Fighting Ebola in West Africa
Published: September 2014
Ebola is a deadly haemorrhagic fever that can spread rapidly between humans and can kill up to 90% of those it infects. First identified in the Democratic Republic of Congo in 1976, the disease resurfaced again late in 2013 in the West African country of Guinea. Neighbouring Liberia, Sierra Leone and Nigeria – to which Ebola has now spread – are nations that are increasingly popular with mining companies because they’re rich in resources like iron ore, gold and diamonds.
As the first of its kind in West Africa, the recent outbreak is proving to be one of the most challenging to contain in almost 40 years. International SOS has been with its clients at the frontlines to help fight the highly contagious disease.
International SOS was quick to take action when Ebola was first recognised in Guinea on 22 March 2014. Although the disease had been spreading for a few months, confirmation that it was Ebola was delayed because the disease had never before been seen in the area. Understanding the potential threat to its mining clients in Liberia and beyond, International SOS reacted quickly. It implemented rapid disease awareness training for staff, adapted its clinic layout to handle Ebola cases and developed educational tools to help reduce the spread of Ebola among local communities.
With no specific vaccine or cure for Ebola, prevention is paramount. “It’s one of the viral haemorrhagic diseases, of which Yellow Fever and Lassa Fever were better known in the area,” says Dr Doug Quarry, Group Medical Director Medical Information and Analysis at International SOS. “What we’ve learned since the first outbreak of Ebola in 1976 is that it occurs in sporadic outbreaks. It is thought that the disease circulates within the bat population, and is then contracted by humans when they eat infected bat meat or other bush animals. Ebola can then spread from human to human by direct contact with bodily fluids.”
For business travellers or expats who need medical assistance, going to a local hospital that might be caring for people with Ebola could be risky. “Variable infection control practices in hospitals allow the disease to spread to healthcare workers,” explains Dr Quarry.
International SOS continues to monitor this and ensures we refer members to Ebola-free facilities. Understanding the situation and making precautionary calls to International SOS reduces the risk of infection and ensures clients receive safe, high-quality treatment from a secure medical centre.
When an individual falls ill from Ebola, initial symptoms typically appear after about seven days. These include fever, muscle pains, headache and sore throat. As the disease progresses, victims may experience vomiting, diarrhoea and bleeding – all highly contagious fluids as they contain large amounts of the virus. The risk of death may also be very high, with as few as 10% surviving. However, with general supportive measures like fluids and oxygen, the death rate can be reduced from 90% to about 60%.
“Because there’s no specific treatment for Ebola, it is a serious public health issue requiring isolation, quarantine and education,” says Dr Quarry. “Every individual living in the affected area is responsible for containing the disease.”
COORDINATED RESPONSE IN LIBERIA
It is crucial when responding to a threat like Ebola that International SOS works side by side with government health authorities and partners with them in their response. “As Liberia is a low income nation with limited medical infrastructure, and had not had an Ebola outbreak before, there were no Ebola-specific processes in place. Therefore everyone was caught off guard,” says Dr Andre Willemse, Regional Medical Director of Special Projects. “We recognised the need for International SOS to step in and complement some of the existing responses by Médecins Sans Frontières (MSF) and the World Health Organisation (WHO), which were already very active in Guinea.”
International SOS used its Paris Assistance Centre as a collaborative headquarters and got to work quickly. A set of simple guidelines to educate medical staff and the local population was developed immediately. The guidelines help people recognise Ebola and prevent transmission to other individuals.
Dr Willemse also worked closely with an internationally-recognised South African physician specialising in Ebola and other viral haemorrhagic fevers. The expert was immediately flown to International SOS’ Liberian clinic, where he ensured crucial training for medical personnel was carried out and the right protective equipment and isolation rooms were in place. He also acted as an advisor to both local and major city hospitals, and consulted the Liberian Ministry of Health & Social Welfare.
