Ebola: Health Workers , the Biggest Losers

Medic-ALL (26:08:2014)

The World Health Organization(WHO) on Tuesday said that the deadly Ebola outbreak in West Africa has been unprecedented in many ways. A high proportion of healthcare workers are among those infected with the virus. 

So far, over 240 healthcare workers, including doctors and nurses, have contacted the disease in Guinea, Liberia, Nigeria, and Sierra Leone and over 120 have died.

According to the WHO, the virus has taken the lives of doctors in Sierra Leone and Liberia, depriving these hard-hit countries not only of experienced medical care but also of inspiring national heroes.

The UN health agency noted that shortage of personal protective equipment or its improper use, too few medical staff to cope with such a large outbreak and working beyond the number of hours recommended as safe contributed to the high proportion of infected medical staff. 

"In many cases, medical staff are at risk because no protective equipment is available, not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used," it said. 

In the past, some Ebola outbreaks became visible only after transmission was amplified in a health care setting and doctors and nurses fell ill. However, once the Ebola virus was identified and proper protective measures were put in place, cases among medical staff dropped dramatically.

Moreover, many of the most recent Ebola outbreaks have occurred in remote areas, in a part of Africa that is more familiar with this disease, and with chains of transmission that were easier to track and break.

The current outbreak is different. Capital cities as well as remote rural areas are affected, vastly increasing opportunities for undiagnosed cases to have contact with hospital staff. Neither doctors nor the public are familiar with the disease. Intense fear rules entire villages and cities.

Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic the initial symptoms of Ebola virus disease. Patients infected with these diseases will often need emergency care. Their doctors and nurses may see no reason to suspect Ebola and see no need to take protective measures.

Some documented infections have occurred when unprotected doctors rushed to aid a waiting patient who was visibly very ill. This is the first instinct of most doctors and nurses: aid the ailing.

The heavy toll on health care workers in this outbreak has a number of consequences that further impede control efforts.

It depletes one of the most vital assets during the control of any outbreak. WHO estimates that, in the three hardest-hit countries, only one to two doctors are available to treat 100,000 people, and these doctors are heavily concentrated in urban areas.

It can lead to the closing of health facilities, especially when staff refuse to come to work, fearing for their lives. When hospitals close, other common and urgent medical needs, such as safe childbirth and treatment for malaria, are neglected.

The fact that so many medical staff have developed the disease increases the level of anxiety: if doctors and nurses are getting infected, what chance does the general public have? In some areas, hospitals are regarded as incubators of infection and are shunned by patients with any kind of ailment, again reducing access to general health care.

The loss of so many doctors and nurses has made it difficult for WHO to secure support from sufficient numbers of foreign medical staff.

Nigeria, last week lost a Consultant Endocrinologist who was one of the senior health workers who attended to the country's patient zero while he was on admission. She was said to have forced the patient back to his bed when he once attempted to escape from the hospital.

On Monday, Liberia's deputy chief medical doctor Abraham Borbor died of Ebola. 

Since the beginning of the international response to the outbreak in March, the WHO has deployed nearly 400 people from across the organisation and from partners in the Global Outbreak Alert and Response Network to help respond to the disease in four West African countries. 

The toll in Guinea, where the epidemic started, is 406, while in Sierra Leone, 392 have succumbed to the haemorrhagic fever. Nigeria has witnessed five deaths so far. 

The outbreak of Ebola began in Guinea in December 2013, leading to an epidemic in west Africa after it spread to Liberia, Sierra Leone and Nigeria.

Ref: WHO media centre

Medic-ALL.Inc 2014