What follows is an account of our experience at the Maternity of Saint Joseph Catholic hospital in MonroviaThere are so many ways to become famous; unfortunately West Africa will mark human being history by being the area on Earth which experienced the worst Ebola outbreak. Ebola disease was known since 1976, but in this part of the world, no one was having an idea about it in November 2013 when the first cases started in Guinea Conakry. The weakness of the health system, the poor communication, the lack of coordination and resources contributed to the quick and large spread of the disease all over the sub region. Ebola created fear and panic in the societies of all countries affected; a lot of health facilities closed because health workers- who paid a huge tribute during this outbreak- became afraid to treat any patients with symptom Ebola-like. So the virus was killing 1 person directly and several others indirectly -mainly women- because all complications during pregnancy are Ebola-like (e.g. infection, eclampsia, bleeding ...).
Our main concern was to find the way to attend to a pregnant woman without touching herOur intervention as Ebola fighters was less to treat patients affected by the virus than to avoid that those who were not Ebola infected died due to lack of proper care. The challenge was to provide maternal health care in the context of the Ebola outbreak. What follows is an account of our experience at the Maternity of Saint Joseph Catholic hospital in Monrovia (Liberia) from November 2014 to June 2015. Our main method of work was to adjust the Infection Prevention Control (IPC) protocols to our reality of referral maternity which has to deal with all obstetrical emergencies. The main rule of IPC is the NO TOUCH POLICY. So our main concern was to find the way to attend to a pregnant woman without touching her. We developed innovative protocol to make it possible.
Suspected cases were sent to the holding center (a building separated from the main hospital building) which was considered a red zoneAll the patients were going through hand washing with chlorine solution 0,05% and control of body temperature at the gate of the hospital. Then everybody passed by the triage to separate suspected (patient with fever and 2 to 3 others Ebola symptoms such as bleeding, body pain, vomiting, convulsion) from clean cases (patients having only pregnancy related problems). Suspected cases were sent to the holding center (a building separated from the main hospital building) which was considered a red zone: an area where the wear of advanced personal protective equipment was mandatory. Quick assessment to evaluate the condition of the patient and blood specimen was taken for major endemic diseases (e.g. malaria, typhoid) and for EVD (Ebola Virus Disease). An initial treatment was started waiting for the EVD result. When the EVD test was negative the patient was then cleared and sent to the maternity for further management. A delivery room was set in the holding building to attend to pregnant in advanced labor that couldn’t wait for the result to come.
Over a 6 month period we screened 4,000 pregnant women, realized 700 deliveries, and performed 250 C-sections Patients without any symptom were then sent to Antenatal care which was a new screening, comparing information of the anamnesis with those from the triage. Women were then scanned with an ultra-sound which allowed a good clinical assessment without touching the patient. Patients in labor were sent to the maternity which was divided in three areas: red Zone (labor room and delivery room, because health professional were dealing with a lot of body fluid), yellow zone (post-partum, because the secretion was small) and green zone (nursing station). Over a 6 month period we screened 4,000 pregnant women, realized 700 deliveries, and performed 250 C-sections. And most important, avoiding the death of so many women who were wrongly suspected of Ebola. However the fight against Ebola is still going on.
[Dr Rudy Lukamba is Medical Field Coordinator at Women for Africa Foundation in Monrovia, Liberia. During this week he is taking part in the Safe Mothers and Newborns workshop in CaixaForum Barcelona]