The Ebola virus epidemic that rocked the West African region between 2013 and 2016 is perhaps one of the most devastating epidemics in contemporary society. The scale of deaths, infections and subsequent orphans and survivors of this epidemic provide the evidence of the devastation caused by the disease. More importantly, however, Ebola served as a wakeup call to the global community regarding the healthcare management on a worldwide level. It became apparent that synergetic efforts were the only through which the microscopic threat could be curbed. This write up offers an analysis of dynamics of Ebola management; that is the challenges, strengths as well as the achievements that have since been realized following the Ebola epidemic. Guinea was first alerted to the Ebola outbreak on the 10th of March in 2014; this was followed by a World Health Organization announcement of the outbreak on the 23rd of March 2014. By this time a team group of European Médecin Sans Frontières (MSF) had already been sent to the area (Coltart, Lindsey, Ghinai, Johnson and Heymann, 2017).
However, by May 2014, the MSF led treatment facility in Macenta had already been closed on the pretext of successful containment of the virus. By this time, however, Ebola cases had already been reported in Liberia and Sierra Leon, with their respective dates being the 30th March 2014 and 25 May 2014 (Coltart et al. 2017). Guinea’s response to the Ebola epidemic was the declaration of a national health emergency followed by the initiation of containment efforts. Some of the containment measures included automatic admission to health facilities for alleged cases, travel restrictions as well as compulsory quarantine of Ebola contacts. In Liberia, the response to the outbreak was the formation of a high-level National Task Force comprising of numerous international non-governmental organizations including WHO, MSF, and UNICEF.
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The Center for Disease Control also sent a team to help in response measures and strategies that were being undertaken by the task-force. The primary focus of the response teams was to enhance surveillance and contact tracing as well as help in the creating of community awareness and training of medical staff. Another crucial part of the response was in providing protective equipment to health facilities. Sierra Leone’s initial response was to declare a state of emergency in the ‘eastern hub’ of Kenema and neighboring Kailahun by the 12th June 2014. This, however, failed to curb the spread of the virus, with the highs of 150 new infections being reported weekly (Coltart et al. 2017). As the spread of the virus escalated, the government moved to issue another state of emergency as well as a three-day national lockdown in September 2014. This particular approach was aimed at minimizing the movement of people in an effort to help identify new cases as well as intensifying door-to-door awareness campaigns. The government also utilized quarantines and curfews in the high-risk areas.
The quarantines were however found to be highly controversial due to ethical as well as medical issues. For instance, tremendous food and medical supply shortages were reported in the areas that had been quarantined. The approach was also found to be ineffective in that asymptomatic patients were not capable of transmitting the disease and that the quarantines affected the movement of necessary medical personnel and supplies. It is also important to note efforts of the international community in the management of the disease. Besides the contributions by International health organizations such as the UNICEF and WHO, individual countries provided crucial assistance in response to the outbreak. The USA’s CDC was vital in resource facilitation as well as capacity building within the affected countries. The UK Government actively provided support to the National Ebola Response in Sierra Leone (Coltart et al. 2017). Collaborations between MSF and Public Health Canada were crucial in boosting the diagnostic element in the response strategies of Sierra Leone. It is important to highlight the fact that WHO’S Roadmap that was announced on the 27th of August was crucial in creating a clear and actionable process of combating the disease.
It is worth highlighting some of the perceived failures that were noted in the fight against the Ebola virus. First, there was considerable regret regarding the delays intervention by both national and international response teams, with the earliest intervention coming after over four months since the first case. National shortcomings included inadequate resources and systems to facilitate surveillance and detection processes which would have been essential in curbing the disease. Secondly, the disease was further escalated by the underestimation made by experts and in the process failing to initiate timely and effective management approaches (Vetter et al.2016). More importantly, it became apparent that the global community lacked the necessary political, economic and workforce capacity to manage global epidemics effectively.
The spread of the Ebola virus is primarily through social interaction; this, therefore, makes the social aspect of the disease a crucial component of the management process. The social response to Ebola epidemic played a crucial role in the continued spread of the virus. First off, the fact that social contact is the primary mode of transmission meant that caregivers had to appear antisocial to bring down the disease. This, however, meant that they were shunned upon by the community (Coltart et al. 2017). For instance, the full-suited caregivers were a rare scene for most villagers. Another social response to the Ebola was fear, which is by far one of the most devastating aspects of the epidemic. The society became distrusting of the control and management efforts that were being conducted by healthcare workers, an element whose culmination was to be found in the death of eight healthcare workers by villagers who accused them of spreading the disease.
