DiversityNursing Blog

By NAOMI CHOY SMITH

When Doctors Without Borders nurse Monia Sayah first arrived in Guinea in March, she couldn't have known she would witness the worst Ebola outbreak in history. Back then, there were 59 confirmed deaths from Ebola, a virus which can be fatal in up to 90 percent of cases. The death toll in West Africa has since soared to 932, the World Health Organization said Wednesday. In Guinea, where the first cases were reported in March, Ebola has killed 363 people.

"The fear is palpable," Sayah said, speaking to CBS News in New York after returning from her latest assignment. "People are very afraid because they never know if Ebola's going to hit their family or their village."

Because of the fear and stigma associated with the virus, Sayah said many infected people are choosing to hide their illness and often don't check in to treatment centers until it is too late. By that point, there is very little Sayah and her colleagues can do. They try to rehydrate the patients and administer antibiotics. But there is no proven treatment for Ebola, though an experimental drug is currently being tested.

Concerns have also been growing for the safety of medical workers in the field. A leading doctor died in Sierra Leone last week. A Nigerian nurse who treated that country's first Ebola victim died from the virus, Nigerian health officials said Wednesday, and two American medical missionaries infected with Ebola in Liberia are still battling the virus at Emory University Hospital in Atlanta.

But Sayah, who has spent a total of 11 weeks in Guinea, said she is not afraid. She and her colleagues take strict precautions to limit their risk of exposure. Before entering a high-risk zone, they suit up in head-to-toe protective clothing including gloves and goggles. "You do have to follow the rules," she said, "but accidents do happen."

She has to limit the amount of time she spends in the infected area. It's hot under the protective clothing, and exhaustion and dehydration are serious concerns. "The risk is you could faint, you could fall. You do not want to fall in a high-risk area," she said. "Maybe your goggles will move up and your eye will be infected."

Working so closely with patients at death's door has taken a personal toll. Sayah described the anguish of stepping outside a treatment facility to take a quick break from the intense heat, only to find that her patient had died in those ten minutes she was away. "It was really hard for me to know that they had died alone," she said, "not with someone holding their hands and reassuring them."

Sayah recalled the "hectic" challenges of setting up some of the first international treatment facilities for Ebola patients. By the end of May, she said, the medical community thought they had almost contained the virus. But soon after she left Guinea, another cluster of infected patients was found in another village. The virus was spreading like wildfire.

Several factors are contributing to the spread. The virus has an incubation period of up to 21 days, according to the WHO, and in West Africa the population is highly mobile, moving easily across porous cross-country borders. Traditional burial ceremonies in which relatives have direct contact with the body can also play a role in the transmission of Ebola.

Sayah found that many local communities distrust the healthcare system and foreigners. "Some have said we brought the Ebola to them," she said. "It's very difficult to contain the outbreak when communities are not cooperating." There were instances of infectious patients leaving the facility, she said, and many weren't receptive to the idea of isolation -- a crucial step in containing the virus.

During her breaks from the field, Sayah stays in touch with her colleagues on the front lines, hoping for the slightest bit of good news. Just this past week, she heard some. One of the patients who'd been under her care was discharged from hospital, apparently free of the virus.

But the situation on the ground remains dire, and Sayah hopes to see a greater response from the international community.

Despite the challenges, Sayah said she will return to West Africa to fight the outbreak. "When you're there and you see how much needs to be done," she said, "there is not a question of 'should I go back or not?'"

Source: www.cbsnews.com

By Joe Sutton and Holly Yan

A second American aid worker in Liberia has tested positive for Ebola, according to the Christian humanitarian group she works for.

Nancy Writebol is employed by Serving in Mission, or SIM, in Liberia and was helping the joint SIM/Samaritan's Purse team that is treating Ebola patients in Monrovia, according to a Samaritan's Purse statement.

Writebol, who serves as SIM's personnel coordinator, has been living in Monrovia with her husband, David, according to SIM's website. The Charlotte, North Carolina, residents have been in Liberia since August 2013, according to the blog Writebols2Liberia. They have two adult children.

On Saturday, Samaritan's Purse announced that American doctor Kent Brantly had become infected. The 33-year-old former Indianapolis resident had been treating Ebola patients in Monrovia and started feeling ill, spokeswoman Melissa Strickland said. Once he started noticing the symptoms last week, Brantly isolated himself.

Brantly, the medical director for Samaritan Purse's Ebola Consolidated Case Management Center in Monrovia, has been in the country since October, Strickland said.

"When the Ebola outbreak hit, he took on responsibilities with our Ebola direct clinical treatment response, but he was serving in a missionary hospital in Liberia prior to his work with Ebola patients," she said.

Deadliest Ebola outbreak

Health officials say the Ebola outbreak, centered in West Africa, is the deadliest ever.

As of July 20, some 1,093 people in Guinea, Sierra Leone and Liberia are thought to have been infected by Ebola since its symptoms were first observed four months ago, according to the World Health Organization.

