Transmission of Ebola within the health system (13)

10 May, 2019

If health authorities and facilities are not talking to victims / families of nosocomial infections, it is plainly bad care! And that is why many of us are looking to see the updated '˜communication plan' that has been promised, by DRC authorities to engage and involve all the stakeholders in this epidemic that has infected over 1,600 persons and still rising.

The decision Whether to take every infected or suspected Ebola case to a health facility or manage them in the community, must be a local decision by those on the ground and facing the consequences of this tragic epidemic. [*see note below] Matters to consider include the resources (material and human) available for either option; the understanding, collaboration and compliance of the community as a whole to which option; where would it be more effective and quickest to contain, manage and eliminate the epidemic.

This reinforces the maxim that context is everything. Lessons can and must be learnt from previous and every incident but one size will not fit all occasions. To adopt but localize is the way forward.

Joseph Ana

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group: jneana AT

[*Note from HIFA moderator (Neil PW): Thank you Joseph. This question of what do do with a suspected case of Ebola in the community is critically important. I had always assumed (perhaps wrongly?) that all suspected Ebola cases in the community should be transferred/admitted to an Ebola Treatment Centre if at all possible. I have been searching on the WHO website for guidance on this, and - very surprisingly - I could find very little. Most of the guidance I could find on the WHO site is on management once the patient has been admitted to an Ebola Treatment Centre, not on what to do with a suspected case in the community. After searching for half an hour, I eventually found the following text in the WHO Pocket guide: Clinical management of patients with viral haemorrhagic fever (20-16):

'The identification of a suspect, probable or confirmed case of Ebola should trigger a “live alert” or an alert based on a suspect, probable or confirmed Ebola death. Laboratory confirmation should not delay the initiation of contact tracing. When a potential Ebola case is first detected at a health facility or in the community, the Case Investigation Team should be immediately mobilized to investigate.'

I would be grateful for clarification from HIFA member Elhadji Mbaye who is on the front line in Butembo DRC, or from others with expertise on this issue. Thank you]