Ebola Crisis: emergency response in Sierra Leone

Prospective healthcare workers at the Kerry Town Ebola Treatment Centre test decontamination procedures.
Prospective healthcare workers at the Kerry Town Ebola Treatment Centre test decontamination procedures.

Save the Children is responding to the Ebola outbreak in four provinces in Sierra Leone, with a strong focus on raising awareness and breaking transmission at the source.

Our programmes also focus on strengthening or helping re-establish national healthcare services where these have been weakened by the outbreak. Our health, child protection, education and child rights work has so far reached around 100,000 people since the start of the response in March 2014.

Kerry Town

The Kerry Town Ebola Treatment Centre (ETC), which opened on 5 November 2014, is now operating at its full 80-bed capacity.

This specialist medical centre – 40km outside the Sierra Leone capital of Freetown – is where people diagnosed with Ebola are referred to receive medical care and ensure that they do not transmit the virus to others.

The centre is working closely with the National Ebola Response Centre and its regional offshoots to ensure patients are referred for treatment as quickly as possible.

The construction of the ETC was funded by the UK Department for International Development and designed and overseen by British Army Royal Engineers over two months. It was a joint Sierra Leonean Ministry of Health and British Government initiative.

As of 30 December, 76 patients treated at the centre have been treated and discharged, and over 210 have received or continue to receive treatment against the disease.

The ETC increased the number of beds incrementally until reaching its full capacity on 25 December 2014. This planned and staged scale-up to full capacity was crucial to ensure staff safety while providing the highest levels of patient care, as ongoing works were also being carried out to ensure high standards of infection prevention and control.

Getting treated at the earliest stages of the disease maximises the chances of survival of those who are infected, and can make the difference between life and death. Since opening, the overall fatality rate is 50%, with strong signs over the past three weeks that this rate is going down.

The onsite laboratory also helps ensure that people both in the centre and in holding centres elsewhere are tested rapidly and can then be discharged or referred for appropriate treatment.

As part of its integrated response to the outbreak, Save the Children has trained 300 community healthcare workers who are now going door-to-door in Ebola hot spots in Freetown, to help families identify suspect cases and refer them for treatment.

Save the Children, in partnership with 100 community leaders, is also carrying out a broad anti-stigmatisation campaign to ensure support for those affected by the disease.

Staffing

The Kerry Town ETC is staffed by approximately 430 national staff and 85 international staff.

NHS staff working with Save the Children have been voluntarily deploying to Ebola-affected countries, but will continue to be paid by the NHS, and managed in country by Save the Children.

All our existing Save the Children staff who are deploying are doing so voluntarily.

Prior to deployment, all staff are thoroughly vetted and trained – this means that they receive both medical and psychological clearance to deploy from an independent third party.

Staff also receive in-country training before they can enter high-risk areas, and they are assessed when they have completed this, to ensure they can put on and remove their personal protective suits in a safe manner.

Safety protocols

Save the Children works in some of the world’s most dangerous locations, and as such we have robust and strict protocols in place to protect our staff and the communities we seek to serve.

At the Kerry Town ETC, these protocols are constantly reviewed and monitored to ensure the highest standards of safety and infection prevention and control for all staff.

Staff are also advised to be careful outside the treatment centre, where exposure to risks can be less obvious, and respect guidance to avoid direct body contact and keep a safe distance.

Save the Children maintains confidence in both our equipment and our protocols, as long as they are followed properly.

Staff safety is our number one priority. In the light of the recent case we are undertaking a specific review to see if any lessons can be learnt.

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Comments

  • Dr John Jennings

    I am concerned at the minimal information you have on your website concerning safety protocols for staff outside treatment centres in Sierra Leone since even these minimal requirements have been simply ignored by staff at airports hugging and social kissing etc. Quite apart from that they are exempt from the current Lockdown in Sierra Leone i.e. attendance at Church. Clearly, Holy Communion at RC churches would be a major hazard. Can you therefore email me a copy of your current staff guidelines, outside treatment centres in Sierra Leone, travelling overseas (back to homebases etc) and can you please address the specific items I have mentioned apart from my general concerns. I am also concerned that your reasons for the delay re treatment at the Kerry Centre are simply not true (see above) as public domain information has repeatedly shown. You know the reasons for the delay as well as I do. This is clearly a case of dissimulation and quite unacceptable.

    Copy to Independent Newspaper, Guardian Newspaper UK

  • Gareth Owen OBE

    Dear Dr Jennings,

    Thank you for sharing your concerns regarding staff safety in Sierra Leone on this blog, which have been passed to myself.

    As you know, Save the Children works in some of the world’s most dangerous locations, and as such we need robust and strict protocols in place to protect our staff and the communities we seek to serve. Save the Children takes the health and safety of its staff and others under its care extremely seriously. We have strict infection control, hygiene, and clinical protocols to mitigate the risks to anyone working in the Treatment Centre, and Save the Children personnel are expected to undergo extensive training prior to working in an Ebola affected area. This training includes clear guidance on avoiding physical contact.

    Once they leave our staff are expected to follow the guidance laid out by Public Health England. It includes monitoring for symptoms and isolation if any potential Ebola symptoms are experienced. The PHE guidance doesn’t include stopping social contact so long as a person feels well.

    It is not yet clear how Pauline Cafferkey contracted Ebola. Save the Children is working closely with the UK Government, Scottish Government and Public Health England to look into the circumstances surrounding this case, and we will not speculate until this full investigation has been completed. The findings of the review will be considered by a panel including independent health experts, which will support Save the Children and make recommendations for any actions if necessary.

    As with other Ebola infections in health facilities, it may never be possible to be 100% sure how the patient was infected. The work of our brave health workers is never risk-free, but we are committed to doing everything possible to learn what happened and, if necessary, to make changes to our protocols and practice.

    Regarding the delay of Kerry Town, the team on the ground worked night and day to build the treatment centre from scratch within two months and was opened on 5 Nov, becoming fully operational on Christmas Day, one week ahead of schedule. We have always made clear we would need to incrementally increase capacity, as is best practice, giving staff time to ensure a safe environment for patients and staff and reduce the risk of infection.

    Thank you again for raising your concerns.

    Gareth Owen

    Humanitarian Director

  • Great post! Thank you for sharing.

  • LIZ PALMER

    Dear Justin, Thank you for taking time to write this note, knowing you are under pressure in the field. Great work, well done.

    Can you share the updated guidelines / link for construction of ebola health care treatment centres, and is there a ‘lessons learned” anywhere from the team to help others also building such structures?
    Many thanks again. Stay safe.

    Liz Palmer
    Humanitarian Shelter Advisor.

  • Justin Forsyth

    Dear Liz

    Thanks for getting in touch and for your support. I would suggest contacting Mark Buttle, our WASH Advisor, at m.buttle@savethechildren.org.uk. He will be able to share any relevant best practice information with you.

    Best wishes

    Justin