âWe learned many lessons during the Ebola epidemic, primarily IPC, which stands for infectious disease prevention and control, as well as training healthcare workers, which wasn't easy but is now better prepared for the present and the future,â says Dr. Senga R. Omeonga, an Ebola survivor and key figure in the reopening of Saint Joseph's Catholic Hospital in Monrovia, after its closure in the summer of 2014 due to the infection and deaths of several healthcare workers, including Brother Miguel Pajares, a nurse and the hospital's supervisor.
Five years ago, on March 21, 2014, the World Health Organization officially declared the Ebola epidemic in Guinea Conakry, little imagining the devastating scale it would reach in just a few months, putting even the international community in turmoil. The nightmare ended in June 2016, when the epidemic was finally declared over.
Ebola survivor Dr. Senga R. Omeonga in his office at Saint Joseph's Catholic Hospital in Monrovia.
Now, all the doctors and nurses at the hospitals and health centers of the Hospitaller Order of Saint John of God in Sierra Leone and Liberia who experienced the Ebola epidemic firsthand agree that many lessons have been learned, but one stands out above all others: IPC. An acronym that stands for Infection, Prevention and Control and which include a whole series of measures and protocols for the control and prevention of infectious diseases that have continued to be applied since then.
Two hospitals of the Hospitaller Order of Saint John of God were seriously affected by the effects of Ebola. The first was Saint Joseph's Catholic Hospital in Monrovia, Liberia, from which Brother Miguel Pajares was repatriated in early August 2014 after caring for its director, Brother Patrick Nshamdze, who also died. The virus later reached Saint John of God Hospital in Lunsar, Sierra Leone, from which Brother Manuel GarcĂa Viejo, a surgeon, was repatriated the following month. A total of 18 people from Saint John of God died from the virus, including Brothers and healthcare personnel in the two affected countries.
When Ebola reached West Africa, it was completely unknown, and there were very few human and material resources available to combat it. However, the human toll it took and the rapidity with which the virus spread throughout 2014 necessitated the implementation of exceptional surveillance and hygiene measures that are still largely in place.
Control and prevention of infectious diseases
Today, the characteristic wooden stools holding a water can with a plastic tap, soap, and a basin are seen everywhere to facilitate handwashing at the entrances to hospital complexes, clinics, and other transit areas. There are also bottles of hand sanitizer on all office desks and counters, and triage and temperature checks are maintained when each patient is registered.
A security guard washes his hands at the main entrance of Saint Joseph's Catholic Hospital.
What has changed slightly is the use of protective suits, which remain in place, but specifically for handling the bodies of deceased patients, in the operating room when surgery involves significant bleeding, and in some exceptional cases when a patient arrives at the hospital showing symptoms of a potentially serious infectious disease such as cholera or lasagna fever. These suspected cases are taken to the isolation unit for observation. However, these are rare cases and usually turn out to be malaria or another common disease in the region, where tuberculosis, typhoid fever, and hepatitis are also common.
Interview with Brother Peter Dawoh, director of Saint Joseph's Catholic Hospital, outside the hospital complex.
Permanent isolation units are another lesson learned from the Ebola epidemic. They were built thanks to cooperation funds managed by Juan Ciudad NGO, which has continued to collaborate with these hospitals in Sierra Leone and Liberia. However, according to Brother Peter Dawoh, director of Saint Joseph Catholic Hospital in Monrovia, "during the epidemic, the entire country received significant funding and support in the fight against Ebola, but when it ended, the NGOs left and the aid dried up. However, we still need cooperation to maintain healthcare, as the population's needs are enormous and mortality is high. There is a lot of poverty, unemployment affects the majority of the population, and people do not have the income to feed their families or cover their basic needs."
The New Kru Town neighborhood with the St. John of God Health Center in the background, in Monrovia.
In Sierra Leone, the situation is very similar, with an added challenge: less availability of specialized healthcare personnel. Saint John of God Hospital is located in a rural region, next to Lunsar, a small town where most people live off small-scale farming, without any technology or government assistance.
âWe currently don't have a pediatrician or an obstetrician, which are the two specialties we urgently need, as maternal and infant mortality is one of the highest in the world in this region,â says Brother Michael Koroma, director of the Lunsar hospital. The center will feature a community health program, involving neighboring communities through meetings and working groups with local leaders and representatives of women and youth groups.
From March 10 to 20, Juan Ciudad NGO visited the San Juan de Dios hospitals in Sierra Leone and Liberia on the fifth anniversary of the official declaration of the worst Ebola epidemic ever known in March 2014, along with a TVE team from the program Pueblo de Dios, to document their current situation.