Testing confirmed the Ebola virus in 786 of those cases; 442 of those people died.

Of the 1,093 confirmed, probable and suspected cases, 660 people have died.

There also are fears the virus could spread to Africa's most populous country, Nigeria.

Last week, a Liberian man hospitalized with Ebola in Lagos died, Nigerian Health Minister Onyebuchi Chukwu said.

Lagos, the largest city in Nigeria, has a population of more than 20 million.

The man arrived at Lagos airport on July 20 and was isolated in a local hospital after showing symptoms associated with the virus. He told officials he had no direct contact with anyone with the virus nor had he attended the burial of anyone who died of Ebola.

Another doctor infected

Confirmation of the death in Lagos came after news that a doctor who has played a key role in fighting the Ebola outbreak in Sierra Leone is infected with the disease, according to that country's Ministry of Health.

Dr. Sheik Humarr Khan is being treated by the French aid group Medecins Sans Frontieres -- also known as Doctors Without Borders -- in Kailahun, Sierra Leone, agency spokesman Tim Shenk said.

Before falling ill, Khan had been overseeing Ebola treatment and isolation units at Kenema Government Hospital, about 185 miles east of the capital, Freetown.

Ebola typically kills 90% of those infected, but the death rate in this outbreak has dropped to roughly 60% because of early treatment.

Spread by bodily fluids

Officials believe the Ebola outbreak has taken such a strong hold in West Africa because of the proximity of the jungle -- where the virus originated -- to Conakry, Guinea, which has a population of 2 million.

Because symptoms don't immediately appear, the virus can easily spread as people travel around the region. Once infected with the virus, many people die in an average of 10 days as the blood fails to clot and hemorrhaging occurs.

The disease isn't contagious until symptoms appear. Symptoms include fever, headache and fatigue. At that point, the Ebola virus is spread via bodily fluids.

Health workers are at especially high risk, because they are in close contact with infected people and their bodily fluids. Adding to the danger, doctors may mistake the initial stages of an Ebola infection for another, milder illness.

Source: www.cnn.com

By Danielle Dellorto, Miriam Falco, and Jen Christensen

The Ebola epidemic isn't getting any better in Africa.

The World Health Organization reports there have been 759 cases, including 467 deaths in Guinea, Sierra Leone and Liberia since the outbreak began in March, according to a statement the organization released on Tuesday.

The World Health Organization has said "drastic action is needed" to stop the deadly outbreak in West Africa. It has sent teams of experts to help locals deal with the epidemic. WHO will meet this week to discuss how to contain it.

Relief workers on the ground said the epidemic has hit unprecedented proportions.

"The epidemic is out of control," said Dr. Bart Janssens, director of operations for Doctors Without Borders.

Complicating matters, the countries hit hardest by the epidemic have major medical infrastructure challenges. There is also a real sense of mistrust toward health workers from communities. In Sierra Leone and Guinea, WHO has said that community members have thrown stones at health care workers trying to investigate the outbreak.

In April, CNN Chief Medical Correspondent Dr. Sanjay Gupta traveled to Conakry, Guinea, to report on what was being done to treat patients and contain the outbreak.

"It took only moments to feel the impact of what was happening here," Gupta wrote after landing in Conakry. "There is a lot we know about Ebola, and it scares us almost as much as what we don't know."

Ebola outbreaks usually are confined to remote areas, making the disease easier to contain. But this outbreak is different; patients have been identified in 60 locations in Guinea, Sierra Leone and Liberia.

Officials believe the wide footprint of this outbreak is partly because of the proximity between the jungle where the virus was first identified and cities such as Conakry. The capital in Guinea has a population of 2 million and an international airport.

People are traveling without realizing they're carrying the deadly virus. It can take between two and 21 days after exposure for someone to feel sick.

Ebola is a violent killer. The symptoms, at first, mimic the flu: headache, fever, fatigue. What comes next sounds like something out of a horror movie: significant diarrhea and vomiting, while the virus shuts off the blood's ability to clot.

As a result, patients often suffer internal and external hemorrhaging. Many die in an average of 10 days.

Doctors Without Borders, also known as Médecins Sans Frontières, has been working to fight the epidemic since March. The group has sent more than 300 staff members and 40 tons of equipment and supplies to the region to help fight the epidemic.

Still, the group warns, it's not enough.

"Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites."

The good news is that Ebola isn't as easily spread as one may think. A patient isn't contagious -- meaning they can't spread the virus to other people -- until they are already showing symptoms.

Serious protective measures

Inside the isolation treatment areas in Conakry, doctors focus on keeping the patients hydrated with IV drips and other liquid nutrients. Health officials have urged residents to seek treatment at the first sign of flu-like symptoms.

There is no cure or vaccine to treat Ebola, but MSF has shown it doesn't have to be a death sentence if it's treated early. Ebola typically kills 90% of patients. This outbreak, the death rate has dropped to roughly 60%.

The outbreak will be considered contained after 42 days -- twice the incubation period -- with no new Ebola cases.

Source: cnn.com