveillance system, as well
as contact tracing and case investigations being carried out
immediately and thoroughly after the identification of a suspect or a
community death...
To read
the full blog of October 26 and earlier ones , visit:
http://tinyurl.com/pbmtha8
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