Healthcare workers face the highest risk of Ebola infection during outbreaks due to direct patient contact, making infection prevention and control (IPC) measures essential for protecting themselves, patients, families, and communities. Key protective strategies include maintaining a high index of suspicion for Ebola symptoms (fever, gastrointestinal symptoms, muscle pain, headache, vomiting, diarrhea, and later bleeding), implementing proper screening mechanisms at healthcare facility entry points, using appropriate PPE based on exposure level (gloves and gowns for screening, hazmat suits for direct patient care), and ensuring early reporting and treatment of any suspected cases. Healthcare workers must also protect themselves from secondary transmission by avoiding moonlighting across facilities, maintaining strict hand hygiene with soap or alcohol-based sanitizers, and reporting all exposures honestly through body systems. The 21-day incubation period requires continued vigilance and monitoring of contacts, while the virus can remain viable on surfaces for 7-10 hours and in wet infectious material for several days.
Your Health First - Ebola ResponseAjouté :
of services at the Africa CDC.
And uh we're going to answer your questions.
And then we'll have a closure by the Director General Health Services.
So with that much ado, uh EG, I'll request you to speak to us.
Thank you.
>> Okay, thank you, Stelvia. Good morning, and thank you for joining in big numbers.
And I think it was very important. We've had some earlier discussions, but we thought we needed to still continue to have this engagement.
Because all of you know that by nature of what we do we remain vulnerable.
So it's a occupational hazard.
But we can be able to mitigate.
For our colleagues who definitely became contacts who were exposed partially before the announcement or the declaration was done is definitely quite unfortunate because probably they lowered their guard on aspect of infection prevention and control.
So we'll take that probably they should be the the last persons who should be have to be contacts.
Cuz as as we speak now a majority of the people who have had to quarantine or who have had to to to to ask to isolate are health workers.
So this remains vulnerable we remain vulnerable.
And by nature of our work we we interact with colleagues.
By nature of our work we interact with the patients.
By nature of our work we interact with our families.
But also by nature of our work we interact with community.
So it means that if you have one health worker in the process of coming to work, he will infect probably the people if he's using public means.
When he's at home, he'll infect his family.
And definitely if he's not So, that's really key that the only way we we can do this is to have the high index of suspicions.
What we also need to know that Ebola Bundibugyo presentation is different from those presentations of which we know about a the other Ebolas, Ebola Sudan, Ebola Zaire and and and all the other types of Ebola.
But specifically, it presents in a very unique way.
And present sometimes with the first presentation might be GIT symptoms, which might be nausea, vomiting, diarrhea, abdominal pain.
And somebody can present with epigastric pain.
And definitely for I'm in fever. And sometimes it can mislead us to make a diagnosis that probably dealing with peptic ulcers. And then we give him a cocktail of vomit blood at a later blood bleeding is really appears at the late late stage of of the disease.
So, what is key is that so, abdominal pain.
But also what we know currently that Ebola Bundibugyo does not have any vaccine.
There is there are no therapeutics. We are just trying to repurpose repurpose therapeutics for for for it.
So, most of the treatment is supportive treatment. So, it means that if you get in you become you in come in contact, it's good that you identify early or when the symptoms start so that you are started on supportive treatment. Because we also were seeing that what will kill kill the person so far the ones which we have had definitely like the case which presents one of the hospitals, he had renal failure.
So, kidney injury is one of those aspects which will do what?
They are issues definitely muscle injury, a lot of inflammation which will come in.
So, we need that you present early. You should not hide.
You should not self-medicate.
So, you you present so that you can be supported.
The last outbreak we had all the those cases which presented to us early were able to save them.
And it's the same thing. So far the people whom we have, I must give you give you confidence that we are managing them and we really would want that they walk out of the isolation alive.
So that they they can be able to but we would not want more colleagues, more health workers to get exposed. So, a good history a good risk assessment, a good infection prevention IPC is really can stop Ebola transmission can protect you as an individual, can protect health workers, protect your patients, but also protect your family.
So the the capsule of the virus as you you you you you listen or you'll be told can be denatured by soap and if that's why you need to wash with soap and water or it can be denatured by by by san- sanitizer alcohol. So we need to be able to to to be able to to do that. So, I really would want that we we we protect the yourself, protect your health workers, protect your other patients.
And if you get in contact, come early. So, that that's those are really the key aspects which we we really would want that look look at it. Also, what you need to know that we by virtue of Uganda development, most most of the people are coming are coming to Uganda for medical tourism.
So, our colleagues from the DRC are in all the facilities in Kampala and beyond.
It's not that we would want to deny anybody transport, but let's be able to articulate, I mean, take a good history.
Also, take also take a good documentation so that we can be able to follow this. For the health facilities, for those who had health facilities, have a small be able to screen because we also what what we know is that if somebody is in a dry phase, when he has not developed symptoms, is still in the incubation period, it does not spread. But, if they start developing fever and all the other diarrhea, members, can we mute?
Members, members, can we mute?
So, I really am happy that you have joined. We hope that the conversation we're having will save lives. I hope the conversation we're having will protect you.
But, if you want you to be part of our surveillance systems, we want to get these alerts coming.
Any any non-trauma deaths, we want to screen it as part of our mortal surveillance. Any non-trauma deaths, we should be able to to take the the the samples.
We are going definitely to change the protocol because we we'll soon Apart we've been taking mainly blood, cardiac blood, but now we might have to change. We might need to take swabs from anal swabs. We might need to take others because we we know that this the disease specifically starts initially as a GIT before it gets into systemic systemic infection.
I think uh chair, these are really the key things which I want to highlight that we can't speak, but what we want that we need to change the culture.
We need to change the way we do we do things. If we continue doing it the same way, lastly, I think what the other aspect which also I've seen that by virtue of the work you do, many of you are moving from one facility to one facility. And so if there's one worker which is exposed in one facility, is bringing infection to to several facilities.
Is moving here, moving to that facility, moving to that facility. So you find that the chain of infection spread is high.
So this animal called moonlighting and moving to my is is going to kill us.
That's also what we are seeing.
We're seeing colleagues who are moving from one facility to one facility.
They have bring themselves to a risk, but also they are bringing a risk to all the patients and the other health workers in their facilities.
So we want to really that to to come out and you need to be able to know that you can continue moonlighting at your own risk because it will bring you into problems.
So I think those those are really my key highlights that Let's practice.
>> speak to the numbers that we have. I read somewhere yesterday and people are asking me, "Do we really have Ebola?"
>> Okay, well that's also a question because the question is that yesterday I I out I outed I outed a an update where we we had two others. So the numbers still remain with one one one fatality. So, those are the numbers which we have. We have one one one one patient one one Ebola patient who has been discharged from the treatment center. Those who are receiving treatment in still our facilities somewhere else for different conditions, but at least it's tested negative for Ebola. So, those are numbers. Most of the cases right now are are still in Kampala, but it does not mean that if you are upcountry, people from upcountry, don't say you are very far from Kampala.
Kampala is I mean it just across this country. So, you need to be able. But out of those nine, we have close now to about 600 contacts. 600.
About 246 or 50% of them are high contacts.
High risk contacts.
So, you you can I mean that they they physically touch the patient physically, handle what?
600. So, it means that if we stop, because that's also what I'm speaking to.
If you are now you are contact, it means that if you have been asked to isolate at home, partially for level four contacts, it means that even your children should not be going to school.
They also mean that they should be able to isolate with you until the time when the 21 days are over.
Otherwise, you will still be putting the community into what? Into risk. So, that's the implications which you have.
It will affect you in as individual.
It will affect you as a family.
And definitely it will affect the nation.
I think I've been clear, Dr. Kabuye.
