Five years ago this fall, the governments of Liberia and Sierra Leone invited Partners In Health to help respond to the world’s worst Ebola epidemic. Although the organization had never responded to this type of public health emergency, PIH leaders knew they would join the fight and not only deal with the outbreak, but also stay for the long term to help rebuild the nations’ weak health systems. The goal was to better guarantee West Africans’ right to health, both immediately and into the future.
The primary reason Ebola ravaged West Africa and not Spain or the United States—where cases were found, but did not spread—is that Liberia and Sierra Leone lacked strong health systems. In Sierra Leone, for example, 7 million people are served by only 150 doctors. Compare this to the 7 million people in Massachusetts, who are served by more than 20,000 doctors. It then becomes easier to understand—but much harder to accept—why Ebola sickened 28,600 people and killed more than 11,000 people across West Africa.
When PIH arrived in Liberia and Sierra Leone in October 2014, clinicians and staff rapidly cared for the sick, accompanied survivors, and helped transform the health system so that—should Ebola return—the deadly virus would never again take such a heavy human toll. And while not perfect, PIH’s response was guided by the firm belief that everyone deserves the best care possible.
Here are some of the ways in which PIH and local partners innovated to provide care in the midst of the epidemic:
- First, care not containment
The Problem: Sierra Leone and Liberia did not have readily available infrastructure to house and care for a vast number of patients sick with Ebola, especially in remote, rural areas. Patients were often quarantined in locations where little to no care was provided. Meanwhile, other NGOs’ first order of operation was to build Ebola treatment units, while patients and the community effectively went without care.
The Solution: PIH collaborated with the Sierra Leonean government to work out of the Maforki Ebola Treatment Unit in the northern Port Loko District. The facility, which was originally built as a technical school for former child soldiers following the civil war, was always packed with patients and served as the only treatment unit in the district. The team worked to improve safety standards, operations, infrastructure, and WiFi access, all while clinicians cared for patients.
And in Liberia, PIH helped the national government design and run Ebola treatment units to the south of the capital, in Grand Gedeh and Maryland counties, and helped respond to a cluster of Ebola cases in River Cess County. Smaller Ebola community care centers were established in Grand Gedeh, Maryland, and Grand Kru Counties to isolate and begin treating patients suspected of Ebola while they awaited lab results.
- Rapid-response Ebola treatment
The Problem: Before PIH’s arrival in Sierra Leone, patients suspected of contracting Ebola were only admitted to treatment units during daylight hours. They also did not receive care until a lab test confirmed they were positive for Ebola, which often took multiple days—if such testing was available at all.
The Solution: The Maforki Ebola Treatment Unit was the first in the country to remain open 24/7 to receive new patients. There, PIH quickly adopted aggressive treatment protocols for patients suspected of contracting Ebola, including IV fluid resuscitation, antibiotics, anti-malarial medication, and more.
- Installing lab and ultrasound equipment
The Problem: Testing outside of the capital of Freetown was extremely rare during the epidemic. Clinicians often relied on physical symptoms to arrive at a diagnosis, yet nausea, vomiting, and fever are common manifestations for multiple diseases, not just Ebola.
The Solution: PIH installed lab testing and ultrasound equipment at the Maforki Ebola Treatment Unit and at Princess Christian Maternity Hospital in Freetown within months of arriving in Sierra Leone. This allowed clinicians to properly diagnose Ebola and rapidly treat patients, or triage them out of the Ebola ward.
- Separate Ebola screening for pregnant patients
The Problem: At Princess Christian Maternity Hospital, all patients used to be screened in the same location. Because women in labor often display the same symptoms as patients sick with Ebola, they were mistakenly assumed positive and isolated together. This made it easier for the deadly infectious disease to spread. Meanwhile, clinicians hesitated to provide care to women in labor, as contact with body fluids increased their chances of contracting Ebola.
The Solution: PIH opened the first Ebola screening unit at the hospital to safely isolate women suspected of Ebola. If patients tested positive, clinicians treated them separately and provided them with the maternal care they also needed, including helping with obstructed labor, managing eclampsia, and treating infections—all common causes of maternal death.
- Continuous care at district hospitals and clinics
The Problem: During the time of Ebola, local clinicians were overwhelmed responding to the outbreak and were not available to help people who needed more routine health care.
The Solution: While PIH clinicians cared for Ebola patients in Sierra Leone, other team members worked at Koidu Government Hospital and Wellbody Clinic in the east and Port Loko Government Hospital in the north to provide routine care to patients, including pregnant women, children with malaria, adults with TB or HIV, patients dealing with complications from high blood pressure and diabetes, and more.
In Liberia, PIH kept hospitals and health centers open and running, including Martha Tubman Memorial Hospital in Grand Gedeh County and J.J. Dossen Hospital and Pleebo Health Center in Maryland County. Meanwhile, community health workers in both counties worked to identify patients with a variety of diseases, such as tuberculosis, leprosy, and HIV, and connect them with care.
- Employment of Ebola survivors
The Problem: Stigma toward Ebola survivors was high. Many returned home to discover that their family members had died, all their possessions had been destroyed, and they no longer had jobs.
The Solution: In Port Loko, PIH employed more than 700 survivors to educate community members about Ebola and help screen for new cases. Others chose to be care providers in the Maforki Ebola Treatment Unit, ensuring patients had food, water, and other basic needs. PIH also helped create the Sierra Leone Association for Ebola Survivors, which continues to provide a supportive community and services, such as literacy classes, to survivors. Other organizations are now replicating these practices in the Democratic Republic of Congo, where the most recent Ebola outbreak is more than one year old.
- “The 5 S’s”
The Problem: Responding to Ebola as a medical emergency was first and foremost in people’s minds throughout the West Africa outbreak. However, once survivors emerged from treatment units, they were stigmatized and suffering from the personal loss of loved ones, all their possessions, and any means of employment. National health systems also were left weaker, as many local clinicians had contracted Ebola and died responding to the emergency.
The Solution: PIH approached the situation holistically, as in every country where it works. Clinicians provided quality care to Ebola patients, but also advocated for survivors so that they could access lodging, food, clothing, and gainful employment. They also provided survivors follow-up care when Ebola-related symptoms, such as vision problems from uveitis, emerged in the weeks following their cure.
Meanwhile, PIH leaders partnered with the national government to ensure the right staff, stuff, space, systems, and social support—the 5 S’s—were in place to help rebuild the health systems in each country.