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How MSF staff stay safe on an Ebola assignment

12 Aug 2019

While the population pays the highest price during the on-going Ebola outbreak in Democratic Republic of Congo, it is important for health workers to remain safe and prevent being infected too. Perth-based Dr Saschveen Singh worked as a Medical Activity Manager at Butembo Ebola Treatment Centre from September to November 2018 and shares some of the precautions she took.

Saschveen Singh prepares to head into the red zone, inside the MSF-supported Ebola treatment centre (ETC) in Butembo in November 2018. © John Wessels / MSF

"When I was placed at an Ebola treatment centre in Democratic Republic of Congo (DRC), my friends and family first asked me why on earth I wanted to go there; and, second, what I would do to stay safe from contracting Ebola. The thought of working in a complex disease outbreak setting is confronting enough, and then you have the added challenges of DRC’s North Kivu and Ituri provinces.These are conflict zones with a crippled health infrastructure, already struggling to cope with everyday killers such as malaria, pneumonia and malnutrition, let alone Ebola.

A year since the outbreak began, political instability and ongoing mistrust mean it’s not yet under control. That’s despite a new Ebola vaccine – which is still in the clinical testing phase but appearing to be effective – and a handful of trial therapies also showing promising results. But there are many ways Ebola workers can stay safe:

 

Mind and body preparation

1. Intellectual: being up to date with information and research on the Ebola virus, the signs, symptoms, diagnostic and treatment methods;

2. Psychological: being emotionally prepared - ready to work long hours, in a remote setting, far from family and creature comforts. It’s being ready to face many challenges, including insecurity due to armed groups; and despite all best efforts, seeing many deaths from this tragic illness;

3. Physical: being in good shape. Working in a treatment centre is physically demanding: the protective equipment is cumbersome, and it can get very hot and difficult to breathe.

 

Vaccinating against Ebola

There is a vaccine available for Ebola, which is being used to curb transmission from patients to their families and contacts, and to health workers. I received this vaccine as soon as I arrived in the DRC, and although we cannot assume it offers 100% protection or can replace meticulous infection control procedures and protective equipment, it is still an important tool.

Preventing other infectious diseases

Preventing malaria is essential. Taking doxycycline or malarone is a pre-requisite, and mosquito repellent is important! But flu-like illnesses, gastroenteritis, chest and skin infections need to be prevented. If you develop a fever, it can be impossible to tell at first whether it’s Ebola or a common cold, so you need to be vigilant. Otherwise you can end up in quarantine and be medically evacuated for Ebola testing and treatment.

 

Personal protective equipment (PPE)

The PPE required for viral haemorrhagic fevers such as Ebola and Marburg has to be meticulously applied and removed in the correct order. Each layer you remove must be decontaminated with chlorine spray.

MSF staff at the Beni transit centre get ready for their round in the high risk area. December 2018. © Gabriele François Casini / MSF

Handwashing

There are handwashing points everywhere, with soap and water and chlorine. As a doctor I’m used to washing my hands frequently, but on an Ebola assignment there’s a whole new level: you wash your hands a hundred times a day.

 

No touch policy

Don’t touch your face! No rubbing your eyes or touching your mouth. This further reduces the risk of contamination. And it is forbidden to touch other people, not easy when even a hug to comfort a distressed colleague is impossible.

Temperature monitoring

Recording your temperature at least twice daily during your assignment and for a further 21 days afterwards. This becomes part of your normal existence, but each time it is a long (and sometimes anxious) minute as you wait for the “beep” on your thermometer to indicate the all-clear.

 

Emotional wellbeing

Although the internet connection in North Kivu was patchy at best, thank goodness for WhatsApp for keeping connected with home! Creating connections with team members was also key. That meant looking after each other when times were tough, and enjoying a few social activities: music, playing cards, even having a laugh over a beer."

 

A version of this article was previously published by the Travel Medicine Alliance