>> Thank you so so much, Prof. Uh you've been very very clear Uh and to the point emphasizing IPC and vigilancy and surveillance uh wherever we are and also making sure that we protect ourselves, protect our patients and our family members by observing the minimum precaution measures.
Um you have also told us that we have uh uh nine confirmed nine uh cases that uh have been reported and we have over six about 600 contacts. So, we need to take care of ourselves, colleagues.
Now, we dive into uh more uh details about uh Ebola virus uh disease and uh uh to take us through that is Dr. Ronnie uh Bahati Mugire, Commissioner uh of Health Services for Clinical Services at the Ministry of Health and also the chair of the clinical or case management pillar in the response.
Over to you, Dr. Ronnie.
Hello. I hope I had Yes, thank you.
Thank you so very much, Dr. Stavya uh our moderator for the day and thank you so very much uh DG uh for giving us a preamble into what exactly we're are with. Good morning our colleagues on the call.
I'm very delighted that we have all of us here and we've been We've been able to make over 1,000 health care workers who are on the call.
Thank you so very much for making the time at such a short notice when we've had to invite us to come and we speak to each other especially on matters to do with the Ebola outbreak that we are dealing with.
As has already been highlighted, as health care providers, we are highest at risk because we are the frontline health care providers. We interact with patients that are coming to us with other concerns and it's our duty to ensure that we take care of these patients and uh as we take care of these patients, we expose ourselves and the issues that we're going to discuss today uh pertain how exactly as health care providers we can offer our care both in a safe environment, safe way to protect ourselves, but then we also protect those that we're caring for. No patient should come to us and contract an infection from the hospital and nor should we expose ourselves to the infections that patients come with when they seek care from the hospitals.
So, that's going to be the gist of our discussion today and it's the reason why we talked about as a health care provider, your health first.
So, in this uh outbreak as we have seen in other outbreaks in the past, health care providers face the highest risk of infection because we always interact with patients at the first go when they are coming to the facilities to seek care.
And that means if we have a low risk of a suspicion or if we have no any mechanisms of screening for a potential infectious diseases that these patients could be presenting with, we find ourselves exposed and that's how as a health care provider you become you start risk in this whole entire cycle of the outbreak.
And therefore it's incumbent upon us as health care providers to protect ourselves as the first step in ensuring that we able to care for those that are seeking for care from ourselves, but then also protecting our families and the community at large by ensuring that we are able to use appropriate PPE when we are caring for patients, but you can only use appropriate PPE if your risk perception is good. Risk perception is determined by your suspicion index and that too by your desire or by your compliance to observe the principles of patient care that have been laid out in the different guidelines that we have both the Uganda clinical guidelines, but then also the infection prevention and control guidelines that we have with us.
All this is laid out on what the basic principles of patient care are and we uh request that each and every time we are interacting with patients even during routine times or uh what we call peace times when we're not in an outbreak period like this, we should be observing these strict infection prevention precautions so that we do not expose ourselves as health care providers. So the choice of PPE will be dependent on your risk perception and your awareness, risk awareness of what exactly you're dealing with in the current times. And uh when you'll be able to uh determine what exactly you should do and where exactly you should take patients. And uh more so at this time when we are dealing with this outbreak, uh a case definition has been produced and shared with all of us that I'll I'll highlight at later point in time uh that should help us uh guide uh patient entry into the hospital space.
When I say hospital, I'm covering the whole entire continuum of care from the lower-level health facilities up to the super-specialized hospitals. So, I'll use the uh the phrase or the word hospital to mean um a health care facility uh right from uh center to up to the super-specialized hospitals.
Uh we need to be sent to protect our patients by ensuring that we identify the uh signs and symptoms that these people could be presenting with. And we can only be able to do this if we put in place mechanisms for risk identification. And uh the only avenue by which we can be able to deliver this is if we put in place screening mechanisms that should be able to sieve through each and every patient that is coming to the hospitals because you can never determine uh which patient could be carrying which bug and therefore be able to protect yourself. So, the right and proper thing to do is have a standard way how you screen each and every patient that is accessing the hospital space uh so that we can be able to increase our uh index of catch for those that could potentially be infectious and manage them accordingly.
Uh mechanisms have been provided on how we can manage uh those that will present with uh signs and symptoms consistent with Ebola and any other infectious diseases during this period of time uh when we are responding to outbreaks, there are so many other incidental infections that we tend to find that we many a time would have otherwise missed.
Like uh we previously had cases of Congo-Crimean hemorrhagic fever that were diagnosed in the Nakasongola area. Not Nakasongola, Nakaseke area, which was an incidental finding because when the lab when the samples that were drawn from these patients were taken to the lab, these patients were found to have a Congo-Crimean hemorrhagic fever as opposed to Ebola, meaning that there are so many infections that are circulating in our environment and therefore it's incumbent upon us as healthcare providers at each and every time to observe the standard precautions for infection prevention and ensure that we are able to protect ourselves. And when we do this, we will definitely be sure that we protect our families and also the community at large that comes to seek care from us. So this is in line with what we have found currently with community transmission of Ebola that is happening within the Kampala metropolitan area right now as as has been highlighted by both the director general and the moderator in the opening remarks.
Currently, we have nine cases that have been confirmed with Ebola in the country from the 15th of May when this outbreak was declared in the country and we have registered one fatality and this was the index case that was discovered in the country. So for those that we have been able to encounter while they were still alive, we have had only one that presented with a severe disease but with acute kidney injury and renal failure which we were able to manage and uh we were able to reverse and this person has since been discharged. Though she's still uh struggling or battling uh the complications that arose from uh uh her exposure to Ebola. And uh we have over 500 contacts that we're following based on uh the nine confirmed cases that we have uh so far registered in the country or that have since been registered in the country. And these have largely come from uh the two uh Kampala metropolitan area districts, that is Kampala and Wakiso.
So, what does this mean?
Uh when you look at uh the exposures that we have seen amongst uh the people that are positive currently, healthcare workers still stand at highest risk of exposure, meaning that uh we need to protect ourselves, we need to protect ourselves and ensure that we put in place mechanisms to protect all those other patients that we care for. The Director General spoke to the aspect of moonlighting, uh which happens where you find uh one healthcare provider uh working in more than uh uh three facilities.
Uh and that means if you get exposed to this Ebola bug, uh potentially if you become infectious, because a person will only become infectious when they start uh uh when they become symptomatic. Uh when you continue working when you are ill, that means you are potentially going to be exposing all the patients that you're going to be caring for in all those other hospitals. And it will not only be the patients that you'll be caring for, but also uh your healthcare worker colleagues that you'll be working with.
And it's the reason why we're saying that we need to be able to uh recognize these signs and symptoms early enough and report them uh and ensure that uh for all of us that we will have these signs and symptoms, isolate ourselves, call for help, and that help will be offered, and you will be attended to appropriately where you'll be taken into isolation, and you will be managed appropriately. Early reporting to care, early initiation of care has proven to deliver better results with a better outcomes as compared to people who tend to wait and remain in the community and care is initiated late.
The Director General hinted on the complications that we are seeing amongst our colleagues that have already been in isolation for the several days that we have seen.
Acute kidney injury is one of those key presentations that we seeing or complications that we are seeing amongst patients that infected with this strain of Ebola. And that means if you stay away and this whole entire disease cycle or process continues, chances of you destroying your kidneys is very high, and by the time you come, you may find that you are very far from being redeemed, and this Ebola could claim your life. So, the key takeaway point from this is make sure that as soon as you do not feel well, especially by having the signs and symptoms consistent with Ebola we are going to see in the case definition, ensure that you report early and be initiated on treatment early. We are able to take off samples and have your results within 4 hours of of testing so that we can know what exactly we are dealing with.
