EBOLA RESPONSE AND HIV PANDEMIC: MILITARY EFFORT Mona D. Sankoh, MPH , FWACN Program Manager DHAPP-Office of Security Cooperation US Embassy, Liberia
Introduction Background Situation Report /Analysis ( WHO/ MOH) (March 2014- March 12, 2015) The Ebola virus disease (EVD) outbreak, which began in December 2013 in the forest region of Guinea, in a town That borders Liberia and Sierra Leone, led to widespread infection and death rates. By February 2015 the World Health Organization (WHO) reported a total of 22,460 suspected, probable, and confirmed cases of which 8,745 were reported in Liberia. The death toll of both countries reflected 8,829 with 3,746 occurring in Liberia within the given period. Health workers were 30 times more at risk than the adult population with total 822 confirmed and probable cases; Liberia reported 374 of these cases. Death toll reported for both countries was about 488 amongst health workers of which 188 occurred in Liberia. Impact on Health System Due to the inherent weakness in the health system there was no robust data and surveillance system for early detection or early disruption of the outbreak. The measure for preparedness and responses were not up to the task, coupled with inadequate coordination of the national authorities for emergency. Command and control mechanisms were not functioning satisfactorily. National and referral laboratories together at the onset could not diagnosed the Ebola Virus Disease (EVD) which was a weak link. The situation was made even more precarious by the severe shortage of qualified health workers combined with poor working conditions and lack of in-service training; significant drops in utilization of health services; outpatient visits dropped by 61% in Liberia, and 51% in the largest counties: Montserrado, Margibi, Bomi, and Grand Cape Mount counties, 43% in antenatal care, 38% in institutional deliveries,
Background of the AFL HIV&AIDS Prevention Program The Armed Forces of Liberia ( AFL) HIV& AIDS Prevention, Care and Treatment Program was established in 2008, with oversight responsibility of the Program Manager, Office of Security Cooperation US Embassy Liberia. The program is funded by the U.S Defense HIV & AIDS Prevention Program (DHAPP), a PEPFAR initiative and implemented by a community based organization, the Community Empowerment Program (CEP) Inc. The program targets military personnel, their families, and residents of communities in proximity to functional military barracks. Priority Areas: ü “ Troop level” HIV/AIDS Prevention Education and Behavior changed Communication ü Improve infrastructure for HIV testing, care and treatment services. ü Ensure testing of all military personnel. ü Improve diagnostic capacity ü Increase clinical capabilities through human resource development ü Train Master Trainers, Peer Educators and HIV Counselors ü Provide effective methodology for monitoring and evaluation procedures.
Program Activities Suspended ( April, 2014- March, 2015 ) The AFL HIV Prevention program is a very vibrant and robust program with frequent community outreaches. However, within this period, movement became restricted and stringent measures enforced by the government of Liberia. Major activities placed on hold: ü HIV prevention activities in all functional barracks- placed on hold ü PMTCT activities-decrease to non-existent ü Fewer to no access to ARVs - movements restricted ü Target Testing-placed on hold ü Nutritional supplements- practically non-existent ü Lost to follow up-increased ü AFL HIV Policy development-placed on hold ü Sero-prevalence and Behavioral Epidemiology Risk Survey-placed on hold ü AFL mid-level health trainee Aid-placed on hold ü Adolescent school program activities-placed on hold ü Community outreach-placed on hold
Impact on the AFL ü The Challenge: The Health Services Department and Medical Unit of the AFL which are charged with the responsibility of ensuring the health and readiness of the men and women in arms, including civilian staff, and their dependents had to undertake this herculean task in the absence of resource and support. Hence, to avert the EVD catastrophe in any of the barracks communities, partnership was needed to respond through education, training, and delivery of prevention materials and supplies. Too Late (April-May, 2014) § Movement became restricted as government enforce stringent mandates § Contact tracing often delayed or not carried out resulted in multiple infections § AFL deployed to borders between Liberia, Guinean, Sierra Leone (no formal training in prevention ) § Health facilities shut down § No access to ARVs/ ART ( movements restricted) § Nutritional supplements practically non-existent § AFL Clinic staffs quarantined- doctor, nurse, HIV Prevention Coordinator and 14 medics including HIV peer educators and counselors came in direct contact with a probable case; a spouse of one of the soldiers, the body could not be tested because it was already disposed of before it could be requested by authorities. § Death of clinical staff and Combat Medics. § The situation degenerated, the EBK barracks which is home to about 1000 soldiers and over 4000 dependents was quarantined follow by the Liberian Coast Guard Based. § Increase contact with proximity communities.
