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Analysis of Health Needs and Responses during the Ebola outbreak in Liberia

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This paper will provide a discussion about the health needs and responses by the different governmental, Non-Governmental organizations (NGOs) and the United Nations during the recent Ebola outbreak that occurred in West Africa in the three countries
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  1 Analysis of Health Needs and Responses during the Ebola outbreak in Liberia Ahmed Alameldeen Submitted for the Master of Science (MSc) in International Humanitarian Affairs University of York Department of Health Sciences May 2015  2 Table of Contents 1.   Introduction……………………………………………………………………………………………………………… 1 2.   Ebola Background History.............................................................................................2 3.   Health System in Liberia before and after Ebola outbreak..... ...........…………………………2  4.   Ebola Health Needs.......…........................…………………………………………………………………. 3 5.   Ebola Response by MSF: Methods used and why they used it.....................................4 6.   Ebola Response by WHO: Methods used and why they used it....................................5 7.   Ebola Response by IFRC: Methods used and why they used it.....................................5 8.   Contact tracing..............................................................................................................6 9.   How the Ebola cases decreased?..................................................................................6 10.   Challenges in Ebola response in Liberia........................................................................7 11.   Evaluation of Ebola Response in Liberia........................................................................8 12.   Conclusion and Recommendations for the future........................................................8 13.   References.....................................................................................................................9 1.   Introduction: This paper will provide a discussion about the health needs and responses by the different governmental, Non-Governmental organizations (NGOs) and the United Nations during the recent Ebola outbreak that occurred in West Africa in the three countries Liberia, Guinea and Sierra Leone focusing on Liberia since I was deployed there with an International Humanitarian Organization from the start of the outbreak in August 2014 till March 2015. The paper will start with brief introduction of the current situation followed by background history of Ebola then focusing in the situation in the healthcare services in Liberia before and after the declaration of outbreak then providing some examples of the health needs and responses by the World Health Organization (WHO), Medecins Sans Frontieres (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) then some lessons learnt and success stories from Lofa county in Liberia that was the first county in west Africa successful in reaching zero cases of Ebola patients and finally addressing some recommendations for the future. In Early August 2014, WHO declared an Ebola outbreak in the region of west Africa (Global Ebola Response, 2015) that started in Guniea in a city called “Meliandou”  bordered with Liberia and close to Sierra Leone and was misdiagnosed in March the same year as “Cholera” disease because of the death among the patients occurring from heavy diarrheal symptoms which is the same symptoms like Cholera (WHO, 2015a). According to Dr. Margaret Chan the Director General of WHO (2015) “ The outbreak of Ebola virus disease in parts of West Africa is the largest, longest, most severe, and most complex in the nearly four-decade history of this disease. ” Which by January 2015 the number of patients reached 22092 with deaths of 8810 distributed between nine countries according to the Ebola situation report published weekly by WHO (2015b). The impact of Ebola outbreak was not  3 only in weakening the already weak health systems in the three countries, but also there was an economic impact affecting the importation of essential goods because of the borders closure between the affected countries and their neighbouring countries who were afraid from the disease to be spread inside their countries like Ivory Coast and Senegal especially when the disease spreads by people movement (Bajekal, 2014). Map showing the location of the village of Meliandou, Guinea, West Africa. Lat/Lon 8.6224 -10.0642 (Probawy Wordpress) 2.   Ebola Background History: This section will provide a brief about the background history of Ebola disease that started in 1976 in Democratic Republic of Congo (DRC) formerly known as “Zaire” and Sudan. The common death percentage is about 50% among the affected people although it reached around 90% in the current outbreak. Ebola disease was characterized by causing internal bleeding with increase in the temperature of the patient that is why it was famously known as “Ebola Hemorrhagic Fever”. Ebola is transmitted first from an animal (fruit bats, chimpanzees and gorillas) so it is called “Zoonotic dise ase ” (Ebola Deeply, 2015) then “   ...spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.” Up till January 2015, there is no approved medication or vaccination that can help in the treatment or prevention of Ebola although some clinical trials started in Liberia, Guinea and Sierra Leone but no results yet (WHO, 2014b). 3.   Health System in Liberia before and after Ebola outbreak: The health system in Liberia and its neighbour Sierra Leone is suffering since long time because of their internal conflict that occurred over a period of 10 years till 2002 that made their health care services and infrastructure malfunctioned that for every one hundred thousand patients, Liberia have one doctor and Sierra Leone have two doctors (WHO, 2014h; Bajekal, 2014).  4 Moreover, after the Ebola outbreak occurred, many of the health workers got infected because there were no proper Infection, Prevention and Control (IPC) measures which made the Liberians afraid to go to the health facilities to seek treatment and the health workers refused to go to their work unless the Ministry of Health in Liberia provide them with proper IPC equipment. All this resulted in shutting down of at least 65% of the health facilities in Liberia (CBC, 2014). Consequently, Liberians did not find a health care facility to seek treatment of common chronic diseases like Malaria and pregnant women could not find a hospital to seek delivery or follow up before and after she gives birth resulting in more deaths among Liberians because of the lack of primary, secondary and tertiary healthcare services. Some attempts by the Liberian Ministry of Health to restore basic health care services during the outbreak but it was not welcomed by many Humanitarian NGOs because they considered it as a developmental intervention rather than emergency one (WHO, 2014a; WHO, 2014f; Dawson, 2014; Landgren, 2015). 4.   Ebola Health Needs: According to the Humanitarian Implementation Plan (HIP) made by the European Commission of Humanitarian Aid and Civil Protection (ECHO) addressing the needs for the countries affected by Ebola the needs were categorized being in a health facilities level and community level, like bringing Human resources with medical background to cover the low number of health workers mentioned above together with equipment named as “ Personal Protective Equipment” (PPE) for better implementation of IPC measures in the healthcare facilities or during collection of dead bodies whether for cremation or “safe burials”  and contact tracing of the infected and deceased for better identification of the infection srcin (HIP, 2014). Image showing the Personal Protective equipment used by Health workers in Ebola affected countries (John Moore/Getty Images)(MSF, 2014a)  5 5.   Ebola Response by MSF: Methods used and why they used it:   Medecins Sans Frontieres (MSF) was the first humanitarian NGO to deploy staff to the field even before the declaration of the outbreak in August 2014. Since March 2014, MSF started its operations in the Guinean village located on the border with Liberia and then they extended their activities in Lofa county in Liberia. MSF was the first NGO to build an Ebola Treatment Unit (ETU) using their past Ebola response experience in DRC, Sudan and Uganda. Since there were no medication for the treatment of Ebola, MSF mainly used these ETUs to isolate patients from their communities and prevent the spread of the disease by their fluids (blood, stool, sweat, etc...) they mainly tried to treat the symptoms of the disease and provide supplementary care and as Dr. Armand Sprecher (2015) the Public Health Specialist in MSF said, that the response was providing “symptomatic care, supportive care, presumptive care, nutritional support and psychosocial counselling”.  Moreover, MSF took the initiative to up date the “clinical guidelines” for the management of Ebola affected person that was published later by WHO and provided capacity building to the Liberian Ministry of health staff on the ways of Ebola case management and passing their experience to them and was able to run a laboratory for the diagnosis of the disease. By the end of January 2015, MSF received around 8000 infected person, around 5000 the laboratory diagnosis was positive showing Ebola disease infection and around 2300 of this number were treated (MSF, 2014b; MSF UK, 2015). Image showing the layout of MSF ETU that was later built by other NGOs with almost the same layout.
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