So, this webinar is uh prepared for all of us as health care providers to ensure that we are able to raise our index of suspicion by making sure that we recognize signs and symptoms uh consistent with Ebola and uh be able to take people out of uh the general circulation of uh uh the hospital space, uh ensure that all these people are appropriately isolated, and as we're doing this, we need to be seen to observe strict infection prevention and control principles by using appropriate PPE, and uh making sure that all those that are caring for these uh people uh observe that as well. And as we do this, uh and as we have already highlighted, these patients come in when they have uh challenges, especially those that will report late. Uh some will be having uh severe uh generalized body weakness as a result of reduced dietary intake. Uh they need to be stabilized. Some of them will be severely dehydrated, and uh that means they'll be having some uh elements of organ damage. Uh we need to be seen to rehydrate them and uh stabilize them.
And as we do all this, we need to observe uh uh strict infection prevention and control, and ensure that uh these patients are linked into appropriate care as earliest as possible to ensure that uh they are initiated on appropriate care.
So, this is uh the case definition that we have for uh this uh outbreak thus far. I do not know how many of us can see this.
Uh it may not be very clear uh because of the magnification that was done, uh but uh we have uh four definitions that have been provided here. We have a community case definition, a suspect case definition, probable case definition, as well as the confirmed case definition. With the community case definition as uh any person who present with uh an illness with onset of fever and or no uh response to treatment. Uh if you have had a fever for some time and you've uh attempted to take an >> Dr. Ronnie?
Dr. uh >> Yes, Dr. Skaria. I think uh you lost me.
>> Yes, we have lost you.
>> Can you see me now?
>> Yes.
>> Okay. Sorry about that.
So, the community case definition is uh any patient that will present with uh an uh with an illness with onset of fever and or no response to treatment and uh any of the signs where we will see bloody diarrhea, uh bleeding, and uh blood in urine, or any history of uh sudden The suspect case definition is uh any person that will present with an illness of fever and or negative laboratory diagnosis for the usual causes of fever and that includes malaria because it's not uncommon for people that are having uh Ebola to present with uh malaria as well, a malaria co-infection, or at least uh three of the following signs: headache, vomiting, diarrhea, anorexia or loss of appetite, and uh generalized body weakness, uh stomach pain, especially epigastric pain, which is being managed many a time as ulcers. Let's be keen and let's be alive to that complaint. When patients come to us and they are saying they have uh epigastric pain, be keen to explore further and understand what exactly they are talking about. Um aching of the muscles and uh difficulty swallowing, as well as uh breathing difficulties or hiccups and convulsions.
And uh what we need to be alive to, colleagues, is uh bloody diarrhea, bleeding from the gums, or uh any other joint any other openings on the body are very late signs. Let us not for not wait for patients to be presenting with diarrhea or any other gastrointestinal tract uh complications and the bleeding as the signs and symptoms for Ebola. By the time a person is presenting with those, that means they are at the tipping end of uh the disease uh uh process.
A probable case would be any person who would have died in the community with any elements of a suspected uh Ebola virus disease and had an epidemiological linkage to a confirmed case but was not tested and did not have a laboratory confirmed result for Ebola virus disease.
And a confirmed case in this case will be a person that will present with uh uh all the signs and symptoms that we have uh highlighted over in the suspect case and will have a positive laboratory result that has been done by PCR.
The real-time PCR and that is our gold standard for now in the country that we are using to confirm people with Ebola, not any other.
This we've already gone through. Uh Ebola was confirmed on the 15th as I was already highlighted, but what is important for us to pick from this slide, colleagues, is uh as was already indicated, we do not have any current uh known therapy or uh medicine that has been known to treat Ebola. However, what we know is supportive care is what of is one of the things that we are doing to ensure that we keep our patients alive and we manage the symptoms that they present with to ensure that they are kept alive.
However, we are also trying out what we call uh trial We are using trial medicines during this video and later in the due course we'll deploy monoclonal antibodies to see whether there can be any sensitivity or efficacy to those known antiviral agents. But as of today, there is no known cure. There is no known vaccine that can be used to target this Ebola virus in the country. And therefore, it's important for us to know that when we feel unwell, the earliest we institute supportive care is or the the best or the better for us to ensure that we keep our colleagues and our patients alive. And in that, we also give them an opportunity to benefit from our these trial therapeutics that we have available with us. And uh what we need to be alive to is the signs and symptoms that these patients have so far demonstrated mimic the signs and symptoms that we see with the common illnesses uh uh febrile illnesses that we have in the country, especially malaria. And therefore, it's not uncommon that a person will have malaria, but then also have uh Ebola co-infection. And it's also very not uncommon that you will have the first test of Ebola being done, and the person will be presenting with signs and symptoms consistent with Ebola, and they will test negative. And it's the reason why every time we we have a person testing negative for Ebola, but they have signs and symptoms that are consistent with this Ebola, we go ahead and keep them with us, and we repeat we've been repeating after 72 hours, but basing on the recent uh observations that we've made where the current uh uh statistics show two of the people that had tested negative at our first test uh seroconverted after 5 days. Uh that means that we will have to extend uh the duration of the repeat test for us to be sure that a person that presented with signs and symptoms consistent with Ebola eventually is retested and is cleared of any elements of exposure. And so, what is expected of us, colleagues, when we encounter such people that are presenting with signs and symptoms consistent with Ebola, especially at our screening screening points, the entry points into our facilities, we are able to isolate them from the general pool of patients, ensure that they do not mix up with other patients because we know Ebola transmits through contact, and we should be seen to use appropriate PPE to ensure that we stabilize them for whichever complications that they will be presenting with, and we inform the relevant authorities and have these people taken into appropriate isolation facilities so that their care can be instituted and they are cared for appropriately.
Uh clinical presentation and uh indicators or risk indicators for the patients that we have so far seen of the nine, uh there is no specific early symptom that these patients present with apart from the common signs and symptoms that we see amongst other febrile illnesses like fever, generalized body weakness, muscle pains, uh headaches, and vomiting, diarrhea coming on as a later signs and symptoms as well as uh bleeding.
So, as healthcare providers, we need to be seen to always take appropriate history from each and every patient at this point in time. Uh colleagues, we've observed over time that uh uh many of us are turning away from the basics of patient care where we no longer take history, where we no longer examine patients. When patients come in and they give us uh their presenting complaints, uh without uh losing time, people uh go straight ahead and order for investigations, and we miss out on the critical information that we could have otherwise gathered from these patients if we took appropriate history and examine them. We are kindly requesting that all of us go back to the basics of patient care, and uh do appropriate history or uh clocking of these patients, pick as much information as you can from these patients, examine them. There is a lot that we will be able to pick from these uh patients as we examine them uh that we could have otherwise picked from case 001, case 002, and the probable uh death that we had if the clinicians that were caring for these patients had been alive to appropriate history taking, physical examination, and even the investigations that were done, because uh when you look at the labs of all these uh three people, they were all consistent with a thrombocytopenia.
One of them presented with uh a bleeding tendencies, and yet they had never had any history of bleeding tendencies. So, there's quite a lot that we could have picked from uh the history, examination, and uh investigations, basic investigations, without doing the high-end investigations, and would have been able to uh perhaps detect this early enough. Colleagues, one thing that we must be alive to is if we do not raise our index of suspicion, it's us that are going to get exposed as healthcare providers, and therein will also find ourselves exposing the colleagues that we work with, but then also our dear families back home uh when we return and we have picked this bug.
So, what is uh required of us, colleagues, is to ensure that we institute appropriate screening uh points at our facilities, and ensure that we are able to tease out each and every person that is presenting with these signs and symptoms and ensure that we are able to hold these people away from the rest of the general pool of the population uh, that is accessing the facility and uh, refer these people to appropriate uh, isolation facilities that will be able to care for them.
