PPE like McLellan’s is a crucial barrier for anyone who works with Ebola patients, bodies, or with sanitation in Ebola clinics. But in Africa, healthcare workers are forced to use donated supplies, often putting together a mix-and-match.
Tropical medicine expert Frederique Jacquerioz is an assistant professor of clinical tropical medicine in Tulane’s Department of Tropical Medicine, but is based in Lima, Peru. She has been working with the World Health Organization and spent part of September 2014 traveling to Sierra Leone to provide technical assistance in Ebola case management and training. She has been developing English and French clinical training materials in collaboration with the IMAI-IMCI Alliance organization to improve the training and safety of health workers.
“The training materials are for people who have never been in West Africa or who have never worked with hemorrhagic fevers,” she explains. While she was in Sierra Leone she was not only observing the current use of PPE but putting the prepared training protocols in place to train health workers and cleaning staff.
Although her primary mission was to oversee the training component, she is also a tropical medicine physician who couldn’t turn away from the need in front of her.
“I shared my time, did clinical care, and also the training of foreign medical teams,” she recalls. “The need now is enormous. The main issue is to find the staff that can work in those centers.”
She observes that communication between the WHO, the CDC, and Doctors Without Borders is improving the response, but the countries involved also must find supplies, incentives, payment, and social support for the health care workers, who also worry about what will happen to their families if they get sick.
“When caring for people with Ebola you have to be sure to work in a safe environment, and you have to have a good supply of materials and good mentoring,” she says. Many experienced doctors, nurses, and lab staff have died from Ebola, creating a vacuum of much-needed expertise. It takes courage to volunteer, says Jacquerioz, and the volunteers need the extended training she and her colleagues have developed.
“When people are informed and they understand the PPE, they can ask questions, the level of fear goes down,” she says. “You have to be cautious. But a high level of fear won’t help you to do a good job.”
Following careful steps in putting on PPE and taking it off, such as making sure to take off face coverings and goggles last, will help protect workers. Even the single direction path health care workers take through an Ebola ward is prescribed, with specific protocols around how they move in the ward and what to do when leaving it.
“We are putting together a one-week training, including practice with the PPE and mentoring. Then there will be retraining every two or three months when people start to be too relaxed,” she says.
“What we are trying to do is make sure that the main principles are followed. What is really important is to keep the protection for the eyes, nose, and mouth the longest you can when you remove the PPE,” she says. For washing hands, people can use bleach. Alcohol is preferred, says Jacquerioz, but inconsistently available.
She has also taken note of foot coverings, finding that washable boots are preferred for working in Ebola wards in Africa.
“The WHO is currently updating the recommendations about PPE,” she says. Those new recommendations will be included in training protocols aimed to keep health workers safe with what they have on hand. Jacquerioz herself is planning to go back to assist, this time to Liberia.
Continued: The Biologist: Lisa Guerrero, MPH