From HIV to Ebola: How to protect health workers in West Africa
From HIV to Ebola: How to protect health workers in West Africa
EDITOR’S
NOTE: What can we learn from the global response to HIV and AIDS that
can be applied now to aid workers dealing with the Ebola outbreak in
West Africa? Mead Over, a senior fellow at the Center for Global
Development, urges donors to help affected governments protect health
workers in Ebola-affected areas.
As the Ebola epidemic in West Africa endures, some parallels are being drawn between the virus and HIV and AIDS.
Both
are spread by quite specific human behavior which is under conscious
control: HIV by unprotected sex, Ebola by unsanitary burial practices,
and both by contact with the bodily fluids of an infected person.
However, with an incubation period of less than three weeks, Ebola
progresses from infection to infectiousness more than 100 times as fast
as untreated HIV. Thus, Ebola is like a pre-treatment HIV epidemic on
steroids. So what can we learn from the global response to HIV and AIDS
that can be applied to the Ebola response? There are a number of lessons
(highlighted here and here),
but I think the most relevant is that donors must give highest priority
to helping affected African governments to protect health workers.
Before
the arrival of HIV, medical personnel around the world had not feared
infection from their patients since antibiotics had become widely
available in the 1950s. Even in a country with a weak health system,
virtually any infection a health worker acquired could be cured with the
antibiotics to which health workers had priority access. For health
workers in Africa, this sense of security evaporated in the 1980s, when
AIDS was spreading and the virus called HIV had just been identified.
Any patient arriving at a health center might be infected with HIV. Thus
a health worker who accidentally stuck himself with a contaminated
needle or inadvertently rubbed a patient’s blood or saliva onto his own
open wound, might catch HIV. At that time there was no treatment for HIV
infection, so each infection meant that, after an “incubation period”
of 8 to 12 years, the health worker, like any HIV-infected person, would
sicken and die of AIDS.
As the danger of
HIV infection became widely understood, but before treatment was
available, worried health workers were reluctant to go to work or to
treat new patients. Patients whose blood tested positive for HIV were
often placed in separate “AIDS wards” and subsequently neglected by
fearful health workers. Entire hospitals would sometimes refuse to admit
HIV positive patients, for fear that the public would designate the
hospital an “AIDS hospital” and shun it.
Now
we see health workers in the African countries of Guinea, Liberia,
Sierra Leone, and Nigeria faced with similar, though more urgent
challenges. Just as in the early days of HIV, African public health
officials and their government and donor supporters must today be
concerned with how to protect health workers from the Ebola infection so
that the providers: (a) stay free of infection; (b) feel secure enough
to go to work; (c) prevent transmission from an infected patient to an
uninfected one; (d) continue to provide good care to routine patients;
and (e) provide both care and comfort to the infected patient.
In
the 1980s and 1990s the policy tool that succeeded in accomplishing all
these objectives for HIV was the definition and promulgation of
so-called “universal precautions” for health workers. Since health
workers had no quick way of knowing which new patient might be HIV
positive, the World Health Organization defined
precautions that health workers should take “universally,” that is, for
all patients. These included simple precautions like hand-washing
before contact with each patient, face masks, gowns and rubber gloves.
Helped by the spread of the information that HIV could not be
transmitted by casual contact, donor and African government support for
“universal precautions” alleviated health worker fears of HIV and of
HIV-infected patients, kept workers on the job, and led to improved
treatment of HIV-positive patients.
Similarly, the following figure, extracted from Annex 2 of the newly updated WHO guidelines, dramatically communicates how carefully health workers are advised to protect themselves from Ebola:
Thanks
to decades and billions of dollars of donor support for the battle
against HIV, many African health facilities now have the rubber gloves,
goggles, and face masks that were defined as the “universal precautions”
to protect against HIV infection. But few yet have enough complete sets
of gowns, masks, hair coverings, aprons, and rubber boots depicted in
the guidelines to protect staff from Ebola. And fewer still have trained
all their staff, including cleaners, orderlies, clerks and
receptionists, in the proper techniques for putting on, removing and
discarding or sterilizing this equipment. African health systems are
better prepared for Ebola than they would have been without the HIV
epidemic. But as the figure illustrates, much more protective gear is
needed against Ebola than against HIV. And as my colleague Charles Kenny
points out in a recent article,
countries like Sierra Leone where health expenditure is only 26 cents
per day do not have the resources to protect their own health workers
from this new threat.
Donors must mobilize
emergency task forces to procure and transport this full-body protective
gear to all health facilities in the affected countries. And donors
must help governments to distribute this gear and train their health
providers in its use. Private providers, including pharmacists, must
receive the same training as those in the public sector. Where African
governments supplement their health personnel with village-based
community health workers and traditional healers, they too must receive
equipment and training. Since most caregivers are women, most of the gear must be distributed to women.
Just
as universal precautions eased the concerns of health workers about
on-the-job HIV infection in the 1980s and 1990s, these new rigorous
precautions can play a critical role in sustaining the existing health
care systems as they control the Ebola epidemic. But given the rapid
incubation period of Ebola, speedy donor action is even more important.
Thanks to decades of lessons learned from the global HIV and AIDS
response, we know more about how to respond to an epidemic like this.
But donors and governments must act far more quickly to implement these
lessons learned, support national health systems, and protect African
health workers as a means to controlling this devastating new epidemic.
Edited for style and republished with permission from the Center for Global Development. Read the original article.
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