Monday, February 16, 2015

EVD: difficult decision making...

Although the situation in Sierra Leone with respect to Ebola Virus Disease (EVD) has improved considerably since November, there are still cases in Freetown every day. With Ebola still present, it is important to stay vigilant and have a high index of suspicion. Every single person that enters the hospital compound needs to be screened according to the case definition, and anyone meeting the case definition needs to be isolated and tested. One positive case can infect many people, and that needs to be avoided. 

It's a skill however to find a balance between isolating the right cases in an attempt to keep Ebola out of the main hospital and stop further transmission, versus not unnecessarily isolating cases in the unit since by doing so you may expose the patient to the virus in the unit. It's not an easy judgment call and I applaud the clinical staff making these decisions multiple times a day. Unfortunately EVD presents like a number of other illnesses, some of which are very common in children, like malaria, and so it really is hard to decide which children to isolate. Work is being done in country to try to refine the case definition for children in order to improve identification of possible EVD cases.

At times it's not only the children who are unwell, but also the caregivers, who are then also isolated and tested. Sometimes we have a group of siblings who are all unwell and so they are all isolated and tested. If the results are negative, it's pretty easy, the patient/siblings/caregiver can either be discharged home or be transferred to the hospital for regular (non-Ebola) care. When the results are positive, it is also pretty easy, although sad, and the patient(s) is transferred to an EVD treatment centre. The difficulty arises when you have a negative patients who is still highly suspect or when the results for a group of patients that are related to each other are different.

What do you do when a mother tests positive and her child tests negative? 
What do you do when two siblings test positive and one tests negative? 
What do you do when a highly suspect child, with a contact history, tests negative and is very sick needing non-Ebola care, but possibly incubating the virus? Can she go to the general ward? Do you keep her in the unit with sub-optimal care and risk of more exposure?

This is when some difficult clinical decisions need to be made and fortunately we make them as a team during our morning briefing after I have shared the laboratory results. At that particular moment you do not know if the negative case is truly virus free, or if they are incubating the virus and may develop symptoms and start shedding the virus at any moment. It's not until 21 days later that you really know and during that time they interact with many people. Experience during this outbreak has shown that children especially, can go from being well to being very sick in a matter of hours, testing positive for EVD and posing a high risk to those around them. 

I remember a mother who tested positive and her daughter tested negative. The mother died before she could be transferred to a treatment centre leaving the toddler, who was improving, behind in the unit. We knew the child had been highly exposed so we kept her in the unit in order to re-test her. However, by keeping her in the unit for two more days she was potentially exposed even more. It was a dilemma. The child tested negative the second time and was referred to an observational interim care centre (OICC), where they monitor asymptomatic exposed children for 21 days. If they become symptomatic, they are referred back to the unit for testing, if they remain healthy, they are discharged home or referred to an orphanage if the family cannot be located or if no suitable relative caregiver can be found. Fortunately we could discharge her to the OICC where she continued to improve on her antimalarial treatment and did not develop any other symptoms.  

Sadly these situations do not only pose clinical challenges but they also carry with them some severe psychological and emotional trauma. Siblings who have been admitted to the unit have watched their fellow siblings pass away. Some have watched on while their fellow sibling has been taken away to a treatment centre, not knowing what their brother or sisters fate would be, and whether or not they themselves were yet to test positive, and whether or not they would be re-united. Mothers and fathers have watched their children die, either due to Ebola or non-Ebola diseases. And occassionally, children have witnessed their parent dying in the unit, being left alone. Recently I went to the unit and saw a mother with her child. I knew the child was positive. Sadly the sibling, also positive, had died only hours earlier. It was only a matter of minutes before a nurse would come to tell the mom that this child too was positive and would need to be taken away to a treatment centre. Sadly these are just some of the many stories.

We are all waiting for Ebola to end, but until that day, or actually until 42 days of consecutively having 0 cases in the country, we need to remain vigilant. All patients and visitors must be screened, patents on the wards must be monitored continuously and staff must use the appropriate protective equipment and exercise good clinical judgement.

Saturday, February 07, 2015

Welbodi is recruiting a WASH engineer for an exciting Infection Control Project...

Welbodi Partnership is looking to recruit a WASH Engineer for an exciting project in Freetown, Sierra Leone. We are supporting the Ministry of Health and Sanitation with the rollout of a national Infection Prevention and Control Program in three hospitals in Freetown. Through this project we hope to make a significant impact in infection control measures in the hospitals and ensure the safety of both patients and staff. Good infection control is only possible with a sufficient water supply, good access at the point of need (i.e. running water on the wards), an appropriate waste management system, etc. To implement the necessary WASH improvements we would love to have a WASH engineer join our team in Sierra Leone. Please forward this to anyone you feel may be interested:

Position: WASH / Civil Engineer
Location: Freetown, Sierra Leone
Start Date: March 1st 2015
Duration: 6-12 months

BACKGROUND: Welbodi Partnership (WP) is a UK-registered charitable organisation based at the Ola During Children’s Hospital (ODCH) in Freetown, Sierra Leone. For the past six years, Welbodi has worked towards improved paediatric care in the Western Area of Sierra Leone through hospital system development, infrastructural changes, staff training, provision of equipment and community engagement in partnership with ODCH staff, the Ministry of Health and Sanitation (MOHS) and the Sierra Leone Institute of Child Health (SLICH). 