And uh, one of the key elements that is expected of us when we are doing clinical stabilization is to obtain appropriate IV access because if a patient comes in and they are uh, vomiting or they've been diarrheting and uh, they have uh, lost their uh, blood volume uh, that means if we do not support them in quick succession, they will uh, deteriorate and we could end up losing them. So, at uh, first contact if you detect that this person could be presenting with the signs and symptoms consistent with Ebola and they are clinically unstable, go in and stabilize them so that as you refer them, at least the team that you're referring them to uh, will be able to find uh, a working IV access uh, that they can use to stabilize and uh, for continuous care for these patients. We need to be seen to collect uh, samples of blood uh, based on uh, the appropriate guidance that shall be provided uh, on uh, where and how to package these uh, uh, samples and transport them uh, and as we are doing this, we need to be seen to use appropriate PPE and uh, we also need to test for malaria because it's not uncommon that these people will present with malaria. So, if uh, you are only looking at Ebola and yet these people could be also having malaria co-infection, they could end up succumbing to malaria uh, as we are screening out for Ebola.
So, let's test for malaria and uh treat it uh when we find it positive. But, as we do all this, if you are suspicious of a sample that or a patient that they could be having uh Ebola, uh despite the fact that you're going to be testing for malaria, be keen to observe strict infection prevention and control principles. How do you take off the sample? How do you process the sample?
How do you handle the waste that comes off that whole entire testing process?
It should not be mixed with other waste because if it's mixed with other waste, yes, we know this is uh uh highly infectious waste just like any other highly infectious waste, but the risk of uh contamination uh becomes uh higher when we are dealing with this viral hemorrhagic fever as opposed to any other blood-borne uh infections that uh we have seen in the past.
Uh for referral, uh we will uh provide mechanisms or contact numbers of the emergency medical services teams that have been gazetted to pick these people from wherever these alerts will be coming from and ensure that uh they are transported appropriately uh by people that are well prepared to transport them into or move them uh into appropriate care uh facilities. Let us not be heroes by doing things that are going to expose us, colleagues. Uh if you suspect a patient to be having uh this uh viral hemorrhagic fever, make sure that uh the appropriate team that is well trained, that is well prepared, is on that uh handles this uh uh event. And as we do all this, we need to be cognizant of the fact that uh yes, much as we are having a viral hemorrhagic fever outbreak in the country, essential health care service delivery uh must continue. And it's our duty to ensure that uh we do not mix up all these uh uh elements that support us in ensuring that we care for our patients.
If you have ambulances, you could get that off one ambulance if you must use an ambulance from your facility to refer the patient. But otherwise, the emergency medical services team has put in place ambulances that will that have been gazetted for this particular response in the spirit of ensuring that that essential health care service delivery continues unaltered and undeterred by having ambulances that are gazetted for that function. So, let's observe those principles by calling for help every time we have a challenge that we face.
Infection prevention, we are expected to maintain appropriate stocks or essential PPE stocks to ensure that we are free from any elements of exposure.
People should have examination gloves.
People should have the gowns. And if people are going to be picking samples from the patients, then they should be provided the appropriate hazmat suits that are prescribed for that level of care. And this is a call to all of us as health managers who could be on this call to ensure that our health care providers are not pushed to do things that are inappropriate because of scarcity and where we are improvising. If you must do something, be aware of the risk that it carries before you go ahead and indulge. But that should not also be used as an excuse for people to avoid providing appropriate care.
>> I wish you know we need to be summarizing.
>> Can you still see my screen?
>> Yes.
I see your casa.
Yes.
>> All right.
So we need to do as advised donning and doffing and appropriate management of the waste that is generated thereof. It should not be mixed with any other ordinary infectious waste because this potentially carries higher risk compared to other highly infectious waste.
And then we need to report every exposure. Colleagues, we must be honest.
The reason why we advocate for a body system during this these kinds of outbreak is to ensure that every action that happens in highly infectious exposures is reported. And colleagues are expected to be as honest as possible not to cover up any colleague. If you were a team caring for a patient that is a positive known to be positive for Ebola and there is a breach and one of the colleagues is exposed, the body should honestly be able to report this event to ensure that that colleague is attended to appropriately so that we do not have any other multiplier exposures that could arise from that colleague.
Regarding workflows, what is expected of us is we need to be able to screen each and every person, separate them and use appropriate PPE, notify relevant authorities and escalate this care as well as stabilizing and documenting these uh events and transfer these patients to facilities that are appropriate. And the key to come from this is to ensure that we are able to screen, isolate, stabilize and protect ourselves as we do all this in our day-to-day activities and refer these patients to appropriate facilities when we are called to duty. So, colleagues, it's important that we observe that as healthcare providers, we are highest at risk when it comes to caring for patients right now because patients are going to be coming in with anything.
As has been happening because I mean ill health brings patients to hospitals. And as healthcare providers, we are trained to offer care for the patients that come to us. But as we do this, we must be cognizant of the fact that and alive to the fact that we have Ebola around us and amongst us and therefore we must be able to watch out for any signs and symptoms that are consistent with Ebola.
So, we must be able to protect ourselves. We must be able to protect our patients, our families, and our communities. So, your health matters.
You cannot care for others unless you're healthy. And the principle of infection prevention and control is protect yourself first.
Thank you, chair. Over to you.
Dr. Xavier, are you there?
>> Thank you so much Dr. Ronnie for that very detailed and informative presentation on Ebola and Ebola virus and Ebola virus diseases.
Um We'll continue to have our questions in the chat and we'll answer some of them from the chat. Colleagues from the ministry who are on from the different pillars, if you see a question following in your pillar, please do answer it from from chat as well.
Uh we'll go to our next uh speaker.
And uh this is a guest speaker uh this morning, like I introduced him at the beginning.
Uh Dr. Landry Landry is uh uh from Africa CDC.
Uh he heads the intercontinental pillar on continuity of health uh services.
We are very blessed uh this morning to have you, Dr. uh Landry uh You'll say your name is properly, Segay.
I respect to the Ugandans and our colleagues who may have joined from other countries. Most welcome.
>> Thank you so much. Thank you so much, Dr. Stavya and uh warm greetings from uh Addis Ababa where the headquarters of Africa CDC is located.
And uh also I want to convey uh the greetings of our director general His Excellency Dr. Jean Kaseya who as you know was uh in Uganda about uh I would say few few weeks or few days ago.
Uh he was uh fortunate to meet with His Excellency the President of Uganda uh to discuss the situation of the Ebola uh Ebola Budibugyo Bunjibugyo outbreak on the continent.
Uh my presentation this morning comes after very excellent uh statements and presentations uh from Dr. Ronnie. I really want to commend Dr. Ronnie because he really covered all the critical points of why we are here today.
And also want to convey or warmly greet Dr. Charles, Dr. Charles Oramo. I think he also insisted in his point that we need to openly discuss what we are facing as the community of healthcare workers. We need to ensure that at the end of this conversation, we are well equipped to take care of ourselves first before we can effectively take care of our population.
And I really want to convey our appreciations also to you, Dr. Starvia, because it's only when we bring the the information to our frontline workers, to our healthcare workers, that we can build that coalition that is needed in times of crisis to strengthen the confidence of our frontline and to our workforce to confront the crisis, to confront and to stop this outbreak.
Really commendable effort that Africa CDC will also share with DRC and other countries that are at risk. As you know, we have about 11 countries at risk. Uh let me now move into my presentation.
At the next slide that you see on the screen is clearly to say the history of this outbreak started quite recently. We are today on the We are today the the 30th of May.
And then clearly you can see that we are in you are 2 weeks 2 weeks following the the declaration, which was done on the on the on the 15th by first of all by the director general of Africa CDC, and then WHO declared what is now called a public health emergency of international concern. A few days later, Africa CDC also declared uh this outbreak as a public health emergency of uh continental security.
