The Ebola Battle

[Japan International Cooperation Agency] [Tuesday, Dec 2, 2014]

The World Health Organization reported on the Ebola cases hammering West Africa that as of Nov. 11, a total of 14,413 people had been infected or were suspected of being infected, and 5,177 had been killed. In Liberia, where the damage from infection is most severe, on Nov. 13, President Ellen Johnson Sirleaf lifted the state of emergency she had announced in August. However, the situation remains critical. While urgent assistance from the international community is requested, the media often reports confusion on the ground. However, there is a JICA ex-training participant in Liberia who works on Ebola countermeasures by dealing with patients every day.

People in denial about the disease, and a shortage of medical equipment

Some 100 people from Liberia have received health training from JICA in Japan or Africa since 2007. Nurse Nicolas Blidi is one of them, and he worked in a state health center in Clara town where the residents are mostly poor, located in the west part of Monrovia, the capital of Liberia, until September this year. He also conducted community case investigation for the area, finding that Ebola infections drastically increased in August, and in September alone, over 10 people died in the clinic. Some of them were already dead when he heard the news and rushed to the residents' homes.

In Liberia, though NGOs including Médecins Sans Frontières (MSF) and the counties jointly work to promote an awareness campaign for Ebola prevention, quite a number of people are still not willing to accept the existence of the disease. When they recommend inspection or quarantine, not a few people resist from a false fear that if they are hospitalized, their liver could be taken for the organ trade.

The health center Blidi worked at had many visitors beginning in the morning. After checking their temperature using a gun-shaped non-contact thermometer, he saw patients with fever in a separate room. If Ebola symptoms were recognized, or a member of their family had died from a suspected case of Ebola, he recommended quarantine.

The shortage of medical equipment was serious. Though the health center covered approximately 48,000 residents in the area, it had only one non-contact thermometer. Personal Protective Equipment (PPE) was scarce, and the health center didn’t have an ambulance. Clinics in Monrovia that had an isolation ward admitted tens of new patients each, and in some cases they could not admit new patients due to a shortage of beds. While all regions were pressed with such responses, they could hardly find time to care for other infectious diseases such as Malaria that need urgent attention in normal times.

Medical staff leave the field, fearing infection

The situation of medical staff who have direct contact with Ebola patients also is serious. People involved in medical care who work long hours risking their lives went on strike on September 14, seeking a pay raise. Blidi, who had been seeing people coming to the health center for help, discussed the strike with other nurses and agreed with it, though he did not close the clinic and continued treatment. Since infections rose rapidly after August, he even worked weekends. “I was just putting in all my time,” he said.

Some medical staff members left the health center, fearing they might get infected. But Blidi, as a leader of the nurses, remained to secure the clinic, which had no doctors. Given the situation in which some people at first decided not to quit their jobs at the clinic but later changed their minds, every day he taught his co-workers the importance of staying on the ground.

There are originally many pregnant and parturient women in populated slums. One day a medical staff member refused to treat a pregnant woman from fear of infection and she died as a result. In a clinic where Blidi works, some staff members were also afraid of treating pregnant women. So he helped make deliveries many times, wearing PPE.

A female doctor and former supervisor of Blidi, specializing in maternal and child health, currently works in an isolated ward for Ebola in Monrovia. According to her, some of the medical staff members she knows have already died of Ebola. Blidi says that the most important support is, “firstly PPE, secondly mental care for the medical staff and children who lost their parents because of the disease.”

Confidence gained at training sessions brings teamwork to the medical staff

Blidi's ability to coordinate dozens of staff members in the clinic stems largely from his participation in JICA’s training program Perinatal, Neonatal and Child Health Care for African Countries in 2013. The training gave him confidence.

While many of the medical staff members afraid of its risky environment where they could get infected any time left the clinic for better compensation, he took the lead in treating patients without even taking days off. By doing so he showed how a medical staff should be to his co-workers.

“Responding to Ebola is a national fight in which each individual should work together.” This attitude brought teamwork among the staff members in the health center, and generated a hope in the area. “What I learned at the JICA training was teamwork. For the Ebola response too, I believed that the power of teamwork built by individuals would win over the disease, even if each can contribute only a little,” he said.

Even before he became tied up with the Ebola response, he used the outcome of the JICA training by voluntarily carrying on an awareness campaign for area residents, or holding training sessions to discuss maternal and child health, reproductive health, nutrition and other topics. On weekends he carried on an awareness campaign for the residents in a town hall, and on weekdays he decided a theme for each day and held reporting sessions, by choosing a time when women participants could take part.

JICA training participants in Liberia receive training in such subjects as maternal and child health, in-hospital infection and hospital management in Japan or in Africa, and after their return, they work by using the outcome of the training. Many of them are also involved in Ebola countermeasure like Blidi. The number of such people is estimated at several dozen in the county of Montserrat, where the capital of Monrovia is located, alone.

Since the end of September, Blidi has been enrolled in a master’s degree course in public health at the University of Ghana. He plans to return to Liberia in the future to work with a surveillance system team of the Ministry of Health and Social Welfare.

Nicolas Blidi in the health center where he works. Blidi studies at the University of Ghana with a scholarship from the West African Health Organisation. This map shows the six countries with Ebola cases in West Africa. (The World Health Organization declared that the outbreaks in Nigeria and Senegal are officially over, as of November 11.)

[Japan International Cooperation Agency] [Monday, Dec 1, 2014]

JICA will provide Personal Protective Equipment as well as Japan Disaster Relief teams in response to the Ebola outbreak in West Africa.

Since the first infected individual was found in March, Ebola has continued spreading, resulting in a shortage of PPE on the ground.

Prime Minster Shinzo Abe said in the United Nations General Assembly and on other occasions that Japan is ready to provide PPE. Following requests from the governments of Liberia, Sierra Leone, Guinea and Mali through diplomatic channels, JICA will provide approximately 700,000 sets of PPE to these countries.

Based on a request from the UN Mission for Ebola Emergency Response, the Government of Japan decided to dispatch an aircraft of the Japan Self-Defense Forces (SDF) as part of a Japan Disaster Relief team. Out of the aforementioned PPE, 20,000 sets will be transported to Accra, the capital city of Ghana, on the aircraft. In line with this, there are plans for another JDR team, consisting of members from the Ministry of Foreign Affairs, SDF and JICA, to also be dispatched to Accra to coordinate receiving of SDF and PPE.

The remaining PPE will be transported by civil aircrafts to Dubai, where it will be handed over to the World Health Organization.