Ebola: Not yet over

Liberia- Liberia is surrounded by three countries, two of which are fighting to get zero infection from the Ebola virus disease.

Guinea, Sierra Leone are said to be reporting cases on a daily basis while Liberia was declared free on May 9 of this year.

Whilst the Ebola outbreak continues in neighboring countries, there is a risk the disease could be imported into Liberia and re-start the outbreak. However, a large-scale outbreak is unlikely due to the current preparedness measures.

Liberia was one of the worst affected countries in the West African Ebola outbreak. Transmission declined in early 2015, and the response scaled back proportionally in some areas.

By March, the last case was released from treatment and all contacts had finished their monitoring period.

A single new case was reported on 20th March, which may have been spread via sexual contact. No further cases related to this one emerged. The source of infection for that case remains under investigation.

It was an isolated case in the nation's path towards disease elimination. Liberia was declared free of Ebola on 9 May.

The nation is still on "heightened vigilance" for three months, per the World Health Organization. WHO will also remain an "enhanced presence" in Liberia for the rest of 2015, with a particular focus on areas that border Guinea and Sierra Leone.

May 9 and the nation has reached the pivotal 42-day mark with no new infections, and the World Health Organization has declared the outbreak over. (The incubation period for Ebola is presumed to be 21 days, so 42 days - or two incubation periods - must elapse with no new cases.)

Officials continue to urge vigilance against the disease, as there is an ongoing risk of importation while the outbreak continues in Guinea and Sierra Leone.

The Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans and is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

In Liberia, some of the challenges faced include, lack of adequate health facilities, Ambulances, professional health workers, contact tracers and proper education on the spread of the virus.

A 2nd year student at the A.M Dlogloitti Medical College which is the only medical college in the country in an interview with our reporter said, “During the outbreak there were challenges including the low publicity people deny the virus outbreak and so during a day we used to receive over 20 bodies and 90% used to be Ebola.”

Mr. Moses Mbayo who worked with the Island Clinic for over five months continued: besides the PPE were not safe and it lead to some of our colleague been exposed to the virus, mostly Dr. Thomas Scotland who was a recent graduate of the Medical school and he immensely contributed to the fight against the virus but unfortunately he died and we considered him as a soldier; Lack of PPE, unsafe PPE lead to some of the tolls of death.”

He stated that he is currently work an Active case findings sector lead in Montserado County who has over 30 persons under him reporting from all communities and districts in the County.

Outlining the strategies; Mr. Mbayo said it was a joint effort between the community and the Government something he said was not done at earlier stage of the outbreak.

“The entire fight was a joint force and we started to publish and we started to break the chain, we started contact tracing and active case findings which was established by Dr. Mosoka Fallah, A Liberian and his reason was that ; many people from the community was exposed and we have no contact tracing in Liberia and we never had team to find cases and monitor those cases the entire aspect of Ebola gradually decline as the cases were reported and monitored and eventually they were placed under control, he narrated.”

Mr. Mabyo continued: “One problem we had was the migration of persons but if you have the virus or you came in contact with someone we have to identify and monitor you and if you have symptoms of Ebola we call the team to take care of you and that was not done during the Ebola outbreak.”

He urged that though the Liberia is free of the virus they stand a good chance of reinfection if prevention methods are not taken seriously.

“Liberia is free but Guinea, Sierra Leone is not yet, so this should be the message it is not over yet till our to neighboring countries are declared by the World Health organization.

Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.

Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission.

Risk reduction
According to the World Health Organization, Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat and Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

Additionally human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

The World health said because the risk of sexual transmission cannot be ruled out, men and women who have recovered from Ebola should abstain from all types of sex (including anal- and oral sex) for at least three months after onset of symptoms. If sexual abstinence is not possible, male or female condom use is recommended.

Contact with body fluids should be avoided and washing with soap and water is recommended. WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Ebola virus.

Controlling infection
In a guide publish by the Ministry of Health and its partners-Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.

Also the Brookings institution Africa growth initiative stated that “Though the number of new deaths is decreasing, the announcement of new cases every day hangs over the continent like an ominous cloud. Neighboring countries are all on heightened alert as the risk to them is highest. An epidemic that was initially confined to three countries impacted the whole continent from east to west and north to south in ways not seen since the peak of the HIV/AIDS crisis.”

“Africa’s growth has remained resilient despite the overall deceleration in global growth. Sub-Saharan Africa was projected to grow at 5.2 percent in 2014 and 5.7 percent in 2015 up from 4.9 in 2013. At a time when Africa was beginning to consolidate its growth, the fatality of the Ebola virus knock the three most affected countries (Guinea, Liberia, and Sierra Leone) off course mainly due to its prohibitive impact on trade, economic activity in the agriculture, mining, services, and particularly tourism sectors, as well as spillover effects throughout the region, especially if the epidemic is not contained. “

Economies Hit
Economic activity has grounded to a halt in these countries as their populations try to protect themselves from the disease.

