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Ebola
Lessons for Global Health
Reflections based on experiences working with FBO facilities in Liberia and Sierra Leone
Dr. med Gisela Schneider
Foya Boma Hospital
Keep Safe – Keep Serving
Ebola and Non-Ebola patients
Discharge recovered patients
Suspect/Probable EVD Priority to transfer to ETUs if wet or unwell
Community health worker
Household
Community shelter
• Family members may need to place the suspect patient in a shelter outside the house while awaiting admission to a HCF/ETU
Community
Triage (separate for
maternity)
Holding Space
Health Care Network (Health Clinic and Health Center/Hospital)
General care zone Clinic area In-patient ward (including maternity)
Ebola Treatment Unit (ETU)
Infection Prevention Control (IPC)
Chertow DS et al. N Engl J Med 2014. DOI: 10.1056/NEJMp1413084
Protective equipment…
LESSONS LEARNT?
RE-BUILDING HEALTH SYSTEMS?
Basic but rtechnically sound….
A clinic with local triage caring for 30.000 people in a suburb of Monrovia
Regaining Trust in communities
Point 5. PHC is essential HC based on
– Practical, scientifically sound and socially acceptable methods that are
– Universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in a spirit of self reliance and self determination and forms a part of the countries health system…
1978 Alma Ata Declaration Primary Health Care
Health System
Governance and Health Policies
Health staff
Medical Products
Technology
HMIS Quick response
systems
Infrastructure
Health System Building blocks (WHO)
Health Financing (all processes and procedures making health care
sustainable)
Health Service Delivery At primary, secondary and tertiary level
Hand Washing…
• „We have no gloves or running water, how shall we implement IPC?“
Level of Triage
No triage or IPC
Basic screening temp and handwashing
Basic triage with targeted questions, following flow chart, hand washing, thermometer
Good protection, following protocolls, hand washing, footbath, sprayer, qualified staff doing questionsing and triage
Maximum protection: Full screening and referral centre:
2 level of screening in the triage, hand wahsing, sprayers, foot bath, explicit holding centre attached, attached doffing and doning areas
What level of triage is needed in the post Ebola
period?
Functional System at all levels
National
District
Community
The core of the system: Health Workers!
Health Workers affected
Dr Martin Saliah, Kissy Meth. Hospital
0
50
100
150
200
250
300
350
400
Guinea Liberia Sierra Leone
HW infected
Died
„Training and Triage has taken away 85% of our fear“
„with the rest fear we need to work…“
Replacing staff that is lost….
Creating training opportunities
Developing real career paths….
Developing human resources…
People – the greatest asset ….
SUSTAINING HEALTH SERVICES?
Will we learn from the Ebola Crisis?
• Yes we must…
• Building sustainable and resilient health systems
• Not for people but with people
• Including all players and stakeholders and the Ebola survivors
MERCI BEAUCOUP THANK YOU