Welbodi Partnership continues to support healthcare in Sierra Leone during the outbreak of Ebola Virus Disease (EVD) by providing coordination support to the holding unit at the Children’s Hospital while at the same time strengthening the safe provision of ‘routine’ health services (non-Ebola care) to children in the hospital. WP is working with the MOHS and other partners to roll out a national programme to strengthen Infection Prevention and Control (IPC) in government hospitals and to ensure that hospitals have the water and sanitation infrastructure necessary to adhere to IPC. Welbodi will implement this programme in three hospitals in Freetown: the national referral Ola During Children’s Hospital, the national referral Princess Christian Maternity Hospital and Rokupa Government Hospital, a community hospital. 

SCOPE OF WORK: Welbodi Partnership is looking to recruit a WASH / Civil Engineer to join the team in Freetown to work in collaboration with the existing hospital maintenance teams and local contractors to improve the water and sanitation infrastructures in the hospitals that are essential for the implementation of IPC practices to reduce the health risks for staff and patients. The WASH Engineer will collaborate with the MOHS established Patient Safety Committees (PSC) as well as the national IPC focal persons and Welbodi Partnership IPC Mentors.

Due to the urgency, applications will be reviewed as they are received and suitable candidates contacted on an on-going basis. This position is for 6-12 months. At this time, WP can only accept applications from citizens or permanent residents of North America, Europe and Sierra Leone due to limitations in the complex evacuation process in case of emergency.

  • To develop a plan for improving the WASH infrastructure at the hospitals based on assessments carried out by partner NGOs in January 2015 and to prioritize the WASH activities according to urgency
  • To prepare technical drawings, BOQs and specifications for water and sanitation infrastructure as well as develop, negotiate and manage contracts with service providers, which will include preparing tender documentation and evaluating capacity and quality of contractors
  • To provide effective and efficient management of the project implementation in line with the project proposal
  • To provide ongoing supervision and mentorship to hospital maintenance staff, technical assistants, contractors and direct labour work teams during the implementation and evaluation of projects
  • To offer technical solutions to problems arising during construction and ensure appropriate safety and construction practices are adhered to at all times on site
  • To collaborate with the maintenance team and local contractors to implement WASH activities and ensure a functioning management, monitoring and planning body for the ongoing sustainability of the WASH infrastructure
  • To carry out further assessments of the hospitals and set up maintenance systems, train staff and arrange repairs of tanks, pumps, generators, pipe networks, drainage systems, etc. as required
  • To support the PSC, IPC focal person and IPC Mentor with the implementation, including delivery of training, of the SOP for “Safe Provision of Hospital Services during an Ebola/Viral Haemorrhagic (Fever)” and the Ministry of Health and Sanitation’s “National Patient Safety Guidelines” – this would include specific WASH related training such as disinfection and waste management and monitoring adherence to disinfection and waste management protocols
  • To take a leading role during the regular hospital PSC meetings on WASH related matters
  • To take a leading role in interagency WASH coordination meetings and develop networks with relevant WASH actors to ensure coordination and works suitability
  • Ongoing monitoring and regular reporting of WASH activities for WP and partners
  • To support the Project Manager / Country Director in evaluating the impact of the programme
  • To perform any other duties deemed necessary to meet the needs of this project

  • University Degree in Engineering or other relevant WASH field(s)
  • At least 3 years of practical, hands-on experience in WASH interventions
  • Experience of programme implementation including financial accountability
  • Experience of staff management and capacity development
  • Excellent people skills and the ability to work collaboratively with people from diverse backgrounds
  • Ability to self-motivate and work autonomously within the scope of the role
  • Excellent computer skills particularly in Microsoft Word, Power Point and Excel
  • A good command of the English language (verbal and written) is required
  • Flexibility in roles and responsibility is essential

Highly desirable:
  • WASH experience in a development, emergency or post-conflict setting with a good understanding of water (especially water networks), sanitation and/ or solid waste management in the African context
  • Experience in a hospital setting
  • Experience in WASH/environmental health related training/mentorship/programme development
  • Krio or other local language ability

SALARY/BENEFITS: Based on qualifications and experience, to be discussed with shortlisted candidates.

APPLICATION PROCESS: Interested candidates should email a copy of their CV, cover letter, and a list of three relevant references to as soon as possible. The job title should be included in the subject line. Your cover letter should include: your country of residence and nationality, your date of birth, dates you are able to commence and duration of availability. Only those applicants shortlisted for an interview will be notified. 

Equality and Diversity Statement

The Welbodi Partnership confirms its commitment to a comprehensive policy of Equal Opportunities in volunteering and employment in which individuals are selected and treated on the basis of their relevant merits and abilities and are given Equal Opportunities within the organisation. It is the Welbodi Partnership’s policy as an employer to treat all people equally irrespective of race, ethnic origin, nationality, sex, marital or parental status, sexual orientation, creed, disability, age or political belief. Applicants for this position should be aware that if successful, they will be requested to complete a Disclosure and Barring (DBS) check, or equivalent in countries other than the UK. The Welbodi Partnership complies fully with the DBS Code of Practice. The entirety of the Welbodi Equality and Diversity statement is available upon request.

~ Act Justly. Love Mercy. Walk Humbly. micah 6:8 ~