It's important to understand why those declarations were made because we needed to quickly elevate our uh uh uh activate our uh our mechanisms to to to not only to rapidly contain the outbreak but also to make sure that we bring all the required uh commodities for uh our health care system or all the required uh medications or vaccines if if they were available uh to stop this outbreak. I also want to insist that that was made clear by uh the director general and the Dr. Roeling that unfortunately we do not yet have approved vaccines, an effective therapeutic for uh this strain of Ebola virus. So, it makes it clear to us that what we have left now is good public health and good clinical practices if we want to protect ourselves and if we also want to save lives. Let me move to the next slide.
Now, this slide is just to let you know that as uh as Uganda is organizing itself to contain the outbreak, to protect its people, to protect its health care workers, uh at the continental level, we are also organizing ourselves as Africa CDC as your Africa CDC to ensure that we bring all the African uh member states. We are now talking about uh DRC and Uganda as those countries affected, but there are 11 countries at risk uh identified and the whole continent has declared a public health emergency of continental security. You are also aware that uh uh we had a meeting in Uganda hosted by the government of Uganda about a week ago uh to talk about cross-border surveillance.
And in that meeting we had minister minister of health of South Sudan.
This is an illustration of why Africa CDC is stressing on the coordination to contain this outbreak, to stop the transmission, and to also save lives.
This diagram just explained to you that if we want to effectively the continent to stop to contain and to put an end to this outbreak, we need to organize ourselves. This is what we are doing working closely with WHO.
We have put in place a continental incident management support team, which is organized I'm not going to go into the details, but you can see that we are bringing around this mechanism close to 40 partners.
Those partners are now supporting our member states across pillars. So, I'm talking to you today about the pillar on continuity of essential services and community health system strengthening.
Next slide.
This pillar we agreed with WHO and other members of the pillar to organize it around three sub pillars. Why? Because we need to first focus on ensuring that our health facilities will not will not face the crisis of disruption of essential services, maternal and child health, immunization, HIV, TB, malaria, NCDs, and others. They should continue.
And we also agreed that Ebola within Buio as opposed to other type of outbreak will affect the continuity of non-health services like the school system. So, we need to already put in place mitigation measures to ensure that the school setting doesn't become a cluster of new infection.
Then the third sub pillar we agreed was to ensure that we mobilize, we train, we protect, we deploy our community health workers. And this is a conversation that is currently ongoing with the Ministry of Health in Uganda to see the best way to deploy the variation team not only to support contact tracing and community awareness, but also to ensure the continuity of routine community health services like uh nutrition, malaria screening, and and others. We should not let the the routine services down as we respond to the outbreak. Next slide.
As I share with you at continental level, Africa CDC and WHO have organized our partners to ensure that we provide the the needed support as our member state are confronting this outbreak. You can see how we have organized ourselves to ensure that the continuity of health services is supported, the non-health services are supported, and the community health systems strengthening is also mobilized. Next slide.
Uh this slide you may recall when Dr. Moeti was talking about the need to ensure that we protect ourselves first.
Because when the health care system start to be affected by our by the the cases among health care workers, it generates it generate fear among our people, our population. So, we need to ensure that we we stop the chain of transmission within the health care facilities.
We need to ensure that zero new infection or zero new case is declared among health care workers. It's so important also because it will address the community avoidance and the fear uh to attend health care facilities. So, it's up to us as health care workers to put in place the effective IPC measures that will prevent uh us from contracting the virus and that we also continue to build the the trust that the population will have with our health facilities because we need to ensure continuity of essential services.
The other point, and this is a point where that we discussed with Dr. Stahli a few days ago, is we need to ensure that the resources that will be mobilized to address the outbreak is not done at the expense of the resources that is currently utilized to provide routine services. One of the critical aspect that you will see in the organization services the triage.
Doing the triage effectively needs more and more people at the triage point. So, it means that either we'll have to relocate colleagues who already assigned to other services to do the triage or we have to recruit.
We have to recruit uh specialized staff of of volunteers who will be trained to effectively effectively conduct the triage within our health care system.
And this is important to discuss that openly because that's the starting point. If the triage is not done well, if the case definition is not implement the way that the index of suspicion, I think Dr. Ronnie made an excellent point on that, is is is is used to have in the highest sensitivity at the triage point. We are going to let a case get into the green zone rather than the red zone.
Next slide.
I want to leave this slide to you because as we discuss service continuity at continental level, we want to encourage a discussion around the context of the country. Uh Uganda context might be different from the DRC context. So, a discussion should happen at not only at national level, but also at district level around how do we implement mechanism, how do we reorganize our district referral system to ensure that this continuity of services from the primary health care to uh the the the the district referral hospital and the tertiary level.
How do we include our VHT in the conversation around continuity of services?
Do we want immunization services?
I think the case of Uganda may not be as as as critical as it is in DRC where some health facilities in some districts where we have a high number of cases already discussing how to bring some of those services like immunization outside the health facility. Uh because you do not want as you address this outbreak to have a lot of missed doses around routine immunization.
We also want and this is the point where I want to comment Dr. Ronnie. He spoke on this.
We want strict adherence to infection prevention and control.
Let's not do any harm to ourselves as health care workers. If we need a commodity for our infection prevention and control, we need to make that case clear.
Those commodities should be made available. That's a non-negotiable.
Without those commodities, our health care workers are going to be exposed.
And we know what to do. We have the list of equipments for PPE that will prevent our health care workers to become infected even when exposed to a high-risk case. We need to ensure that as we reorganize our services, there is flexibility. Let's take for example, how do we ensure that there's a dispensation of multi-month doses of chronic chronic disease medication like hypertension and diabetes or HIV medication. How do we ensure that we reduce the number of clients coming to the health facility?
Also, of course, reducing the burden to our health health care workers because they have to they have to manage Ebola cases as well as they have to ensure the continuity of chronic care.
We need to also look at the protection of our health care workers because the body system that Dr. Ronnie mentioned is critical. Let's let's care for each other. If my colleague is not feeling well, I need to pay attention to what's happening. And and maybe he he may underestimate what or she may underestimate what she's going through.
I remain we need to have an alert system within our health facilities to make sure that we don't let any colleague who is not feeling well unattended. The next slide will tell you more about how we summarizing the organization of services. This is not new, but we really want to emphasize on this because this conversation should happen at the level of a district, at the level of a region, or at the level of a country.
Uh I I I know that Uganda has already already identified the specialized center for Ebola treatment. Now, the question is, how do we connect primary health care facilities with facilities that may be considered as red red zone facilities, or within the same primary health care facilities or a district hospital? How do we organize the services so that when your client comes in, he starts or she starts with the green zone where he or she is screened, and that screening will either keep him or her within the green zone, or move him to the red zone. This is a critical discussion that should happen in every facility at this point in time. And this is where the risk management becomes critical, because the way you behave as a health care worker within the green zone is not the same as as you are in the red zone. And this is where I think Dr. Ronnie was insisting on the need to have the highest level of suspicion, and to activate the the the Let's call it the transfer of high-risk patient from the green zone to the red zone before more more more people are exposed within the green zone. It's so critical to have this conversation. And how do we connect the red zone to the specialized facilities? I think he mentioned the ambulance system and the need to have a very well-thought-out referral system to avoid more exposure during the referral to the Ebola treatment center. The next slide is also important, and I'm not I'm not going to dwell too much on this. Maybe in the interest of time, I will leave it to to you, Dr. Stavya, to share with participants. It's It's It's really explained a bit in details.
How What are the options that we have to ensure the continuity of chronic disease management.
You remember I was talking to you about the multi-month dispensation. This is an option that you can consider if your health care system is overwhelmed. You may want to see how to to give three or six months supply for some conditions like HIV TB, hypertension and diabetes. You may want to also utilize the community drop-off.
