I am a Spanish doctor in Sierra Leone working with an NGO on the
matter of Ebola which, as you know, has been hitting part of Africa for
more than six months, and that now, unfortunately, has reached Spain.
This was the first case of direct transmission of Ebola outside of an
African country in the history of the disease.
We are launching in
Bo, which is the second largest city in Sierra Leone, a center of
isolation and treatment for Ebola patients. Both suspected and confirmed
cases, are hosted in the center as the first symptoms appear, which is
usually fever, displayed when disease begins to be potentially
infectious. The pertinent tests are made and we take care of the
patients until we have the results from the laboratory. If it is
negative, the patient goes home, but a medical team will visit daily and
will monitor the patient and his relatives for three weeks. If the
result is positive, we start the intensive care and treatment of the
patient.
So this is how it works in a country where there are, so
far, over 2,400 positive cases and nearly 700 deaths, according to
reports from the Health Department. Although there are probably more,
considering that communication did not work very well and there may be
many lost cases. It is known, thanks to the wide media coverage of this
issue, that each infected person can infect 2-6 people.
Madam
Health Secretary, with all due respect, something went wrong. And
honestly, I think the information you are giving to the media in Spain
on the sad and unfortunate case of an infected colleague, while still
being true, is not entirely accurate. Here, on the ground, where we live
the day-to-day of this disease, we have another point of view, and
certainly very different responses from the ones the government and some
officials are giving.
It is not my intention to distress anyone
or create alarmist situations, but they are making up the facts. Or they
are not saying things clearly. I do not want to believe it's on
purpose, I prefer to think it is due to ignorance of the subject and not
really knowing what they are speaking of.
You should be aware by
now that the personal protective equipment, technically called PPE
(Personal Protection Equipment, although I will call them protective
suits to shorten up) which were used as protection were not adequate for
this disease. As you may know, WHO has different degrees of protection
according to the disease addressed, and Ebola requires the highest level
of protection for its severity, high risk of infection and, above all,
the lack of knowledge professionals have of it. The appropriate
protective suits isolates completely from the environment -- there is
not a micron of uncovered or unprotected skin -- and some elements are
double, as in the case of the gloves.
My colleagues who regularly
enter a danger zone, isolation zone or may be in contact with suspected
or confirmed patients, in addition to wearing the protective suit,
receive two weeks of training in a suitable center by qualified
professionals. In our case, here in Sierra Leone, Doctors Without
Borders (MSF) gives us the training, with professionals with greater
experience, the ones who know best how to treat and manage Ebola.
Protective
measures are much more than the protective suit and they are constantly
carried out (spray with chlorinated water, containers for hand washing
with chlorinated water in each corner, disinfection with this same type
of water for shoe soles, etc.). Just so you have an idea: proper placing
of the protective suit (PPE) takes about 10 minutes, and the removal of
it is a process of about 20 to 25 minutes where some orderly steps are
strictly followed and supervised by two people: one, continuously
disinfected with spray; and another, who remembers the steps to follow.
Even the experts in the issue, who go in and out of the risky areas
several times a day -- because you can not be in a protective suit of
this type for more than an hour due to dehydration risk -- even those
widely accustomed to the long and tedious process to apply and remove
the personal protective equipment, sometimes forget steps or they are
wrong about the order of processes and protocols, and this can lead to
infection.
To prove it here is this fact: over 90 percent of
infected health workers (which are many), were infected by not following
the proper protocols or for not wearing a proper protective suit, all
due to human mistake. The other 10 percent were infected outside the
work environment, by a relative, sex, etc.
Anyway, I will not bore
you more, but it is all very complex and it is not surprising that
unfortunately there has been a contagion. I wish this begins and ends
here and that you learn of the mistakes (if any) and, above all, that
everything goes well for the infected colleague.
Yours sincerely,
Dr. Jose Maria EchevarrĂa
cred- El Huffington