Ebola diaries: Helping people to stay safe

Carmem Pessoa da Silva, an infection control specialist

Dr Carmem Pessoa da Silva is an infection control specialist at WHO. She was first deployed to Liberia in September 2014 when the Ebola outbreak was at its height. The number of people ill with Ebola greatly outnumbered the number of treatment beds. People needed help to safely care for their relatives and friends while waiting for an ambulance. This is how Dr Pessoa da Silva and colleagues brought that help.

Carmem Pessoa, WHO infection control specialist, at a technical discussion with Ebola holding centre staff, Liberia
WHO/N. Komiya

"In early September, when the Ebola outbreak was at its worst in Liberia, 80% of patients were forced to stay in the community. Ambulance services could only respond to 30% of calls and there weren’t enough beds to isolate sick people in Ebola treatment centres.

Communities were desperate and started to find their own solutions, such as improvising with plastic bags to protect themselves when treating their loved ones. While WHO could not endorse this as good practice, we recognized that people needed to do whatever they could at the time to reduce the spread of infection.

Knowledge and hygiene - the best protection

With so many partners working on the Ebola response, we had to come up with consistent recommendations. So, as part of WHO’s role supporting the government, we helped set up an infection prevention and control taskforce in Liberia.

This taskforce brought together more than 20 partners, with the aim of harmonizing all protocols into standard operating procedures for infection control in both community and health-care settings. The taskforce also developed a consistent set of guidelines for infection control in all health facilities, which helped such work as calculation of supplies.

People tend to think that infection control is only about putting on and taking off personal protective equipment (PPE), but it covers any measures that prevent infection. Not only does it include Ebola treatment centres and health facilities, but it extends out into the community.

Ebola is a disease that spreads because of lack of hygiene. People need to know how it is transmitted and have the means to protect themselves. And it is very important to make sure that the measures used are effective and safe.

Hygiene kits may have reduced Ebola transmission

A paper published in the Lancet suggested that the hygiene kits contributed to reducing cases of Ebola in Liberia.

Carmem Pessoa, WHO

We were worried about personal protective equipment (PPE) kits being used in the community. It’s difficult to train people on their proper use, and safe disposal is challenging. Used PPE and latex gloves could become dangerous toys for children, if they were found discarded.

We came to the conclusion that we needed to distribute hygiene kits to families that had Ebola cases to protect them until the sick person could go to an Ebola treatment centre. So the Government of Liberia launched a Wash Ebola Away campaign, which involved distributing kits containing buckets, chlorine, rubber gloves and plastic gowns to targeted households in Ebola ‘hot spots’. People were already used to using this kind of equipment and it was part of their routine lives so it was much easier for them to learn how to use it properly.

The Ministry of Public Works coordinated with partners for the distribution of kits and provided information to households on how they could prevent Ebola infection. A paper published in the Lancet has since suggested that the kits contributed to reducing cases of Ebola in Liberia.

Training health care workers to improve infection control

Carmem Pessoa, WHO infection control specialist, at the training of health workers, primary health centre, Liberia
WHO/M. Amara

During WHO training sessions on infection control, we discovered some health workers who performed very well. Some of them have now been retrained as IPC technical assistants. This has been a real success story as these people are now working in the counties, setting up IPC programmes and improving the standards in health facilities.

WHO has been working with educational institutions and external partners to develop an IPC curriculum that will be integrated into health worker training programmes in the long term. We hope the technical assistants will help build expertise in the country.

Along with assessing Ebola treatment centres our work also included infection control assessments of regular, “non-Ebola” health facilities. Many of these facilities were partially closed during the epidemic, often only the outpatient department was open.

Part of our work is supporting the Government to rebuild its health system."