Oct 14, 2014

  New Government Ebola Hospital discharges 49 survivors after two weeks of operation

The new Government Ebola Hospital at the Hastings Police Training School organized a discharge ceremony for 49 Ebola survivors on Monday October 6. The occasion was celebrated with considerable fanfare, graced by the President, Dr Ernest Bai Koroma, and other top government officials. Opening the occasion, the Chief Medical Officer, Dr Brima Kargbo, informed the audience, which also included the Ebola survivors and medical workers, that the hospital had opened on September 19, the very day the recent "ose to ose" Ebola campaign began. Ministry officials had realised that the campaign would discover a considerable number of new Ebola sufferers and there would be a need for additional beds to accomodate them. The Ministry had rapidly put together a team of entirely local medical personnel to operate the facility, which had been made available by the Sierra Leone Police. He informed the audience that the 49 patients who were about to receive their discharge certificates had been tested and were now free of the disease.

The Inspector-General of Police credited the onlooking President with encouraging them to think out of the box, which inspired him to offer the Hastings facility, as there was no police training ongoing. The Chief of Defence Staff, General S.O. Williams informed the audience that the Sierra Leone Military had made two army doctors available to the new facility.

President Ernest Bai KoromaIn his address, President Koroma thanked the Ministry of Health for the tremendous work they had done in establishing an Ebola Treatment Center in so short a time and praised their efforts in curing so many survivors. He called the exercise a great success and a showcase of our national and collective efforts in the fight against Ebola. He said it would show to the international community that Sierra Leoneans themselves were making considerable effort and would give them a stronger voice when negotiating with international partners. He praised the efforts of all concerned, including the Sierra Leone Police and military.

The Minister of Health, Dr Abubakarr Fofanah, told his audience that the survivors were cured entirely by Sierra Leonean doctors and nurses, with no external intervention. He disclosed that the new, 120-bed facility had admitted 175 inmates in the 17 days since it opened its doors on September 19. The facility has a complement of 9 doctors,  104 nurses and 80 support staff. The Minister claimed a Case Fatality Rate for the facility of 28%, much lower than the WHO estimate of overall CFR during this outbreak, even as he disclosed that  most of the patients are still admitted at the facility (see West African Ebola - What is the true Case Fatality Rate). He informed his audience that the CFR would have been even lower if those Ebola patients who died soon after arrival were excluded. He did not, however, disclose what special techniques the hospital staff had been using to achieve this low CFR figure. To demonstrate his absolute trust that the discharged survivors were no longer infectious, he embraced one of them.

We at natinpasadvantage would urge caution in the operations of the Hastings Ebola Center. It is certainly a highly laudable effort to help Sierra Leone by the Ministry of Health and the doctors, nurses and other health workers involved, but bitter experience with Ebola teaches us that the disease should never be underestimated. Every effort should be made not to compromise safety, even in the face of urgings for greater efforts from politicians and top ministry officials safely ensconced in remote, air-conditioned offices. International experts working with Ebola are extremely conservative in handling it because they know how dangerous it can be. The government-run Kenema Ebola Center ended in well-documented (see Are we repeating the Kenema mistake in Freetown?) disaster. MSF, with the most experience of any organisation in handling Ebola, ideally start their centers slowly and take considerable time training their staff. They are careful not to overextend their workers or subject them to fatigue, because they are well aware that fatigue encourages mistakes. They rotate international staff out of the country after a tour of  some weeks.

MSF's Kailahun Case Management Center, operating since the start of the outbreak in May had admitted a total of 606 patients, with 391 confirmed Ebola cases in the four months to Sept. 24. Its new Ebola clinic in Bo, opened on the same date, Sept 19, as the Hastings Center, had admitted just 15 patients up to Sept 24. With 502 hospital beds in the West African region and somewhere between 2,239 and 3,058 health workers (depending on what category of staff are included) MSF has between 4 and 6 staff members per hospital bed (all sources MSF webpage Ebola ). The Hastings Ebola Center has less than 2 staff members per hospital bed. The Red Cross started its new center in Kenema (the replacement for the ill-fated Kenema government Ebola center) on September 12, with 80 local workers and 19 international staff caring for 21 patients (see New Ebola Treatment Center). They plan to slowly increase the number as they build up experience and train staff.

Under the most favourable conditions, in developed countries treating a single patient in climate controlled conditions with sophisticated equipment, ample staff and medical supplies and top-quality Personal Protective Equipment, we know that Ebola still manages to find a way to infect medical workers. It happened first in Spain, now in the United States. If this is possible in these countries, how much more likely is it here, given our conditions? Infection of health workers is one of the prime methods by which the virus spreads, and is to be avoided at all cost. We would urge a slow, careful, studied buildup of experience in Ebola treatment.

Editor's note: A week after this ceremony, and after our initial publication of this piece, the hospital discharged an additional 33 Ebola survivors.