SAN DIEGO, Calif. – “It ain’t over when it’s over,” said Ian Crozier, a physician with the Infectious Diseases Institute of Kampala, Uganda, at his plenary talk kicking off this conference of infectious disease researchers and clinicians. He was referring to his own case after contracting Ebola while caring for patients in Sierra Leone last year.
With repeated references to the 513 healthcare worker deaths from Ebola, Crozier offered details of his own clinical challenges since his initial recovery from acute illness, ranging from Ebola virus in his eye, short-term memory deficits, ringing in his ears, and severe seizures.
Crozier has now turned his attention to connecting with Ebola survivors from this current outbreak and from previous outbreaks in Uganda, to enhance understanding of the long-term health impacts of infection with Ebola.
“I would like to connect my ‘N of 1’ with so many others,” he said.
Armand Sprecher of Médecins Sans Frontières agreed, adding how Ebola survivors are treated is important. “When they go home and are treated like pariahs and outcasts, people see that and it prevents them from seeking care when they develop disease,” he said.
It’s not only Ebola survivors who face stigma and discrimination, he said, noting that national MSF staff “did the lion’s share of work and don’t get rotated out after four weeks, they go home at the end of the day and when their friends and neighbors know what they’re doing for work, they don’t have an easy time,” he said.
When describing the moment Sprecher and his colleagues first realized how large the Ebola outbreak was around the MSF Ebola treatment unit in Monrovia, Liberia, he quoted a line from the movie Jaws – “we’re going to need a bigger boat.” After conducting an estimation analysis, MSF found that there were 800 people infected with Ebola in the immediate area surrounding their treatment unit in Monrovia – a unit that had less than 200 beds. Five months into the outbreak, he said, the number of patients they dealt with tripled.
MSF expanded their units as quickly as they could, but, Sprecher said, building up the treatment unit infrastructure was the easy part – the hard part was getting staff and scaling up care. With medical workers only able to wear personal protective equipment for one hour at a time, their ability to scale up care was significantly impaired with the available staff they had.
“There’s more to Ebola than working in a treatment unit,” Sprecher noted. “Out in the community is really where the game is won or lost,” he said.
MSF workers provided mental health services in communities, distributed over 75,000 home kits including gloves, bleach, and other items, distributed antimalarials to reduce the burden of malaria on the over-burdened healthcare system, and did health promotion and other types of community outreach, all on top of contact tracing which involved visiting people exposed to Ebola for 21 days to see if they developed symptoms.
The outbreak moved so quickly, however, that contact tracing and health promotion became difficult. “By the time we worked in one location and got it under control, the outbreak had moved on to another place,” Sprecher said.
But no activity gave MSF more trouble than burying Ebola victims, he said. “For many people, it’s their last opportunity to pay respects to the deceased and when you deprive them of that, they get very upset,” Sprecher said. “A year into the outbreak there were still people washing out the mouths of the deceased with bleach so oral swabs would test negative, so they could bury them on their own,” he said.