The total fiscal impact of the crisis is well over half a billion dollars in 2014 alone in Guinea, Liberia and Sierra Leone (World Bank 2014a) and could deepen in 2015. Their economies are expected to deflate by over 20-30 percent.

The agriculture sector, which employs over two-thirds of their rural populations, was hit significantly, with agricultural growth in all three countries revised downwards for 2015 (In Guinea from 5.7 to 3.3, Liberia from 3.5 to1.3 percent, and Sierra Leone from 4.6 to 2.6 percent) (World Bank 2014b).

Thus, in addition to economic activity contracting, increasing food prices threatened to compound the Ebola epidemic with a food security crisis. Liberia, Sierra Leone and Guinea all depend on natural resources, including the mining sector, for revenue and jobs.

In 2012, total revenue from natural resources, including mineral exports accounted for 26.1 percent, 8.6 percent and 30.1 percent of GDP, respectively. The Ebola virus has disrupted these supply chains and, in many cases, forced the slowdown or outright closure of mines. In Liberia, for example, ArcelorMittal (MT), the largest mining company in the country, decided to postpone its planned investment to expand its production capacity from 5.2 million tons of iron ore to 15 million tons. China Union, the second-largest mining company, shut down its operations in August.

As a result, the mining sector growth forecast by the World Bank for 2014 has been revised from 4.4 percent growth to a 1.3 percent contraction. In Sierra Leone, the country’s second-largest iron ore producer, London Mining, shut down. The London-listed company was one of the country’s largest employers, with over 1,400 employees.

The mining sector in Guinea does not make up as much of the economy as in Liberia and Sierra Leone. Thanks to the fact that Guinea’s major mines are far from the affected zones, the expected contraction is not projected to further deteriorate: The initial projection of mining sector growth was -3 percent and the revised projection of -3.4 percent is only slightly worse. However, exploration work on the Simandou mine, with one of the largest iron ore deposits in the world, could slow considerably, impacting Guinea’s long-term growth prospects (Cussen n.d.)- (The Brookings institution Africa growth initiative).

A 4 year professional registered nurse in Liberia; Madam Salome Chenoway said that one of the challenges they faced as health workers that there was no equipment as several of their colleagues died during the outbreak.

She currently worked at the incident Management system of the Ministry of Health that directly deals with outbreak of diseases, during the outbreak of the EVD they were at the fore front in the country collaborating with partners to ensure that Liberia be free of the EVD.

The Ministry of Health in its vol.4 No.1 January-March 2015 healthy life newsletter it reveals that as of October 2014, there were 10,000 health workers in its database of public sector health workers.

The public health workforce included 117 physician (0.03 per 1,000 population), 436 physician assistants (0.08 per 1,000 population, 2137 nurses(RN/LPN) (0.4 per 1,000 per population) and 659 midwives(0.12 per 1,000 population)which presented 30% increase for 50-60% increase for the other three core health professionals since 2009.

MOH newsletter further revealed that there were 3,143 cumulative confirmed cases and 3,747 cumulative confirmed deaths. There are nearly 4,000 children who lost one or both of their parents to Ebola.

Of the 371 health care workers infected with the disease, 179 died. At present over 1, 4000 persons have survived Ebola.

Survivors of the EVD is still facing stigmatization in which psychosocial counselors of regulatory agencies include the Red Cross, Gender Ministry, religious leaders are at the front to make sure that survivors are reintegrated into their community.

Tonia Corneh is a mother of two-and an Ebola survivor. Her sister died from Ebola while giving birth with no one left to care for the baby, Tonia took the new born orphan home. That how she and her children got infected; “I was not sick but my two boys were, it was very bad,” she said.

She used to import second handed clothes from Guinea and sell them in the market, but with the closure of the borders during the Ebola crises, she lost that source of income. To make things worse, all her belongings were burned when she was discharged from Ebola treatment unit where she was discharged from ETU where she and her children were treated, leaving the family in a dire economic situation.

Partially equip
Not all Ebola survivors are empowered financially something they have on numerous occasion complained of.

Nancy Stephens a mother of six disclosed that she had to resume responsibilities of her late brother’s five children including her four but no efforts and funds have been given to the children since they lost their parents to the EVD.

She said that all efforts to at least have the children place on Scholarship have failed something she terms as regrettable and frustrating.

Though some don’t have funds nor support, The ICRC has a funded cash assistance program which has empower several survivors.

The ICRC launched the assistance program November 2014 aimed at helping survivors get back on their feet as they reintegrate into their communities.

April this year, the ICRC disclosed that over 1,700 people had been assisted including Ebola survivors and family members who relatives died from the virus, each of the recipient received 200 USD.

The Cash assistance program is expected to end this June and apart from ICRC initiative no other has been designed to empower survivors.

Published in collaboration with Ouestaf News and with support from Osiwa.