Treatment Centers
A patient admitted to the ETU at Island Clinic in Monrovia, Liberia on September 22, 2014 resting in his bed with an IV. USAID helped the Government of Liberia and WHO open this facility, which was filled to capacity in one day. Photograph by Morgana Wingard, courtesy of USAID
Treating Ebola Patients
In the initial days of the epidemic, Ebola virus disease mortality rates were as high as 60%. Most hospitals in West Africa lacked the equipment to provide even basic supportive care and isolate suspected Ebola patients from the rest of the general hospital patients.
We know that early isolation and treatment with fluids and other care offers patients the best chance to survive Ebola. Providing early oral and intravenous fluids (IV) and balancing electrolytes (body salts) addresses the dehydration caused by vomiting and diarrhea. Maintaining oxygen status and treating other infections if they occur help stabilize patients. Survival rates improved once people began to seek treatment at the first signs of symptoms and access to care facilities improved.
This 2014 poster was designed to urge people to seek treatment if they experienced Ebola symptoms.
A Ugandan health worker wearing PPE treats a patient with Ebola virus disease at the Island Clinic in Liberia. The clinic opened its doors as an ETU on September 21, 2014, and within 24 hours was filled beyond capacity. Photograph by Christopher Black, WHO
Triage Alternatives: Community Care Centers and Transit Centers
Through early fall 2014, the sheer number of people who needed to be evaluated for suspected Ebola virus disease overwhelmed health systems. People who were sick often had to travel many hours to reach a treatment facility. If they survived the journey, they were not guaranteed a bed. Particularly in rural areas, people were often afraid of seeking treatment because people who did so were often not seen again.
As part of an evolving strategy, Community Care Centers (CCCs) were established in rural communities. Simple and low-tech, CCCs provided isolation areas and basic care for people suspected of Ebola virus disease, while they awaited results of diagnostic tests. If the test was positive or as the patient became sicker, the patient was transferred to an ETU.
Newtown Community Care Centre, supported by UNICEF in the Western Area Rural District, Sierra Leone, January 2015. Photograph by Mark Naftalin, UNICEF
Although some responders predicted that CCCs would spread rather than control the disease, the increase in available isolation beds may have helped to reduce the number of cases. Family members appreciated the fact that they could keep an eye on their loved ones. The CCCs reduced fear and increased knowledge about the disease.
Other alternatives were transit or holding centers, places where people came to be diagnosed, and, if necessary, be treated while waiting for an ambulance to move them to an ETU for care.
After medical assessments, persons suspected of Ebola were assigned to either an area for those exhibiting "dry symptoms," including high fever or stomach pain; or an area for those exhibiting "wet symptoms," including sweating, vomiting, diarrhea or bleeding.
Rapid Isolation and Treatment of Ebola
Beginning in early October 2014, CDC and partners, including UNICEF, designed a strategy of rapid isolation and treatment of Ebola in Liberia (RITE). This strategy controlled outbreaks faster, and supported the care of patients in remote areas, cutting the time to control outbreaks in half, and doubling survival rates.
Rapid Response Center in Jene-Wonde, Grand Cape Mount, Liberia, December, 2014. Photograph by Helene Sandbu Ryeng, UNICEF
Women and a child stand in a cordoned-off area for patients confirmed to have Ebola at MSF's ELWA 3 treatment center in Monrovia on August 29, 2014.
Photograph by Kieran Kesner
Design Matters: Building Confidence and Engendering Trust
In the early days of the epidemic, the inability for family members to witness what was happening to their loved ones in ETUs fed dark suspicions, resulting in some attempted rescues. In response, MSF and others advocated for ETUs to be designed without high, opaque walls to minimize fear of facilities. This simple design modification permitted family members to visit loved ones in ETUs, either by talking with them across the fence or inside the ward wearing PPE.
The graphic below visualizes a typical MSF Ebola Treatment Unit. A border fence, typically made of orange snow-fencing, encloses the ETUs’ tents, and temporary and pre-existing buildings. The patient treatment sections include: a triage area where people are initially evaluated for Ebola; two zones, one each for suspected and confirmed cases; visitor areas; and exits for survivors, suspected cases who were negative for Ebola by testing, or for bodies to be picked up by the morgue to be prepared for safe burial.
The staff sections include: PPE changing areas; the staff entrance into the high-risk zone leading to the confirmed cases; and the staff exit from the high-risk zone where decontamination would occur. In addition, this area includes a laundry, incinerator, and office tents.
How We Treat Ebola graphic, 2015. Courtesy of Médicins Sans Frontières