U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s be effective for a highly mobile population whose movement patterns reflected not just trade routes but social networks and kinship visits. The response by airlines in cancelling flights to the affected areas of West Africa, which Wilkinson and Leach describe as ‘hysterical’, made it difficult for the international mobilisation of health workers and essential goods to the area. The initial response from officials warning people against eating bush meat was another myth that Wilkinson and Leach maintain was irresponsible in the extreme, depriving people of essential protein and suggesting that Ebola was transmitted from animal to human rather than human to human. An opportunity was lost for education on the safe use of bush meat and honesty about transmission of the virus. Implementing a centralised treatment model and failing to work with communities was another misleading assumption that cost lives. The distances and the roads made it impossible for sick people to make the journey. Community education, engagement and co-operation at the local level from the beginning would have done more to halt the spread of Ebola, identify infected people and trace contacts. Working with communities to find solutions for dignified burials, Wilkinson and Leach state, would have contributed to a greater understanding of the way the disease spread, and allayed fears about the reason for decisions made and the dehumanising personal protective equipment worn by health workers. The Commonwealth response The Commonwealth Nurses and Midwives Federation (CNMF) has a close relationship with the Sierra Leone Nurses Association (SLNA), which advised the CNMF in late June of the deaths of three nurses from EVD. This was reported in the July 2014 issue of the CNMF e-News and messages of support from other CNMF members were sent to the SLNA, with regular communication and support established. Could the CNMF have done more? Yes, of course. An attempt was made by diaspora nursing groups in the United Kingdom to enrol volunteer nurses and midwives from all Commonwealth countries to go to Sierra Leone under the auspices of the UK government. Despite the fact that a positive response was received from nurses in Commonwealth countries outside the UK, the logistics of gaining permission from their own country to travel to Sierra Leone, the implementation of travel restrictions to West Africa and the uncertainties within the UK programme as to how they could ensure the safety of volunteers from other countries, meant that the programme was limited to UK nurses only. Putting out a call for individual nurses from Commonwealth countries to donate personal protective equipment to send to Sierra Leone was not a feasible option with flights suspended to the region. Continuing to raise awareness and encouraging nurses to do the same at a national level was considered the only option available, but it was grossly insufficient. On 1 August 2014 the Secretary-General of the Commonwealth issued a statement offering condolences, and expressing appreciation and encouragement to health workers treating the sick at personal risk to themselves, as well as commending the response of the international community (Sharma, 2014). On 17 October 2014 the Secretary-General announced that the Commonwealth Secretariat had funded an expert to provide technical assistance in Sierra Leone to the government to prepare Ebola response plans at the local-government level. In January 2015 the Commonwealth Secretariat advertised a one-year position for a public health management expert adviser to be based within the Sierra Leone Ministry of Health and Sanitation to assist with strengthening the Sierra Leone public national health system post-EVD. Symptoms and incubation The signs and symptoms of EVD include sudden onset of fever, intense weakness, muscle pain, headache and sore throat. These symptoms can be followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and, in some cases, both internal and external bleeding – nose bleeds, blood in vomit, blood in bowel motions, bleeding from the conjunctiva and mucous membrane of eyes, nose and mouth (MSF, 2015). The incubation period for EVD is two to 21 days. People are not infectious in the incubation period, but become infectious once they start exhibiting symptoms. Patients are considered free from infection once a blood test for EVD is negative. Recovery from EVD provides immunity to the strain of the virus that caused the infection. The WHO, however, advise that the EVD virus can be isolated in semen for up to three months post-infection and recommend abstinence from sexual activity during that period. 62 Commonwealth Health Partnerships 2015 Treatment and transmission Transmission of the disease can be animal to human or human to human. In the current outbreak in West Africa, human-tohuman transmission was the major mode of transmission. Those most at risk of contracting Ebola are family members or anyone in the community in contact with, or caring for, an infected person; and health workers and family members, mourners and others involved in the burial of casualties. Direct contact with dead bodies, for example at funerals, was one of the main ways the disease was transmitted. Funerals are a significant practice in the communities affected by the outbreak and involve people washing and touching the body, expressing their love for the deceased. In the last hours before death, the virus becomes extremely virulent and therefore the risk of transmission from the dead body is much higher. For these reasons, ensuring safe burials is a crucial part of managing the outbreak. The Ebola virus took advantage of people’s basic instincts when caring for an ill family member – that of touch – and with the difficulty of transport and access to an appropriate health facility in rural areas, many family and community members were also infected. There is no specific cure for EVD, although several vaccines are under development. Standard treatment is limited to supportive therapy, consisting of maintaining hydration with intravenous fluids or oral rehydration solutions that contain electrolytes; maintaining oxygen status and blood pressure; providing high-quality nutrition; and giving antibiotics for any concomitant infections (MSF, 2015).
Commonwealth Health Partnerships 2015
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