AFL Response The health system collapsed leaving some doctors and nurses dead in an attempt to provide health care without proper protective gears ( PPE) and inadequate medical experience to manage the disease. The entire country degenerated with no hope with each painful death, resulting into fears and doubts. The AFL HIV & AIDS Prevention, Care and Treatment Program was faced with the dilemma of standing by without hope or getting involve to safe lives as each day presented the possibility of the death of a military personnel or dependent. There was no way of knowing who the next victim would be. The thought to seek approval from DHAPP to re-program funds became urgent; a life and death situation. Hence, justification was forwarded and the budget line ( OHSS-Health System Strengthening) was the only way out, with this approval, the AFL Ebola response began.
Approved Funding
Training Sessions N Barracks Soldiers Spouses Date Total o. /Depend ents 1. MoD 53 0 August 53 13,2014 2. Coast Guard 78 77 August 155 Base 13,2014 3 Camp Ware 166 16 August 182 14,2014 4. Careysburg 81( community 0 August 81 Community dwellers ) 15,2014 5. Camp 93 79 August 172 Tubman 15,2014 6 EBK 379 219 August 598 18&19,2014 7. Grand Total 850 391 1,241
Partnership and Coordination Approaches ü Partnership MOH USAID CDC JHPIEGO NAC OOL Mentors (June- December 2014) ü Information and Communication Trans-barracks Ebola awareness and sensitization activities as below: Ebola awareness/sensitization to 1600 soldiers and 2400 dependents in 5 barracks 6000 community dwellers in proximity to 5 military barracks Infection, Prevention and Control (IPC) training to 53 clinical staff including Combat Medics ü Synchronization of institutions efforts (AFRICOM, OSC, MOD, MOH, JHPIEGO) Hand Washing materials: Faucet buckets Bleach / chlorine Hand sanitizer Detergent Face mask Gloves Infrared thermometer
Approaches Cont. ü Community Engagement § The AFL HIV Prevention program and AFL LOGCOM through AFRICOM conducted a quick assessment to supply buckets and bleaches to all barracks residents (5 barracks). § Establishment of hand washing facilities in 5 Military clinics( Edward Binyah Kesselly, Liberian Coast Guard, Camp Tubman, Camp Ware and Head quarter (MOD). § Distributed 900 pcs of 20-liter rubber buckets with installed faucets to needed homes for the establishment of hand washing stations in 3 communities ( Dwazon, Careysburg and Bong Mines Bridge), Bleaches and hand sanitizers were included. § Distributed Face mask, gloves, Infrared thermometers to deployed soldiers. § Conducted EVD Prevention awareness activities to 100 community leaders i.e. youth, religious, block leaders, etc. ü Leadership and governance § Establishment of triage units with support from UNICEF- to avert the spread of the EVD in 4 military health facilities. A process to determine the priority of patients' treatment based on the severity of their condition. § Establishment of contact tracing mechanism with the MOH “Ebola Response Team”
Approaches Cont. ü Sustainable health § Frequent nutritional support, fluids(juices/water) and vitamin supplements to 34 AFL personnel and 21 dependents quarantined as a result of possible contacts with suspected or confirmed cases in or out of the barracks. § Frequent follow-up and nutritional supplies to 13 persons (soldiers, dependents, clinical staff) admitted in ETUs of suspected and confirmed cases of EVD. ü OVCs Support § Provided backpacks with school materials to 40 OVCs infected or affected by both HIV/AIDS and Ebola in Buchanan in preparation for the reopening of schools; orphans with death of both parents were prioritize.
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