Like I think I mentioned I mentioned that. How do you activate your community health system network of civil society organization or people living with HIV depending on how you're organizing your in your city in your in your country.
For maternal child health, you definitely we need to look at options which will will definitely prioritize the green zone. You remember I talked about I talked about the green zone. So, how do you secure maternal health and child health services within the green zone? And how do we ensure that any mother or child with the highest any suspicion is also screened from the green zone and moved to the red zone.
It's going to be an important conversation moving forward, Dr. Staviah. My last slide and we stop there.
Next slide.
Yes. This slide is is a proposal. It's a proposal that we are discussing. We discuss this slide next week with Dr. Staviah and the team in Uganda as well as the team in DRC.
It's We as I shared with you, we are within the first 15 days. So, within the first 15 days we should have implemented the the the separation in green and red and the triage mechanism. That should be fully implemented within our our affected districts. And the next 15 days we need to have implemented an adaptation and decentralization system as I shared with you so that no excess death is recorded within the affected district due to high burden conditions like malaria, HIV, TB and others. Especially, we should not let our mothers dying due to pregnancy and delivery because we are managing the Ebola crisis. That is not going to be acceptable because we know what to do to prevent maternal death.
And beyond 30 days, we need to have a system that is very resilient and that can sustain hopefully within the next 30 days we should have been able to stabilize this epidemic, but in case we we we we we are not able, we need to have in place a resilient system that would provide continuity of maternal child health and chronic conditions.
Uh Dr. Stahli, this is what we prepared for this conversation. This is not the last time we are talking with your community and we'll be available for the next opportunity. Thank you so much for having us.
>> Thank you so so so much Dr. Endre for for this wonderful talk to our health care team and to us and the guidance that you bring at that level of the continental continuity of health care services during emergencies.
Uh we colleagues, we have the slides and we'll be able to share with us.
You can still continue to learn and learn. We also have our guidelines.
We'll be posting them on the uh on the website so that you can uh pick how to reorganize the services that you offer.
We will now go into question and answer session for the next 15 to 20 minutes. If you have any question you have not posted in the chat, but we shall also go to the chat and pick your questions and they are posting them over.
They are quite a number. Thank you.
Um We will attempt to answer most of the questions.
Uh this is the first session. I'll request if uh Dr. is on for gatherings, you combine all the gathering questions and answer them.
Um Uh Ronnie, you tell us what if we have confirmed cases beyond the health workforce beyond the health facilities.
Someone wants to understand what non-trauma death is. I think Ronnie will also explain that as well.
Um Those who are in schools, how should we Uh we have guidelines for this. I don't know that Dr. you are on call.
So, let's start with the answer session.
And as we do the answers, I'll request the admin to post the a small poll that we have prepared for each to tell us what you have readily available.
Make sure that you protect yourself.
Feel free to Uh, click the link and tell us genuinely what is available where you are working.
So, let's go to the first questions. Uh, So, should Arsenal games be watched in from homes? That would be the best for you and me. If you can watch from your home, that would be the best. Avoid unnecessary uh, mixing with people that you may not know where they are.
You cannot avoid touching where they have touched. So, my humble uh, answer would be avoid as much as possible to be going to the crowded spaces, especially when it can be avoided and you have an alternative.
Ronnie, over to you for the uh, trauma death.
Uh, what is non-trauma death? And uh, have we had cases outside the health uh, system?
>> Thank you so much, uh, chair, and uh, our colleagues that are asking these questions. Very important uh, because it means that we've been really very attentive. And that was the purpose for which we organized this. And non- >> trauma death is any other death that is happening at community level or in the facility and is not linked to trauma.
Um, like we've seen in uh, accidents, a person is involved in an accident, is taken to the accident and emergency, and uh, they succumb to the severity of injuries that uh they've uh sustained and they die.
If we're having any other mortalities other than those, we have instituted what we're calling uh mortality surveillance, where samples are being picked from these patients from these corpses just to be able to understand if there could have been anything else that could have caused these mortalities. And this is happening both at facility and community level to ensure that do not leave any uh area uncovered. And this should also help us increase our uh our scope in terms of uh catching any suspicious mortalities that could be happening. As we have observed, uh the people that got exposed at uh one of the hospitals in uh Kampala, they were exposed by one, the patient that they managed uh and they didn't know what exactly they were dealing with, but then also uh we are seeing the mortician who got exposed to the the body or who handled the body and uh embalmed it also developing signs and symptoms, meaning that bodies are highly infectious. So, it's the reason why we are doing these uh mortality surveillances and that's the reason why we are saying any non-trauma mortality should be investigated.
Have we seen any uh infections outside uh of the uh health care providers? What we have uh so far seen amongst the nine cases that uh have been declared by the country are a linkage between all these cases.
Uh the imported cases and uh the few health care providers that managed these cases when they came into the country.
We haven't had any uh other uh local transmission that is outside of this chain of people that came in to seek care from the Congo and those that care for them directly especially those that participated in the cardiopulmonary resuscitation of this patient the the probable case when before shortly before he died.
Thank you and back to you chair. I chair maybe I'll be allowed another opportunity to come back.
I have a short video of 2 minutes that I'll share.
>> Yes, I think there will be We'll take these questions into the most frequently asked questions if they're missing and we'll be also sharing answers to them so we'll share with the with the team. How long does the virus remain available on the surface outside humans?
Talk about blood donation.
Yes.
Um Share with us here the contacts of the team leads and the treatment centers.
We have a toll-free line which we are going to to share with you.
It is the most uh immediate tool you have to reach us in the chat if someone can type it there.
Maybe difficult to share all the contacts of the of the case managers but Dr. Ronnie's is available as well.
You can post it Dr. Ronnie in the chat and maybe the one for Alan.
Um What is done to prevent more entries from Congo? What is the incubation period for the Ebola virus?
Looks like all questions are are are I to to uh the presentation of of running most of them. That's soap alone. Is soap alone enough?
Or we need the jik as well.
How do we dilute the jik for hand wash?
I can hear the questions, colleagues. They are very very nice questions.
I first first to be added.
That one we shall do.
Need clarity on the screening point level of protection. I think this is to do with PPE.
Type of mask for staff at the screening point.
Um if the mask is is necessary. Is it mandatory for all clients that come to the hospital to wear a mask? Of course, um no.
This is not COVID-19. This is a contact disease, colleagues. You touch uh contaminated uh material. It's not an airborne disease.
Uh so, we we will be providing detailed answers. Uh I don't know Ronald, if you can wrap up the many other things that have come up related PPEs, the level of application, the uh the time the virus stays on the surface, and the incubation period.
Is sex greatly affected by Ebola? Even that one is very important cuz when we discharge, the virus stays in the semen. So, Ronald, go ahead again.
>> Thank you so very much, uh once again.
Um colleagues, the incubations uh uh period of uh the virus that we are working with currently is uh 21 days.
Meaning that if you've been exposed, it's until after 21 days that we can uh be sure that you are virus free. Meaning that at any one point in time in that period, you could uh seroconvert. So, you need to be to stay vigilant and uh ensure that uh you report any signs and symptoms that you're um emerge uh in that period of time.
How long?
Uh The other is uh which PPE is appropriate for use?
We have different levels of uh exposures and uh we have uh different um levels of uh PPE that are uh guided depending on what exactly is uh being done. If you're conducting a screening, if you're manning a screening point, uh all we need to have with you is uh uh as long as you're keeping your distance, uh have your gloves on, your examination gloves on, and uh keep uh taking the temperatures and uh uh writing documenting the temperatures of the people that you have uh screened into uh a log, and ensure that you do not share any of your uh uh items that you're working with, if it's a pen or anything, so that you can minimize any aspects of a cross contact that could ex- uh potentially expose you. And uh what we need to be seen doing at each and every of these points is uh strict hand hygiene and ensuring that uh you minimize as much as possible uh picking any uh bugs from uh across uh your people that you're going to be handling.
