Deploying to Ebola Centres in West Africa - MamaYe Sierra Leone

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Page 1 ... place on you and how you will manage these stressors. For example: ... the breakdown in social networks inclu
Managing your Personal Health while working in Ebola-affected countries Introduction Taking responsibility for your own personal health while working internationally is an essential part of ensuring you keep resilient, enabling you to make sound decisions while working effectively and safely on your placement. This is particularly vital if you are working in one of the countries currently affected by the unprecedented West African Ebola outbreak.

‘Think smart, act smart’ You are more likely to contract insect-borne diseases such as malaria, or diarrhoeal diseases, or become involved in an accident than you are to contract Ebola during the current outbreak in West Africa, as long as you follow the detailed guidelines and training you have received on Ebola infection prevention and control. Ensuring you are adequately prepared, you eat the right food, wear appropriate clothing, use suitable equipment, take your medication regularly, maintain good personal hygiene and get sufficient rest will enable you to remain healthy, resilient and effective during your time in West Africa.

 Before departure (Prepare) We recommend you follow these guidelines before you travel to a country currently affected by an Ebola outbreak: 

Get briefed – attend briefings and trainings provided by your sending organisation. Obtaining detailed, reliable and up-to-date information about the current outbreak will help reduce the stress of the unknown.



Gain understanding - of the effects of Ebola in the wider context, the stress this can place on you and how you will manage these stressors. For example:             

the collapse of health care systems the decline in the local and national economies the lack of food and employment and closure of schools the sheer scale of the outbreak coping with the high case fatality rate having to turn sick patients away owing to the lack of facilities and staff the lack of life-saving treatments (emphasis on supportive care) being stigmatised, abused or ignored by families and communities the breakdown in social networks including the rejection of Ebola patients and survivors by family members and communities children orphaned by Ebola with no one to care for them dealing with physical isolation (not being allowed to physically touch others) the fear of becoming infected and infecting others the feeling of constant insecurity



Get vaccinated & obtain travel health supplies – visit an experienced travel health clinic, ideally several weeks before you depart, to get up-to-date advice on any vaccinations, antimalarials, mosquito repellents, medication, first aid kits and equipment tailored to your location, medical history and type of placement.



Have a medical - be prepared to disclose your full medical history, including mental health issues, to ensure a pre-existing condition doesn’t flare up during your time overseas.



Check you are not pregnant – pregnancy is not compatible with deployment to an Ebola-affected country.



Learn about the risks – set aside time to learn about risks you may face: diseases (including Ebola), environmental, safety and security and general travel risks.



Family support – provide your family and friends with sufficient details, particularly in relation to safety measures you will be following to keep stress levels at a manageable level.



Health & travel insurance – familiarise yourself with the insurance cover provided by your organisation and the plans that are in place in case you require medical evacuation. Ask your organisation to help you identify health care facilities in-country you could access if you require medical treatment (not just for Ebola).



Contingency plans – ensure all your legal affairs, including making a will, are completed before you travel. !

During your assignment (Sustain)

Local healthcare systems have virtually collapsed in Guinea, Liberia and Sierra Leone so do all you can to remain healthy and free from all infections. In addition to the Ebola safety regime you are expected to follow, there are several steps you can take to keep physically and mentally resilient while working in West Africa: !

Good personal hygiene – poor personal hygiene leads to ill-health and may cause a range of skin diseases, bacterial, viral and parasitic infections. Regular body and hair washing as well as keeping fingernails trimmed and clean prevent the spread of infections. Good dental hygiene will help avoid a need for dental treatment including fillings and the removal of teeth.

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Wash your hands - use soap and clean water which can remove up to 99% of pathogens, including bacteria and viruses. An alcohol-based product containing at least 60% alcohol can be used if soap and clean water are not available. Wash your hands before, during and after preparing food (avoid touching raw meat) and treating a wound, after using the toilet, handling rubbish, touching an animal or after blowing your nose, coughing or sneezing. Make use of chlorine hand washes and sprays as necessary.

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Social interaction – practise safe behaviours. These include: no physical contact with colleagues and friends (no hand shaking, kissing or hugs) and abstinence from intimate relations. This helps to reduce the risk of transmission of respiratory-tract and gastrointestinal infections as well as Ebola.

