As part of continuing efforts to combat Ebola in Liberia, Doctors Without Borders/Médecins Sans Frontières (MSF) has set up a ten-bed Ebola transit unit near Redemption Hospital in the densely populated slum community of New Kru Town on the outskirts of Monrovia.
The Liberian health care system has been severely tested by the Ebola epidemic: many hospitals and clinics are now closed, and those still running are turning feverish or vomiting patients away, for fear they are carrying the virus.
Redemption hospital is a 200-bed public health facility. It was closed for regular service and was turned into a holding center for Ebola patients at the height of the crisis this past August. As the only facility offering free medical care for a catchment area of 90,000 people in Monrovia, this was a severe blow to the city’s inhabitants—especially to those not able to afford private health care. Many patients and health workers have died since the Ebola outbreak and the hospital was shut down entirely in October.
Although the outpatient department (OPD) has reopened to treat people with less critical conditions, the hospital remains closed to the public for all other services. Since mid-November, MSF has been aiming to isolate as many Ebola patients as possible from New Kru Town by supporting triage at the hospital’s OPD and by running the transit unit that allows for quick isolation, diagnosis, and referral to an Ebola management center (EMC) for Ebola suspects if needed. This should help the hospital to return to its role as a secondary health care provider in due course.
“The closure of Redemption has been dramatic for people in Monrovia, as they have no other free medical service provider to turn to,” says Sebastian Stein, MSF project coordinator in Monrovia. “It is crucial to allow the hospital to reopen safely and to restore confidence in the health system and in health workers.”
Whoever comes to the hospital’s OPD or directly to the transit unit has to go through a screening process in which specially trained nurses check for Ebola symptoms and decide whether or not the patient can go for a normal consultation or needs to be admitted to the 10-bed unit. At the transit unit, MSF nurses take a blood sample of the suspected patients, who are then placed in an individual room where they receive standard medication, food, and drinks while waiting for their results. If the test comes back positive for Ebola, MSF will arrange for a quick patient transfer to an EMC for further care.
“We believe that infection control measures and triage points should be implemented urgently within regular health facilities. Not only to reduce the spread of Ebola, but also to stop people dying from preventable diseases and unmanaged complications,” says Stein.
Authorities at the hospital are enthusiastic about the transit unit, but much remains to be done to make the hospital fully operational again. Part of the task at hand is to disinfect the hospital’s entire inpatient area. This is an immense undertaking for which, thankfully, the International Committee of the Red Cross (ICRC) has stepped in and is currently working nonstop to ensure an Ebola-free environment inside the hospital building.
As community involvement and understanding is key for every aspect in the Ebola response, MSF has been organizing visits for community leaders from the greater Monserrado county, in which Monrovia is located, since the opening of the transit unit in November. They are shown the structure’s low-risk zone and receive information about the set-up, in order to raise awareness about the unit and its significance in helping the community to combat the virus. Visits like these help to demystify Ebola-related facilities and to show key community influencers, such as zone chairmen, religious leaders, or heads of community-based organizations, what is happening inside the closed off areas and to prevent rumors and misperceptions.
For the same reason, the transit unit is also open to the families of suspected patients. In a specific area, they can see and talk to their relatives inside the isolation part. Health promotion and psychosocial teams are there to support both patients and family members.
“People need to understand what is going on, from their admission to the transit unit to their potential transfer to an Ebola management center, all the way to their discharge,” explains Stein. “Our teams are also following the survivors when it comes to reintegrating them into their communities, as stigma is still a big issue for Ebola survivors.”
In Liberia, MSF runs a 240-bed Ebola management center (EMC) known as ELWA 3 in Monrovia, as well as a 10-bed EMC in Foya, Lofa County. The organization has deployed emergency mobile teams in River Cess and Grand Bassa counties. Health promotion, outreach activities, and the distribution of malaria treatments are also going on in these areas.
MSF began its Ebola intervention in West Africa in March 2014 and is now operating in Guinea, Liberia, Sierra Leone, and Mali. The organization runs six Ebola case management centers with a total capacity of more than 600 beds. Since March, MSF has admitted more than 6,500 people, of whom approximately 4,134 tested positive for Ebola and 1,796 have recovered. MSF currently has some 300 international staff working in the region and employs 3,125 locally hired staff.