Ebola Outbreak: Protecting Health Care Workers

You're a doctor at one of the few clinics equipped to deal with trauma patients in a capital city. Several people critically injured in a nearby car crash are brought in. Some are bleeding severely.

What do you do?

Oh, one other thing: Ebola has been reported in your city.

CRS training provides practical experience on how to put on and take off protective equipment, and how to manage and properly dispose of waste. Photo by Michael Stulman/CRS

This is one of dozens of scenarios Catholic Relief Services is asking more than 3,000 health care workers in Guinea to envision as we teach safety procedures that protect doctors and nurses from Ebola, and help to stop this deadly virus from spreading.

"Doctors should be safe. And first you have to protect yourself in order to be able to care for patients," says Dr. Phillip Diffo, an instructor working with CRS.

"The training has taught us a lot about protecting ourselves," says Dr. Moriba Haba, who completed the CRS training. "It's important because we are often the first people to get infected with Ebola, because we see patients."

Developing health care workers' reflex to first reach for the pair of gloves or facemask is not easy when the workers are accustomed to handling patients with limited resources—too few beds, staff, medications, laboratory tests and protective equipment. But that step is crucial to protect the workers from the bodily fluids that spread the virus

Because health care workers have treated patients before protecting themselves, Ebola has spread rapidly in health facilities. To date, there have been more than 800 cases of Ebola among health care workers in West Africa.

Training doctors, nurses and maintenance staff to spend scarce time and resources to properly use protective gear requires dedication, skill and patience. With support from the U.S. Agency for International Development's Office of Foreign Disaster Assistance, CRS is taking on the task.

Establishing a 'culture of safety'

"Do you expect us to wear everything?" asks one training participant. After all, personal protection can include face shields, facemasks, head covers, disposable waterproof gowns, reusable rubber boots and reusable rubber gloves.

The answer is sometimes yes, and sometimes no. The right combination of protective equipment depends on the situation.

As hard as it is to put everything on, taking it off is even harder. Removal may take up to 24 steps after possible exposure to Ebola.

"Mistakes happen when taking off protective equipment in a hurry," says Dr. Diffo. "If you don't follow protocol, it's dangerous. Being careless kills."

Equipping health care workers

Health care workers in Guinea have historically been poorly equipped and are used to handling patients with minimal precautions. They need extensive and detailed training in infection control to keep Ebola from spreading. Photo by Michael Stulman/CRS

Training health care workers does no good if they don't have the protective gear. In Guinea, most facilities lack crucial equipment including hand-washing stations, gloves, masks and eye protection.

Moussa Kourourma, a physician in the capital city—Conakry—sees at least 15 patients per day, sometimes more. This requires a lot of protective equipment for each visit. "We need equipment. Sometimes we take money from our pocket to buy gloves."

CRS and our local partners, including the Pharmacie Centrale de Guinée, are working to stock and distribute medical supplies to health facilities around the country.

Reviving routine care

Across West Africa, health facilities have closed because of Ebola, and it has become a challenge to address other common and urgent medical needs, such as safe childbirth or treatment for malaria.

"The most important lesson is understanding the ripple effect of contamination. One person can affect an entire community," says Dr. Diffo.

"The good news is that Ebola is easy to destroy," he adds. "We hope that after this training, health care workers are aware and know how to deal with epidemics."

According to Camara Gnékéré, a nurse based in Conakry, "People see me taking precautions. They believe it's safe to visit my clinic, and slowly, people are beginning to come back [to health facilities]. This is my job. I became a nurse to help the sick … [to] aid and protect them.

"I am not running from Ebola," he says.