Sierra Leone UK Diaspora Ebola Response Task Force - Volunteer Roadshow 20/10/14 London Royal Society of Medicine 1 Wimpole Street.

Sierra Leone UK Diaspora Ebola Response Task Force - Volunteer Roadshow 20/10/14 London Royal Society of Medicine 1 Wimpole Street. 

The meeting, convened by the Sierra Leone UK Diaspora Ebola Response Task Force to recruit and register volunteers to go to Sierra Leone for a four week period, was well attended by many medical and non-medical potential volunteers, both Sierra Leonean and non Sierra Leoneans. Present to recruit volunteers, give short briefings and answer questions about what the tour of four weeks would entail, were UKMED, Medecines Sans Frontieres, Public Health England , DfID, Save The Children, GOAL, Kings Sierra Leonean Partnership, The Sierra Leonean High Commissioner and others. The briefings and short Q&A were followed by a networking session when volunteers were able to individually meet and discuss with the various agencies. 

UKMED urged NHS staff to register on the UK International Emergency Medical Register (UKIEMR) for the ebola crisis, in order to be considered for a volunteer post in Sierra Leone.

Medecines Sans Frontieres was represented by a  young UK doctor just returned from Sierra Leone's Kailahun Ebola Centre after his tour of duty. During his presentation he stressed the vital need for adequate quantities of  protective wear and chlorine for health workers. He gave a brief of the regime as a volunteer doctor. One doctor within a six hour shift would have two one hour sessions in the isolation unit with Ebola-confirmed patients. One hour was about the limit anyone could take in full contamination gear. Within that hour a person would sweat to soaking point; he showed a film of himself wringing large amounts of sweat out of his clothes after exiting the isolation unit. He explained there were many orphans of deceased ebola victims, some recovered patients actually stayed on to look after them and to help out at the clinic. Doctors will see on average six out of every ten of their patients die. Many patients arrive at the clinic in an already advanced very weak state, they are unable to eat, and most die quickly. There is a great need for nutritional support for patients who can't eat.  Those who present early stand a better chance, but can spend 6 -8 weeks struggling with the illness, some patients take longer resulting in psychological trauma that needs attention. One patient (described as #460 was still there as patient #750 was being admitted) she was frantic that the disease had still not left her. Eventually she did recover. He reported that the International Federation of the Red Cross and Crescent is performing the burials for their centre. Whole families have died, volunteers need to be prepared for this. Often all they have available to give patients is oral rehydration therapy and paracetamol.  15 days is the 'time to survival' for those patients who are able to recover, at which time their appetite returns. The Kailahun centre takes all cases from Makeni and Port Loko at present. After recovery, recovered patients stay in a holding hostel and are fed they need further psychological support and then they require transportion back to their home regions, which are many miles away. Some recoverers stay on to help, there is a network of patients and interrelated families who give mutual support at the centre, and there are encouraging stories of great compassion shown by patients and many Sierra Leoneans, and of survival. The young doctor showed pictures of the involved process of robing with many layers of protective wear (scrubs, plastic overalls, hood, inner gloves, 2nd gloves and outer gloves, goggles, apron, mask, etc.) that must be worn in the high risk isolation area. He also described the even more involved process of disrobing and decontamination. Disrobing is much more dangerous, those exiting the isolation areas are sprayed down with 0.5% chlorine solution both before and after removing each layer of protective clothing. They are coached  by experienced Sierra Leonean assistants who talk the doctors and nurses through the complex disrobing process. Part of the process is to wash hands 9 times between each layer. Hence the need for large supplies of chlorine, water and protective gear.

A short video was then shown, of a nurse in Connaught hospital, Mustapha Koroma. He made an impassioned plea to both outsiders and Sierra Leonean health care workers to volunteer in Sierra Leone and assist their ongoing fight against ebola. These brave nurses do not leave after 4 weeks, they are permanently involved in the daily battle.

