The struggle against Ebola is evolving.
Fighting the disease in West Africa now requires smaller but more medical teams in the countryside while stakeholders are increasingly thinking about how to address the long-term effects of the outbreak, according to sources who attended Friday a high-level meeting with U.N., EU and NGO experts in Brussels.
The discussions, which included the Ebola coordinators from the United Nations, the European Union and several EU member states took place behind closed doors, but several EU sources who were present informed Devex of the proceedings and were cautiously optimistic about the outcomes.
“In the beginning, we were overwhelmed by the crisis and had to invent a response,” said one participant. “That takes time, but now we’re starting to have an impact.”
An important factor in this advance is the increasing involvement of the local population, which is finally beginning to respond to health safety messages. Experts noted they expect to see a peak in the number of cases in January, and then the numbers are expected to go down. At the same time, the epidemic is becoming more complex, as it is receding in areas of first infection but flaring up elsewhere.
“Initially, we thought we were tackling Ebola in three countries, but now we are facing a hundred mini-epidemics, each of which have to be tackled on the spot,” one EU source said. “This requires a flexible and mobile reaction. In every place where Ebola rears its head, we must hammer it down immediately.”
The United Nations is breaking the field of action down to “high risk” 62 districts, which each need their own mini-response — and this has consequences for medical staff deployment. Right now, only Guinea and Sierra Leone have Ebola Treatment Units in Conakry and Freetown, while Liberia has none in its capital Monrovia. Each ETU consists of 25 foreign health specialists — doctors, nurses, ancillary staff — who have to be replaced each month. Hundreds of locals are then needed to help with cleaning, building and repairs.
International aid organizations are now looking at setting up smaller but many more ETUs in the countryside. Each of these should have a small staff, five to 10 beds, an isolation facility and access to a laboratory. The World Health Organization provides constant updates on the number of beds available across the region.
The European Commission — the EU’s executive arm — is coordinating the offers for medical staff by EU member states, as well as non-EU member states Switzerland and Norway. If a country wants to send a medical team, it must be big enough to take responsibility for an ETU and to relay itself after one month for a sustainable period of time. Also, the medical workers must be flexible enough to move to another area if needed.
A major challenge for swift treatment of suspected cases in holding centers is that it takes too long to separate infected patients from the rest. In order to test them, a sample must be taken to the lab, and that takes too much time. However, there could soon be a breakthrough here as the U.N. may loosen its strict rules for transport on its aircraft and helicopters. Infected samples are now not allowed on board, but this could change if the samples are packed in a secure way.
See more news on the Ebola crisis and response:
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Getting foreign health workers into the field
The main bottleneck, however, is still the lack of trained foreign medical staff on the ground, especially epidemiologists.
Since training takes precious time, WHO, France and the United Kingdom have developed theoretical “cold” training, but the best preparation is provided through “hot” training by doctors with field experience. Most of these are from French medical group Médecins Sans Frontières, but they are finding themselves very busy actually combating the disease. Fortunately, as more medical staff is engaged on the ground, experts expect more experienced doctors to become available to offer “hot” training to new colleagues.
A precondition for getting foreign medical workers in the field is to ensure that there is a proper evacuation system in place to transport infected staff to Europe for treatment. This is already being demanded by several nongovernmental organizations to work in West Africa. Right now, requests for evacuation are channeled via WHO, which alerts the European Commission, which in turn contacts European governments that have volunteered to fly people out.
The process also contemplates finding a treatment center within hours. Since the beginning of the crisis, there have been nine medical evacuations. Spain, France, Norway, Italy and the U.K. have taken out their own nationals, while Germany, the Netherlands, Switzerland and France have accepted third country nationals. In the latest case, WHO used a U.S. carrier last month to evacuate an infected Cuban doctor to Geneva.
A recent audit showed that exit screenings from the region are solid and can ensure that Ebola does not reach Europe by air, but more resources are needed to keep the screenings working.
For the moment, EU sources who attended Friday’s meeting said funding is not the most urgent concern. The EU and its 28 member states have pledged more than 1.1 billion euros ($1.37 billion), of which 400,000 to 500,000 euros have already been committed. Furthermore, the United States promised $730 million and the World Bank another $1 billion.
Financial support, though, will become an issue when the real fallout of the Ebola crisis is to be addressed through rebuilding health systems, the economy, agricultural production or access to education. This will be covered by an international Ebola conference that the EU Ebola czar Christos Stylianides is preparing for early 2015. The high-level meeting called for flexibility in financing, including budget support for the governments in the region.
Attendees found that — surprisingly — the health systems in the three countries has not fully collapsed. The major problem is that patients and doctors do not meet: patients see the health centers as a possible source of infection, while doctors fear that they can be contaminated by their patients. Due to these fears, other diseases and necessary medical interventions are not taken care of. This requires a thorough flow of patients that carry an increased risk, and a considerable awareness raising among the population.
Other countries at risk in the region are now aware that a high level of preparedness and a swift reaction can stave off the disease. Thus, for instance Mali seems to have contained the epidemic thanks to a quick and effective response, thanks in part to a French team that immediately set up contact tracing to monitor who had been in touch with infected persons.
“So even in a country with a weak health system like in Mali,” one of the EU sources explained, “Ebola can be contained.”
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