It is also important to note the aspect of culture and its impact on the intervention and management approaches. The burial procedures observed by most communities in the West African region resulted in a rapid spread of the disease. The burial rites include cleaning the corpse and keeping Virgil with the corpse for a day. Ebola-infected bodies, however, need to be cremated or safely disposed of in body bags a move that brought about a clash between medicine and culture. Proper sensitization and awareness creation had to be conducted to minimize conflict and tension among the local communities (National Academies of Sciences, Engineering, and Medicine, 2016). The greatest challenge that response teams faced in the management and mitigation approaches was that of equipment and resource inadequacy in the poverty and war rampaged nations. Not only are Sierra Leone, Liberia and Guinea among the poorest republics in the world, but that they have also experienced bouts of civil war and conflict in the past resulting in hampered progress and development.
As a result, these countries have poor or damaged health, communication, and transportation infrastructure which were ill-equipped to address the magnitude of the 2013-2016 outbreak. For instance, the essential aspect of Ebola virus management is making a timely diagnosis; however, with inadequate laboratories, diagnostic confirmation became time-consuming result in unnecessary hitches in the management of the disease. Learning institutions in the affected areas are inadequately funded and facilitated; this, therefore, meant there was an acute shortage of trained personnel to work as caregivers, with their numbers being further minimized as they succumbed to the disease. The propagation of the Ebola epidemic can also be attributed to the population structure of the West African region. First off the outbreak occurred within a rural area that is highly remote, this, therefore, meant chances of a timely detection were minimal. Secondly, the Kissi are within which the first case was reported spans the three affected countries (National Academies of Sciences, Engineering, and Medicine, 2016). The porous border in this highly tribal region allows for free movement across Liberia, Guinea, and Sierra Leon.
It is also important to note the fact that cultural factors were a great impediment to the response measures that were instigated against the virus. The local cultures within the affected region, observe traditional burial practices, which in the wake of the Ebola epidemic proved to high-risk factors for infection. Safe burial approaches had to be developed to help qualm the conflicts between healthcare workers and local communities. One crucial aspect that came out strongly during the management of the Ebola virus was the role of the primary caregivers within local as well as global healthcare systems. Nurses are often overlooked and ignored despite their risks and efforts that they channel into ensuring proper care. Primarily, healthcare works provided the supportive care to the patients suffering from the condition (Robert Wood Johnson Foundation, 2014). This meant providing oral nutrition, cleaning the patients and more importantly monitoring their overall status.
The direct contact between nurses and Ebola patients also proved vital in helping shape the national care and personal protection guidelines for the disease. The provided vital information to various decision-making bodies to help develop policies and procedures that would increase efficiency and effectiveness. As earlier, noted one of the greatest impacts of the Ebola epidemic was the fear associated with the disease. A great deal of panic was spreading around the world, a move that was further exacerbating the problem by discouraging more volunteers that were direly needed. Nurses came in handy in helping calm such panic by elaborating to the public how the virus was transmitted and managed (Robert Wood Johnson Foundation, 2014). The caregivers achieved this by attending talk shows and interviews in various media outlets all over the globe to help raise awareness the disease and the associated management approaches.
References
Coltart, C. E., Lindsey, B., Ghinai, I., Johnson, A. M., & Heymann, D. L. (2017). The Ebola outbreak, 2013–2016: old lessons for new epidemics. Phil. Trans. R. Soc. B , 372 (1721), 20160297.
National Academies of Sciences, Engineering, and Medicine. (2016). The Ebola epidemic in West Africa: proceedings of a workshop . National Academies Press.
Robert Wood Johnson Foundation. (2014). Ebola care is nursing care . Retrieved on 8 February 2018, from https://www.rwjf.org/en/library/articles-and-news/2014/11/_ebola-care-is-nursing-care.html.
Vetter, P., Dayer, J. A., Schibler, M., Allegranzi, B., Brown, D., Calmy, A., ... & Iten, A. (2016). The 2014–2015 Ebola outbreak in West Africa: hands on. Antimicrobial Resistance & Infection Control, 5 (17). DOI: https://doi.org/10.1186/s13756-016-0112-9.
