Ebola Isolation & Treatment
Case Management: Isolating and Treating Ebola Patients
The international non-governmental organization Médecins Sans Frontières (MSF) was already working in the region when Ebola virus disease was first confirmed in March 2014. In response, MSF converted existing clinics and erected new Ebola Treatment Units (ETUs)—drawing upon its extensive clinical experience in treating the disease. However, the unprecedented spread of Ebola quickly overwhelmed MSF’s capacity, as well as local hospitals, which were poorly resourced and unprepared for the intense demands of treating people with Ebola.
This urgent and dramatic need for additional beds, care centers, and isolation units became a priority of the global response in Fall 2014 because the best chance for survival was early treatment. The United States government played a major role in supporting the establishment of ETUs. In collaboration with USAID’s Office of Foreign Disaster Assistance, World Health Organization, Department of Defense, and multiple other partners, CDC provided technical support and training. CDC was also involved in developing other infection control and treatment strategies, such as community care centers and household protection kits.
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.
Addressing Treatment Challenges
In late August 2014, there were just 500 beds available in Guinea, Liberia and Sierra Leone in eight ETUs—five run by MSF and three run by the Ministries of Health with WHO support, plus a private sector ETU run by Firestone Liberia. The number of ETU beds rose to more than 1,500 in December 2014, and peaked at 2,044 the week of February 8, 2014, with 49 operational ETUs. Building sufficient beds where proper care could be provided was key to encouraging people to come forward for help.
Beyond practical considerations, there were other social and cultural factors that hampered treatment in the early days of the epidemic: fear of ambulances and hospitals, particularly when loved ones disappeared without a trace; treatment by traditional healers uninformed about the disease; early resistance to safe burial practices; and an epidemic of rumors and distrust.
Thus, solutions were multi-faceted: multiple and accessible treatment centers sensitive to the needs of the patients and their families, and widespread community outreach messages about the disease and the importance of personal responsibility to prevent the spread of Ebola.
The following oral history interview is with Charles Keimbe, who was the surveillance pillar lead for the entire Western Area, both Urban and Rural in Sierra Leone.