IamA First Responder to the Ebola Virus outbreak in Liberia
Thank you from me and Jorge for all of your questions. It's been a great discussion.
If you would like to support International Medical Corps' work to tackle Ebola, you can donate to our emergency Ebola appeal
To meet the health workers we work with in Liberia every day, visit our First Responders photogallery. First Responders is a joint campaign with International Medical Corps and the European Commission to celebrate the ordinary people delivering extraordinary actions during times of crisis, like the health workers of our Bong County Ebola treatment unit.
For live updates on our Ebola response and more, you can follow me on Twitter as well as Jorge, International Medical Corps UK and the European Commission
Thanks for your support!
My name is Sean Casey, and this week my team from International Medical Corps opened the 6th Ebola Treatment Unit in the whole of Liberia. We began treating patients on Monday.
I am joined by Jorge Castilla, the European Commission's expert on Ebola.
Definitely donations. All humanitarian responses require funding, and this one is particularly expensive, given the scale and all the inputs required.
We especially want to raise funding to support training and equipment for Liberian first responders. This is something we integrate into all of our work, but it's particularly important here, as this response requires enormous human resources. Around 90% of our staff here are Liberians, and our first priority is to support them to work safely and effectively.
How big is the risk that the recent murder of several relief workers will lead to aid agencies withdrawing from impacted areas? If that happens, how will it affect the future of the outbreak?
big problem, have no solution in the pocket
I don't think that this will stop agencies from responding, but it will definitely impact how and where they work. Staff safety is paramount for all of us, and we need to know that we can do our work without threat of violence. The violence in Guinea is worrisome, and hopefully the authorities there will do what they can to prevent this from happening going forward.
What do you think about the promised US Military involvement? Will it make a difference?
This is an extraordinary situation and it requires an extraordinary response. We view this as a very positive move - and a very necessary one.
How does local media react on Ebola spread? Or locals don't read newspapers, watch TV.. what then? Radio?
Ebola is almost the only thing anyone is talking about here. The media are obsessed with it, and with good reason. Most people rely on radio for their news, and the radio stations across the country are providing constant updates and hosting regular discussions on the situation.
How do you feel seeing so many people die like this? Does it take an emotional toll on either of you? How do you deal with that?
It's hard to see, for sure. I went to pick up a 12-year-old patient on Monday and spoke to him briefly before he boarded the ambulance. An hour later he was dead and the next day I saw his body being carried away for burial. The suffering is definitely difficult to see, but it also inspires us to do more, and to keep up the fight.
What is actuallly needed for the response now that those of us back in the US/Europe etc can push for /provide? Is it supplies? health staff? money? something else?
We need all kinds of things, but many of them are quite specialized - like doctors and nurses, and specific models of personal protective equipment. The most useful input that the average person with some interest in helping can provide is money to support the operations. Ebola response is very expensive - operating one 70-bed treatment unit can cost up to $1 million/month!
Where should we be directing people to donate then?
Agencies like International Medical Corps (where I work), Save the Children, the Red Cross and others are worth considering. We're all scaling up our responses and need funding to support this work.
Thanks for being here. What do you think are the chances of EVD being held inside the three west African countries --- will it break out into the rest of the world?
Ebola is actually already in six African countries - Senegal, Guinea, Liberia, Sierra Leone, Nigeria and the DRC. Containment is a major concern for all of us. If there is an enormous scale-up in response capacity, it might be possible. But there is a legitimate threat that Ebola could continue to spread if we do not significantly ramp-up efforts and fast.
How are the other 40+ countries in Africa helping? We hear so much about the international communities aren't doing enough fast enough but never addresses help from those close to home.
The African Union is sending in about 200 doctors.
Given the nature of Ebola transmission and it's spread within families, do you tend to see a correlation in family groups with survival levels? For example, if a mother survives, do you see a trend towards her children being more likely to survive than the statistical average?
I'm curious after the research into Ebola Sudan that showed a genetic test that could predict your probability of survival, prior to infection.
We're seeing quite a few families present together. It's normal for relatives to care for each other when they're sick, so this is a common vector for transmission.
How is the situation in Monrovia now? I assume hospitals are overwhelmed, but otherwise is there law and order and people going about their daily life?
It's quite calm, but there is a sense of concern. There aren't protests, and security is as usual.
Hospitals are mostly closed, as health workers are not safe without personal protective equipment (PPE) and training on how to use it. As more ETUs open, hopefully hospitals will too.
Are you planning to trial transfusion treatment there, and if not, can you explain what treatment in your centres will look like?
With the level of Ebola infection in the community unknown, does your team remain isolated from the community when not at work (to prevent infection outside of the workplace?)
How big a risk do you think communal vehicles present in this outbreak (in light of stories showing people desperately travelling by taxi to try to find a treatment centre that will accept them).
We're in a very remote site, so transfusion isn't really possible. We provide IV fluids, oral rehydration solution, pain medication, presumptive malaria treatment and symptomatic care.
What do you think the odds are that Ebola makes it to the USA or a major European country within the next year?
Pretty low. And even if it does reach Europe or the US, it's unlikely to spread the way it is in West Africa, as isolation capacity is much stronger, infection controls are better, sanitation systems are more developed, and people generally live less densely.
Thanks for doing the AMA. What made you decide to help people there ?
I've worked with International Medical Corps in a number of humanitarian emergencies - from the Cholera outbreak in Haiti to the conflict in Mali, from the typhoon response in the Philippines to the battlefields of eastern Ukraine. This is the kind of work that we do, and for which we have unique capacity. When I saw this situation getting worse and worse, I wanted to respond because I knew that we could make a substantial contribution to the effort.