Uh if you're going to be uh examining patients on the general and uh you assess that the risk is uh low, you can use uh an apron, you can use uh the examination gloves, and uh you'll be uh safe. If you're going to be taking off samples, if you're going to be caring for patients, if you're going to be manipulating uh uh the patient to either cannulate or do anything uh that is going to bring you into close contact with the patient, we expect you to use a level four PPE where you have to don uh a hazmat suit uh complete with uh the uh hand uh surgical sterile gloves, uh gumboots, and uh goggles as well as uh uh headgear to which it which comes with uh the uh hazmat suit uh because the risk of exposure at that point in time is high. So, uh PPE, that's the reason why we use the word appropriate PPE uh is uh determined by your risk assessment of what exactly you're dealing with. We do not expect people at uh the screening point where there is no no or minimal contact with uh uh patients that are coming into the facility to start wearing hazmat suits. And the hazmat suits, which is level four uh uh PPE is reserved for people or health care providers that are going to be having a direct contact uh with the patients that have been found uh infectious or the suspects that have been isolated.
>> So, thank you so much, Dr. Ronnie. Uh what measures are we putting place for Congo? Uh we are doing our best uh as far as border surveillance is concerned.
I don't know whether Dr. Allan, you are in or Dr. um Bernard Uh but also we closed off the the uh people movements. We only allow cargo and food movements across the borders.
But by the time we did that, the the first cases, of course, had already come, and some of them suspects are already with us.
Uh so, we need to deal with those who have already reached us.
Uh let me hear from Peter, Judith, and Akena in 1 1 minute each, starting with Peter.
>> Yeah, thank you so much, Dr. Stahlie, for giving me the opportunity.
Uh, mine is to say that uh, this outbreak should be theoretically uh, a lot easier to contain than the respiratory COVID cuz it's about touch.
And uh, given that, I'm appealing to the DG and Dr. Ronnie, to consider giving the private clinic a subsidy for gloves, urgent subsidy, because uh, on a daily, even without the outbreak, gloves are uh, a high-cost item for us.
So, if you give us a subsidy, we are ready to buy and uh, make them uh, available and they will protect our people.
And I'm sure uh, there are many donor partners who can actually willingly uh, give us these things for free.
So, Mr. DG and Commissioner, can you please consider that urgently for the next 6 to 8 weeks?
Over.
>> So much, uh, Peter, you bring a very valid concern.
Uh, most of the health workers are working without gloves, especially in the private facilities.
Uh, Judith and Judith, go ahead.
>> Yeah, thank you very much, Stahlie.
Thank you very much, Dr. Ronnie and Dr. uh, Landry for the presentation. I'm Dr. Judith Kose from Africa CDC, based in the Eastern region. So, I wanted just to bring uh, uh, uh, another angle to what both Dr. Ronnie and Dr. Landry presented in terms of uh, keeping safe, but also keeping our clients safe, especially um, mothers and children. One of the issues that has been raised in one of the forums is how do we handle a pregnant mother or a lactating mother that is exposed and perhaps is symptomatic? So, what do we advise them in terms of and I'm thinking about Dr. Landry, what you presented in green zone and red zone and referring the patients. So, what happens to a mother who is whose baby is in who's exclusively breastfed, but the mother is symptomatic and exposed? How do you handle those or do you separate them in terms of the safety? So, I don't know if maybe either of you can speak to this in terms of guidance. Thank you.
>> Akena Uh Akena, we're not allowing more hands, colleagues. We gave ourselves 20 minutes to the questions. Type your questions in the chat. We shall pick it and we shall provide an answer. Dr. Edson, don't put your hand down.
Uh Akena is not speaking. Edson, go ahead.
>> Hello.
Uh Judith Hello.
>> Uh let me Hello.
We can hear you.
We can hear you.
>> Uh uh thank you so much. This is Dr. Akena again.
Uh sorry for the interruption.
Uh I work with the UPDF, that is Bombo Military General Referral Hospital.
Uh I had a question for the presenters.
Uh And they this is I'm I realized they mentioned the issue about uh one of the complications you get with the this Ebola virus, the Bundibugyo, is uh is the kidney failure. I was uh concerned if there's a specific management in case you have a client with this kind of condition with acute kidney failure resulted from a Bundibugyo Ebola virus. So, do we have experts involved in this area to guide us how we manage with IV fluids and all that?
And how we can make sure we save these patients. Thank you.
>> Okay, thank you. Dr. Edson, please go ahead as we close the question session.
>> Thank you, Commissioner.
Uh, mine is a is a a recommendation uh, to the biggest problem which is a fear.
Fear of health workers and fear for all the community. And most fear comes because they don't know what to do.
So, I was a recommending that through our our regional teams the districts should be well trained.
Uh, after being trained, they go down and train health workers on how on what to do. The health workers will go to the to the village health teams.
Uh, the task forces at the village level. So, that when a suspect is a is identified the community knows what to do. The household knows what to do. The health worker at the lower health facility knows what to do. And uh, the everybody doesn't fear this patient.
They just help the patient uh, to reach at the designated health facility. So, if we can do that, I think we can support our country very well. Thank you. Over to you, Commissioner.
>> Recommendation were taken Eugene his closing marks remarks were further substantiate on on that.
Um Well, we Well, we you still want to ask your question. You don't want to type it. Please go ahead, Joe.
>> Thank you so much. All protocols observed.
My concern is we sometimes in all of these BHTs in these programs which run, for example, the past COVID-19 which we went through, BHTs were involved in connecting the clients to the hospital.
But, they end up not being paid or they are just underpaid.
What have we put in place to curb that gap? Thank you so much.
>> Thank you. That is taken note of. So, thank you all for the questions.
Segi and and Ronnie and then we'll go into the closing session.
>> Uh Dr. Stavya, do you want me to comment first?
>> Yes, go ahead and make your comment then Ronnie and we shall go into the >> Yeah, thank you so much.
I think I want to focus on two important points.
The first one being how do we reorganize our our clients pathway, our services within the principles of green, red, and referral to the ATC, Ebola treatment center.
I think that's that's an important consideration. And if you want to focus on a specific group, right, the pregnant mothers or the pregnant women, you may want that to have that conversation with uh uh the district uh management team as well as uh uh uh the expert in maternal child health within the district because there's no one-size-fits-all, but there are principles that we need to to respect. Uh I mentioned that in my presentation. So, you really need to go through those principles, the principle of the principles of do no harm, do no harm to the health care workers, and do no harm to the mother and the child. Uh really really really important. This conversation today is also emphasizing the availability of the commodities.
When we talk about commodities, it's it's also the commodity to do screening.
Uh you need you need those thermometers, those pistol uh because because if if you want to ensure that the screening is done uh at the point of uh entry in the health facility, those people that will be positioned there needs to have the right equipment.
And they also need to ensure that when they screen the mother or the child coming for uh maternal child health services, they should they need to know the the the the criteria for suspicion.
They need to be well trained about it so that the mother and the child uh uh uh well well taken care of. Now, now, the the what would be a critical issue is if the child is is uh let's call it at risk or identified as a potential or as a probable or or a suspect a sus- sus- suspect case, what do we do with the mother? I think we need to always treat the the mother and the child pair together.