The director of the People of God Program, Antonio Montero, interviews Brother Michael Koroma, director of the hospital in Sierra Leone, in the classroom where he teaches at the St. John of God Nursing School in Mabesseneh, twinned with the Sant Joan de DĂ©u Teaching Campus in Barcelona.
Little by little, the two hospitals and their satellite health centers are recovering, as patients have once again flooded their hallways and consulting rooms, having gradually lost the fear people once felt when they associated health centers with death, due to the health crisis caused by Ebola.
Saint John of God Hospital in Lunsar treated 32,400 outpatients in 2014, and the number has gradually increased to 41,000 in 2018, with an expected 43,500 this year. General surgery operations have also increased, from 855 to 1,040 in 2018, with an expected 1,100 this year.
Saint Joseph's Catholic Hospital in Monrovia currently has up to 200 patients on peak days, dropping to 75 on off-peak days. In 2015, the hospital saw 17,000 outpatients, 866 general surgeries, and 533 cesarean sections. In 2018, the number of outpatients rose to 23,700 and 1,050 general surgeries, with a decrease in cesarean sections to 333. This decrease is due to the fact that in 2015, Saint Joseph's was the first hospital in the country to begin providing maternal health care amid the Ebola epidemic, as only Ebola centers, such as ELWA, remained open.
A staff member at Saint John of God Hospital in Lunsar with three Ebola survivors in one of the communities surrounding the hospital. These people continue to suffer from stigma and after-effects of the disease, such as muscle pain and vision loss.
Malaria is currently the leading cause of death in both Liberia and Sierra Leone, and both countries face the challenge of improving maternal and infant mortality, which is among the highest in the world. This is largely related to the high rate of teenage pregnancies and inadequate prenatal care, due to the difficulty girls and women have in regularly attending hospital checkups, and the fact that many do not go to the hospital to give birth.
On the other hand, the sustainability challenges for these two hospitals remain significant, primarily due to the high costs of staffing (medical, administrative, cleaning, and maintenance) and the daily fuel consumption required to supply them with electricity from generators, as there is no reliable, permanent state grid. Medicines and medical supplies are the other major areas to cover.
Juan Ciudad NGO is currently developing several projects at these centers, including field assessments for the design and implementation of a Community Health Program at Lunsar Hospital and the IGORCADIA research project at Monrovia Hospital.
Dr. Anna Cirera, community health program auditor, along with Josua Sandy, nurse and communications officer at Saint John of God Hospital in Lunsar, at a working meeting with local leaders in the village of Mange.
The initiative to create a Community Health Program is coordinated by Dr. Anna Cirera. Among its priority objectives is the integration of Saint John of God Hospital into the Port Loko District health system based on Sierra Leone's national health policies and strategies. It also seeks to coordinate the hospital with the various levels of health care, from the community level to primary health care and the hospital level. This program is funded by Juan Ciudad NGOs, received from donations, and by the Hospitaller Order.
IGORCADIA is a research project in Monrovia, Liberia, coordinated by the Barcelona Institute for Global Health (ISGlobal) (Spain) in partnership with the Liberian Medicines Agency (LMHRA), the Juan Ciudad NGO (Spain), and St. Joseph Catholic Hospital in Monrovia. This project has received Horizon 2020 funding from the European Union for research and innovation programs.
Dr. Cristina Muñoz, coordinator of the IGORCADIA research project, with a laboratory worker at Saint Joseph's Catholic Hospital in Monrovia.
The primary purpose of IGORCADIA is to strengthen the mandate and regulatory capabilities of the Liberian Medicines & Health Products Regulatory Authority (LMHRA) in the use of investigational diagnostics and diagnostic research for infectious diseases.
Experts agree that new epidemics of emerging infectious diseases, primarily caused by viruses, will become increasingly common. Hence the importance of keeping up to date with the lessons learned during the last Ebola epidemic in West Africa. Most of them are being applied in the current Ebola epidemic in the Democratic Republic of the Congo, where the situation remains very worrying. For now, prevention and surveillance remain the best tools available to hospitals and healthcare centers, summarized by the acronym IPC.
Primary care in the Mengue community. Nutritionist Miatta Bangura of Saint John of God Hospital in Lunsar weighs a five-month-old baby suffering from malnutrition.
Social worker Bounde Breeze-Barry of Saint Joseph's Catholic Hospital in Monrovia addresses patients in the main waiting room.
Group photo in the village of Menge with the TVE team from Pueblo de Dios together with Adriana Castro, Communications Manager for Juan Ciudad ONGD, (4th from the left) and Anna Cirera, expatriate from Juan Ciudad ONGD to coordinate the audit for the future community health program of the Sant John of God Hospital in Lunsar, (3rd from the right).
Text and photos: Adriana Castro TerĂĄn, Communications Manager for Juan Ciudad NGO, from Monrovia.