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Antimalarials – take your antimalarials regularly as instructed to avoid the risk of contracting malaria

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Use sunscreen & avoid mosquito bites – apply sunscreen frequently to avoid damaging your skin and developing sunstroke. Also use and reapply insect repellent frequently, wear loose-fitting long-sleeved clothing and trousers and sleep under a mosquito net to avoid contracting mosquito-borne diseases such as malaria, dengue fever, etc. Sunscreen and insect repellent should be reapplied after washing or sweating heavily, and insect repellent should go on after the sunscreen to ensure it is your outer most layer.

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Avoid contact with bats, rodents & primates: whether dead or alive. They not only act as a reservoir for Ebola but can also transmit other diseases eg. Lassa Fever, leptospirosis, rabies etc. Do not visit caves. Cover food and water, wash fruit, vegetables and crockery before use as they may have been in contact with bat or rat urine.

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First aid for injuries – wash your hands first and wear gloves before providing first aid. Avoid direct or indirect contact with blood and body fluids. Seek medical advice regarding the need for tetanus immunisation and/or if a wound become infected.

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Seek urgent medical care - if you are unwell. If you develop symptoms compatible with Ebola, you will be tested to clarify the diagnosis as soon as possible. You also need to report immediately any needle stick injuries or cut with infected material.

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Peer support - create a safe space within which you and your colleagues can talk openly about daily challenges and fears to promote a sense of psychological safety and reduce stress levels.

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Basic needs – ensure you have adequate sleep, nutrition and exercise. Take a minimum of one day off each week. Find ways to relax and rest despite the heat and extraordinary work context. This will help reduce the risk of error, impaired judgement and a weakened immune system.

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Heat stress – take regular breaks and ensure you are adequately hydrated (with salt and sugar replacement) to minimise the risk of errors as well as fainting or collapsing while attending to patients or carrying out procedures involving body fluids or the transport of bodies. Good hydration also prevents urinary tract infections.

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Regular contact with family & friends – keeping in touch with loved ones will help your resilience.

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Ebola Exposure Risk Assessment – book this with InterHealth Worldwide (email

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HYPERLINK "mailto:[email protected]" }) shortly before you leave West Africa. This assessment should take place one or two days after you have returned home (further details under Post-Assignment section below).

o Post-assignment (Aftercare) Follow these guidelines once your deployment in West Africa has concluded: o

Antimalarials: continue taking these regularly for the period of time recommended.

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Ebola Exposure Risk Assessment – you should undergo this assessment with InterHealth Worldwide within a day or two of you returning to your home country. It is a 15 minute telephone consultation which needs to be booked in advance. The assessment is based on the latest Public Health England guidelines for humanitarian care workers returning from Ebola-affected areas. You will be assigned one of four risk categories, each with its own specific instructions and plan of action, until the end of the 21 day incubation period. The risk category you are assigned is based on your likely exposure to Ebola cases during your assignment.

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Monitor your health: Ebola has a maximum incubation period of 21 days and you should monitor your health during this period, particularly if you were in direct or indirect contact with blood or body fluids. Watch out for Ebola symptoms such as severe headache, muscle pain, vomiting, diarrhoea, stomach pain, unexplained bleeding or bruising and seek urgent medical care if you experience any of them. Limit contact with other people including when travelling to the doctor; avoid using public transport. Remember it is much more likely that malaria or another disease is the cause of your illness, but doctors treating you will need to discount the possibility of Ebola. During your Ebola Exposure Risk Assessment you will be recommended who your designated contact person should be if you develop symptoms within the 21 day incubation period. Make sure you have their contact details easily accessible as you will need to contact them promptly in the event of symptoms occurring.

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Don’t go travelling – don’t go on holiday and stay within easy reach of a regional hospital during the 21 day monitoring period on your return home.

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Re-establish simple routines - this is very effective in helping you readjust to life back in your home country. Before you leave West Africa, contact your family and friends to reassure them that there is no risk in you having contact with them as long as you are not suffering from any symptoms. Repeat this information when you are home and don’t be surprised if some of them prefer not to spend time with you during the first few days you are back.

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Communication – ensure you have contact with at least one friend or colleague with whom you can be completely honest as you process your experiences from the placement. Don’t rush into making major life decisions until you feel settled at home.

Sources ·

InterHealth Worldwide

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US Centres for Disease Control & Prevention

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MSF Briefing Paper: Stress management for Expat working in Ebola Mission (Caroline Joachim)

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MSF Expatriate life on an Ebola Mission

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MSF GB Briefing Paper Ebola Stress Management Expat Staff (Caroline Joachim & Bérengère Denis

InterHealth Worldwide Authors Dr. Simon Clift (Director of Health Services), Cathy Travis (Health Information Manager) Last updated: October 2014