International SOS wanted to help the communities in the area in any way it could, and a fast response was critical. Shortly after the organisation released its guidelines, Ebola spread to Monrovia, after an infected woman caught a taxi to a hospital in the Liberian capital. Although the urgency of the situation increased, it was essential that everyone remained calm and collected. “If medical personnel start to panic, they might fail to turn up to work and our high-quality healthcare could be compromised,” explains Dr Willemse. “We needed everyone to understand the protocol and feel safe in their working environment, so we coordinated daily calls between International SOS’ medical directors and the professionals on the ground.”
International SOS is in constant contact with its 30 clients in the affected areas and provides them with similar guidelines to those provided to medical personnel. A special team is working around the clock to provide the latest information and travel advice on a dedicated website, which is open to the public: internationalsos.com/ebola. “On our trusted website we have free training materials, the latest news stories, country summaries and FAQs,” says Dr Quarry. As International SOS continues to experience a large volume of requests for information, special webinars for clients and members all around the world are taking place on a regular basis.
Some client operations are at risk of disruption because employees become increasingly fearful of the situation and are considering leaving. International SOS assists them with dedicated educational materials to address concerns. “Through regular training and communication sessions, using this developed training material and the presence of the Ebola expert on the ground, we can restore confidence to our clients’ employees and help them to continue their work,” reports Dr Willemse.
Equipped with the right advice and understanding, expatriates are at very low risk of contracting Ebola. The greater risk rests with national employees who may be exposed to the bodily fluids of Ebola victims. However, as a result of International SOS’ diligent processes, not a single client or staff member has been infected with Ebola. “We are well prepared and determined to remain vigilant about the wellbeing of everyone in the affected regions,” adds Dr Willemse. “Our clients expect International SOS to lead the way, and we have proven ourselves capable of doing that.”
Members are encouraged to contact one of the 27 International SOS Assistance Centres if they have any concerns.
COOPERATING WITH LEADING HEALTH AUTHORITIES
In early August the World Health Organization (who.int/en/) declared the outbreak a 'Public Health Emergency of International Concern', meaning that it is a serious public health event that endangers international populations.
International SOS’ medical experts have set up urgent meetings with representatives from the Liberian Ministry of Health and international organisations such as the United Nations, Red Cross, WHO and MSF. In this way, International SOS can align its own client-oriented responses with the country’s response as a whole.
As part of the collective effort to contain Ebola, International SOS’ guidelines have been made available to the United Nations and other organisations in the affected neighbouring countries.
INDUSTRY-LEADING CAPABILITIESWhen asked about the key elements of the organisation’s response to the West Africa Ebola outbreak, Dr Quarry cites the team’s ‘collaboration’, ‘speed’ and ‘comprehensiveness’.
Dr Willemse adds that International SOS’ network of experts of experts helped to direct its approach to the Ebola outbreak. “We could immediately add to our existing provisions by just sending an e-mail or two to our friends in the medical field.”
According to the WHO (as of 17 August 2014), there have been a total of 1,383 confirmed cases and 760 deaths across Guinea, Liberia, Nigeria and Sierra Leone, and the numbers are still rising.
The key learning International SOS will apply to its ongoing response in West Africa and future epidemics is the need for clear and constant communication. International SOS has taken a lead role in providing timely advice to clients and the wider community in the affected regions, and maintains close contact with the WHO, the US and European Centres for Disease Control and Prevention to stay fully up-to-date with developments.
Ebola has become a new area of expertise for International SOS, joining a long list of other diseases for which it is a globally respected authority. “International SOS has a strong epidemiology department that is responsible for monitoring disease outbreaks across the world. It’s part of our bread and butter,” says Dr Quarry. “We provide information and guidelines for all diseases that can affect travellers and expats. We also have special websites for emerging respiratory viruses like bird flu and MERS, as well as Ebola.”
International SOS’ combination of disease preparedness and exceptional network of experts means clients can continue to expect steadfast support when they need it most.