Kings Sierra Leonean Partnership spoke about their past work within Sierra Leone on other diseases and their recent work in Connaught (apologies for previous error) for Ebola. Unlike Kailahun their unit was much smaller and again unlike Kailahun they had the resources to provide overall health care to patients, not just for Ebola but cholera, malaria and other diseases.  Kings' Goal is to keep Connaught going as a hospital treating all types of conditions. But this is only possible if they can have an effective triage unit for separating and isolating Ebola patients, who they can then refer to Ebola treatment centres.  At the moment they have a very limited isolation facility with only 18 beds at Connaught. Kings are also keeping abreast of the real time bed availability status in other Ebola facilities. There is a need for volunteers to do jobs like site visits, patient and family support coordination, ensuring all local Primary Healthcare Units have precautionary equipment and procedures in place at all times, technical advice, updating databases, etc.

Save the Children spoke about their Volunteer Support Framework as part of their Ebola response programme; they have taken on the role of recruiting and training staff in conjunction with the UK Ministry of Defence who is training Save the Children and their volunteers at their military facilities, to practice in highly contagious clinical environments.  Volunteers will attend a course at the military base and be taught all the necessary protocols as well as have the oportunity to to practice these protocols in a non hazardous environment, before going on their volunteer placements. Currently, every patient with Ebola is resulting in 1.5 to 2.5 additional cases. The  UK MoD is constructing bed units in Kerry Town Freetown. Save the Children have made the Ebola emergency their Category 1 emergency for the next 12 months. The organisation's Ebola aims are ; Isolation and Case Management , Behaviour Change (there is more acceptance now of the existence of ebola but there was no word on their activities or progress on behaviour change), Non Ebola health system support (they are not even close on completing the planning for this), addressing vulnerability (food security children protection etc). The UK MoD is currently constructing a 12 bed facility, it says this is 'to encourage health care workers to continue to come to work' though they admit it is too small to have any direct impact on the crisis. 

Questions & Answers 

Question: Is there an isolation period on return to the UK, for doctors and nurses in the NHS, how will this affect our return to work in the UK?

Answer: Public Health England answered; it depends on the type of work done in SL and in UK. If just case management in Sierra Leone then a volunteer could go back to normal clinical duties with some restrictions eg; no exposure-prone procedures for 21 days.  Save the Children answered: Those with Category 2 exposure would be restricted to passive surveillance on their return during the remaining incubation period, Category 3 would be excluded from work during the incubation period. Individual NHS  trusts have their own policies. UKMED answered; The tour entails 4 weeks in a treatment centre, one week in-country to rest, then 2 weeks self isolation, however this would be clarified by Public Health England who will update them.

Question: How do I fit in  as a volunteer?

Answer: Kings Partnership answered; they had clinicians booked until December by which time they would need more, there could be need for administration and health checks, in addition to the need for clinicians. The important thing was for all those willing to volunteer to register.

Question: Would you require retired healthcare workers to still be registered in order to volunteer, and if their registration had lapsed could they still volunteer?

Answer: Save the Children Answered; The clinical volunteers they were looking for would need to be currently working and registered for clinical roles. Although there were other possibilities for roles in family liaison and discharge liaison for example.

Question: I am an accountant but I want to help, what roles are there for people like me?

Answer : There were administration roles for example, among other things.

Answer:  DfID answered; They were now realising there is a massive pool of potential volunteers interested, including those retired. Their representative would mention this at DfID and see whether they could do something about it. While in an ideal situation they would normally require clinical staff to be registered, these were not ideal situations, they would discuss with UKMED and with the Government of Sierra Leone to see what was possible.
Answer: The best suggestion was for volunteers not to be concerned whether to register but to do so regardless of background and leave it to the organisers to sort out the issues.

Question:  There has been a great emphasis on treatment and isolation but not on prevention, what is being done on prevention?

Answer: GOAL answered; they (GOAL) are currently involved in social mobilisation in Sierra Leone and are recruiting volunteers for those roles. 

Question: What of pending unanswered volunteer applications? Many have applied and are still waiting to hear anything? 

The meeting was then interrupted and had to be moved to the hall where people were invited to continue their questions, all members of the panel remained and discussions continued one-on-one.