Uh there there's definitely going to be a high risk of suspicion for the mother if uh if the child has a fever or if the mother has a fever, we need to really continue to keep them together. Now, within the red zone, the experts in the in in the country will have to decide or to guide us on how they will approach managing a mother and a child if one of them is is is is is is is is is is in is at high risk and needs needs the other. This is especially the case for breastfeeding breastfeeding mothers. I think though that those are critical case-by-case issues that may need to go into the in-country guidelines. But now, my last comment is related to the the concern around what do we do for What do we do in the management of kidney kidney failure? I think we need to understand that kidney failure comes most cases as a complication of late late attendance.
It comes as a result of severe dehydration. So, I think one message we need to put it clear to our community as well is that early early attendance to the health care facilities will also prevent the occurrence of such complications. Over.
>> I thank you so very much chair and thank you so much Dr. Kawambugu for the questions asked about actually it wasn't a question but it was um uh an ask um for the Ministry of Health to support private private health care providers to uh subsidize the cost of PPE.
Uh this is going to be considered and it will be presented at the national task force or at the Ministry of Health top management to guide on how best we can go about with this. And the director general is here.
Perhaps you'll be able to speak to this.
But we will take this through because as was highlighted, we've been doing our support supervision in the Kampala metropolitan area.
And one of the key findings that we have is people are not observing the basic principles of infection prevention and control. And many a time people will cite expenses as one of the inhibitors of observation of these principles. So we will try and uh see how best we can get there.
And ensure that we are able to support you. When you're not healthy, when your health care providers get exposed, the whole entire Kampala is at risk because those same health care providers that you're working with also share in other work spaces, especially in the public sector. So we could find a crossover of or an overlap of infection transmission from the private sector into the public. So we are one health care workforce in this country and we will be viewed as such. Uh there was a question on how long the virus stays alive or viable on inanimate surfaces. Uh literature that I've been able to come through with is uh uh states that these viruses can stay viable for up to several hours, 7 to 10 hours uh on inanimate surfaces like door handles worktops and everything else uh that is inanimate.
and that they can uh be destroyed when we use uh alcohol hand rub or alcohol uh based hand sanitizers uh to make sure that we uh decontaminate or we continually clean these surfaces.
However, when uh we find infectious material like blood, vomitus, or stool that remains wet on uh on the down surface uh despite a drying of the top surface the viruses will remain viable for up to several days. Uh what we need to be alert to is uh we are dealing with uh an RNA virus, which is easily uh uh uh destroyed by any of these uh interferences like if you use alcohol or uh any form of a disinfectant. So, the reason why we are guiding that we should observe strict hand hygiene during this period of time and even in the future.
Uh we've learned these lessons since the COVID-19 era and we need to continue with these uh uh practices as a new norm uh going forward. Uh share, I have a very short video to show uh on why hand hygiene is very critical, especially during this time and even during other uh peace times when we are dealing with especially uh multi-drug resistant organisms. If I may be allowed to show it so that all of us can be able to uh share in this space uh with uh these basic principles.
>> I think you can share it or give it to the admin to do so.
I want to thank uh you, our dear presenters, for the wonderful work you have done this morning and our participants.
We have posted the link for you to share with us the situation of masks, gloves, and so on in the chat.
Take off time to fill in uh that uh form uh as we also get the video from uh Ronnie and then uh uh DG be preparing to close off the session.
How long is the video, Ronnie?
>> 2 minutes.
>> Okay, 2 minutes. Uh please stay on for 2 minutes as we wait for the final closing. Thank you.
>> Uh Dr. Ronnie, there's no sound in the video.
Could share it >> With me I can quickly uh put the sound if you need help.
>> Isaac, I've shared it with you.
>> Okay, thank you.
So, as we uh put the video on uh key things that we have learned this morning uh the need to uh to stay safe for us to be able to continue offering services.
Uh you may need to make money today uh but you have to be alive for you to make the money. So, safety is first like the theme is But also even if beyond the outbreak, we will need to continue observing these safety precautions for ourselves.
Because most of the times we have had to get a border in our health facilities and usually we get it when we are not suspecting. So, the precautions we are talking about should be part and parcel of the process of the process process uh of caring for patients.
Uh of the process of caring for patients.
The video is ready to start.
Please go ahead. I'm just uh talking.
But what is important, we need to make sure that we do not neglect to offer the service that we are uh keeping safe.
Uh otherwise we'll have more deaths from We will have more deaths from the common conditions that we have malaria, uh pneumonias, maternal child-related issues than the border outbreak itself. So, let's put the precautions in place and continue to offer the services and make adjustments when we see that uh uh the population is not reaching out for our services to make sure that they are accessible. Let's go ahead with the video.
>> Brains.
Brains.
Brains.
Brains.
>> Thank you so much.
Yes, and let's circulate the video in the different chat rooms. You can also post it in the chat here.
Let people pick it.
I am really, really, very happy that we all were able to join and stay on. We still have over 800 people.
We are grateful that you waited in this session.
Uh DG, I now invite you. We will continue to have these sessions, please.
Always mobilize so that we keep alert.
And the recommendations that we have picked, we shall also see how to put it in practice. Over to you, DG.
Dr. Lara, are you on? Professor Lara, I'm sorry. Are you on?
>> Uh Dr. Xavier, the DG is not on the call.
>> Okay, the DG is connecting. I think he was pushed out of the meeting because of the numbers.
At at the time when we had the uh over 1,000. So, let's talk that DG.
I hope we have filled the form.
>> Yes.
>> Good. Thank you so much.
>> Please reshare the link for the form.
>> Reshare the the link of the form. Kindly Isaac, keep on sharing. Keep on sharing and you have good saturation.
>> Uh Stabia, chair.
>> Yes. Now you can go ahead, DG.
We have completed the the sessions and the answer session.
Uh we got uh key asks. One from the private sector that if we could subsidize the gloves, they can easily acquire them.
Or if there is a a partner who can support them because it makes one of the most expensive items they they have to use.
And then uh uh one of the DHOs posted that uh if it's possible, we can scale the capacity building to make sure that at regional level, they train the DHOs and the DHOs train their health facilities and facilities the the VHTs uh so that we have uh the country on trend in terms of awareness to the Ebola virus. Over to the DG.
Let me mute it.
Uh, as I kindly unmute the DG.
>> Oh, okay. Thank you. Thank you, chair, and thank you, members, and um I think it has been a I want to thank We we look at those asks, and we look at it.
Because we would want to prevent infection from any wherever it happens, because it doesn't make good sense for us to be prepared in the public, and we were not we're getting gaps in the in the private, but uh So, I think we'll continue to engage. Um, I might not be able to confirm it in this meeting, but we look at all the different partners who are working with us to see how they can be able to come in to support the private the private sector.
I think information is key.
So, but the but the the theory which we have learned is different from the practice, so let's see see differently how this translates into what we do on a daily basis.
And I think also I'm happy that we have shared on the continuity of the essential services.
It's really one of those things we really want to drive. Sorry for the noise in the background.
But I want to look forward at we'll regularly continue to engage. So, if we have I hope also we we share the the different lines where you can be able to communicate any alerts, communicate any information.
But we remain available. So, let's protect each other. Let's be each one's own our own brother's keepers and see how we how we move. We would really would want to bring this outbreak to an end as early as possible so that we can open our country and so that we we don't get this wobbling where every other country wants to close us. I think I'm seeing it the first time. Well, we had this the ninth outbreak of Ebola and other the the world has not closed before, but look like this time everybody wants to close us out. So, let's see. Well, we can only do this if we are able to know that all the contacts, we have them.
And we would be happy if we have the contacts only who turn positive are in in quarantine or we already know them.
Because if we have I mean, those positive cases which come out from the community, they change the ballgame. So, I'm really looking forward to your support.
And it's only through your support when and that's when you can bring this outbreak to done end in the shortest time. So, let's continue the conversation.
Um thank you, chair, for convening this.
>> Thank you so much, uh Director General Health Services. And thank you, and everybody.
Meeting adjourned. Over.
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