Sean what does your 'average' day look like? What kind of support is offered to local staff and their families (to deal with risk, stigma etc )
Hectic! It usually starts at around 6am and ends at around midnight. In Monrovia, lots of coordination meetings. In Bong, troubleshooting at the ETU, coordinating with government representatives, and sometimes chatting with patients. No two days are ever the same - it's one of the things I love about my job.
We have a psychosocial team that provides support to our staff and their families.
Question from @lumia_glow on Twitter: I wonder how surgeries are being performed when there is a risk of Ebola contamination? Any special measures?
Almost none are being done. Hospitals are mostly closed. This is a big part of the problem here - secondary mortality is climbing because there aren't normal health services to care for patients.
Are you scared?
I'm not scared for myself, but I do fear that this could continue to grow and potentially become endemic - a frightening scenario.
Anything the media never tells us or fudges about potential medical outbreaks like these?
I think there are lots of untold stories about the very brave health workers here. They're the real first responders, and they're continuing to work despite the fear and risk. One of our nurses saw six of her colleagues die from Ebola, but she's continuing to fight the disease by working with International Medical Corps at the Bong ETU.
What are the symptoms of Ebola? I've heard if this actually spreads it could wipe out whole nations, tbh I think it's scary! Thanks!
The most common are fever, vomiting, diarrhea and rash. Unfortunately, these symptoms are common to many infections, so Ebola can sometimes be difficult to confirm. Lab tests are required. For this reason, we separate confirmed and suspected patients in our Ebola Treatment Unit (ETU), and ensure that suspected patients are kept one to a room to avoid potential infection of someone who is negative.
Question from Twitter: @nyakasanga
Do the #UN or #WHO manage any Ebola #centers themselves or is it only humanitarian agencies. If not why not?
WHO has staff supporting several ETUs. There are currently six open in Liberia: - Fyoa (MSF) - ELWA III (MSF) - ELWA II (Ministry of Health) - JFK (Ministry of Health with WHO) - Island Clinic (Ministry of Health with WHO) - Bong (IMC)
I understand home kits are being distributed. Do you think this should be expanded to help reduce the overcrowding at the treatment centers and allow people to remain with their families?
Yes, there is a move towards distributing home protection kits. This isn't an alternative to admitting patients, but really a stop-gap when there are no beds available. It's critical that patients be removed from the home and isolated whenever possible.
What do you think of Obama's deployment of 3000 U.S. troops? It seems the affected countries (Sierra Leone, Liberia etc.) invite foreign military intervention due to their lack of logisitical and operational capacity. Would you like to see more military presence (from the U.S. or other nations), or less? Is the African Union going to participate? Do you worry about the possibility of relief becoming occupation?
At this point, the response needs all the help it can get. Military resources will bring enormous logistical capacity.
Good morning, I'm involved in a humanitarian project to gather information on medical facilities set up for Ebola response. Can you please tell how many beds and staff are at your facility? Are you set up in an existing building or tent? Whereabouts are you located, which town and street name. Thank you and take care.
International Medical Corps is now operating a 70-bed Ebola Treatment Unit (ETU) in Bong County, Liberia. We just opened to patients on Monday. There isn't really a street address, as it's in a forest down a dirt road. Our facility was purpose-built, but others - especially in the city - are in repurposed buildings.
How do you feel about the new WHO regulations strongly suggesting sealed suits with self-powered respirator units?
I haven't seen that recommendation. Maybe you can share a link? We are using MSF and WHO-recommended personal protective equipment (PPE) that covers the whole body with material that is impermeable to biological and chemical agents. Because Ebola is not airborne, we use N95 masks, but respirators are not necessary.
Regarding the treatment center you just opened. What is the number of beds and how quickly are they filling up? Is there sufficient amount of staff to handle? Can you give us a day in the life of a treatment center? Thanks!
We'll have 70 beds at full capacity, and we have 10 open at the moment. They're all full. We have sufficient staff, but as more and more ETUs open, it will become harder to staff them.
You're doing the Lords work my friends. How can folks in N. America donate to the cause? Where do we help?
*Thanks, will share these links as much as I can.
If you'd like to donate to International Medical Corps, you can go to our website - www.internationalmedicalcorps.org. Other NGOs are also in need of contributions. Thanks!
Do you have a death wish?
Not at all. We take our health and safety very seriously. I don't feel like I'm in danger as long as I'm following the protocols. Actually, I'm probably taking better care of my health here than I normally would.
Airborne droplet transmitted ? What do you know ?
Pictures of patients ? Why there are no pictures of patients in different phases of infection ?
Why is there confusion with symptoms ?
CDC - New symptoms:
Symptoms of Ebola include
*Fever (greater than 38.6°C or 101.5°F) *Severe headache *Muscle pain *Weakness *Diarrhea *Vomiting *Abdominal (stomach) pain *Unexplained hemorrhage (bleeding or bruising)
CDC old web page
Symptoms of Ebola HF typically include: *Fever *Headache *Joint and muscle aches *Weakness *Diarrhea *Vomiting *Stomach pain *Lack of appetite *Some patients may experience: *A Rash *Red Eyes *Hiccups *Cough *Sore throat *Chest pain *Difficulty breathing *Difficulty swallowing *Bleeding inside and outside of the body
screen shot of old page
Also, symptoms of ebola on mural in liberia
Can you spot the difference ? Why ?
Can you give us pictures of people infected in different phases of infection ?
Photos won't tell the whole story. On Monday, I went out with International Medical Corps' Ebola ambulance and we picked up a 12-year-old boy and his step-father. Both walked to the ambulance with ease and the boy even climbed in on his own. About an hour later, he was dead. Ebola can kill very quickly, and much of the damage can be happening internally, with few obvious symptoms.
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