Infection Prevention and Control Training
By: Renée Zandvliet, Kingtom, Freetown, Sierra Leone, October 2014
It is a hot and sweaty Friday afternoon in Kingtom, a community in the centre of Freetown, the capital of Sierra Leone. Some 20 health workers have gathered in the outpatient department of the local police hospital for a training so important it could literally mean the difference between life and death. They are here to learn how they can protect themselves from becoming infected with the Ebola virus.
The Infection Prevention and Control (IPC) training is meant to prepare government health workers to identify and isolate a suspected EVD patient and prevent further transmission. The training package and plan were developed by the DFID-funded Ebola Response Consortium (ERC), of which Concern is a member, the Ministry of Health and Sanitation, the Centre for Disease Control and Prevention (CDC) and UNICEF. Concern is the lead agency for coordinating the IPC training in the Western Area, which comprises Freetown and its surrounding towns and villages. Health workers in 105 health facilities in the Western Area will benefit from the training.
Wilmot Adeola is a Community Development Officer with Concern Worldwide’s Child Survival Project in Freetown. He is also a trained nurse and the facilitator of today’s training. Wilmot participated in a two-day program facilitated by the “Master Trainers” from the Ministry of Health and supported by the CDC. Following the District training session, and to ensure District Trainers would be able to condense the two-day training course into one day, Concern organized a pilot training in three health facilities “just to identify issues that needed to be improved.” Here the trainers had an opportunity to see how the day would flow, practice the demonstrations and tighten the gaps. The IPC trainings in the Western Area are delivered by 11 teams of two, with each including one health worker selected by the District Health Management Team (DHMT) and one NGO worker from either Concern, GOAL or Save the Children. Wilmot is facilitating today’s training with midwife Edwina Conteh.
“Of course we have been trained in infection and prevention control measures, for example using gloves, but most nurses were not taking that seriously or didn’t actually have gloves” Wilmot explains, referring to his own nursing training. “As a nurse, it is a joy for me to pass on knowledge to my colleagues and share with them what I have learnt so that they can protect themselves.”
The most challenging part of the training, Wilmot says, is removing the Personal Protective Equipment or PPE (protective clothing, masks, goggles, gloves, etc.): “That’s a point when you can be easily infected. When participants are distracted or not paying attention, they may miss important information. People should really pay attention to how to remove the PPE because they can’t afford any mistakes.”
“I am facilitating this training in different health centers so I know I am exposed, but I have the knowledge and I take the protective measures to protect myself. I don’t shake hands, I wash my hands so many times, I use hand sanitiser”, says Wilmot. “I don’t take chances because I know Ebola is a killer disease.”
The training is supervised by Hannah A. Cole, a midwife who has worked in the health sector for almost 30 years. Hannah, who lives with her old father, her three children and six other family members, normally works at a local health centre in central Freetown. About two months ago she was approached by the Directorate of Nursing and asked to become an IPC training supervisor with the District Health Management Team, a role she is enjoying: “It exposes me to different settings” she explains. “Most health workers got information on IPC during their training, but the actual situation is quite different now and most of them have not had any refresher training. Being a supervisor makes me understand better what the issues are and how health workers can get ready so that they don’t get infected.”
“I don’t take chances because I know Ebola is a killer disease.”
One of her responsibilities as an IPC training supervisor is to check and advise on the preparedness of the health facilities to isolate suspected Ebola patients: “We were trained on what to look out for. We need to check if they have what is needed, like water, chlorine, drugs, protective gear… We need to see where the isolation unit should be set up, if there is no isolation unit yet, and what the action points are. Like in this health centre, they are using a room in the new, unfinished hospital building next door. Unfortunately there is no water inside. I also advised them to have separate rooms for putting the protective gear on and off.”
“Most health workers got information on IPC during their training, but the actual situation is quite different now and most of them have not had any refresher training.”
Hannah says she is concerned about the high infection rate, particularly in the Western Area: “This training is very timely. Ebola is here and so many nurses are dying because we have direct contact with the patients. The spread of Ebola, she feels, “is not an issue of poverty but of refusal and denial. People don’t want to accept it. Sensitization shouldn’t just be ‘talking and passing’; you need to spend time with people and see what they are doing. Like what we are doing with this training, we go to the health centers and see what people are actually doing and try to make corrections.”
When asked how her family feels about her involvement in the Ebola response, Hannah laughs: “Whenever I come home from work, my youngest child jokes: Don’t touch mommy, stay there and take off your clothes! We joke about it but of course they do worry and they tell me to be careful.”
The spread of Ebola “is not an issue of poverty but of refusal and denial. People don’t want to accept it.”
Augustine Mustapha Ensah, a Community Health Officer (CHO), is the Ebola Coordinator of the Kingtom Police Hospital, which he joined in May this year. When a patient shows two or more Ebola symptoms, Augustine is called to support the screening process and to determine if the patient needs to be isolated. When a patient is considered a suspected EVD case and taken to the isolation room, he tries to encourage him or her: “I explain I am going to dress up with a mask and goggles and I tell them: Don’t be afraid, I am not saying you have Ebola but we need to do things appropriately to keep us both safe.” So far, two suspected patients have been isolated at the hospital. Augustine looked after them: “Many others are afraid so I did everything,” he smiles, “I was the nurse and the cleaner. But I don’t take chances, I was very careful.”
Augustine was made Ebola Coordinator because of his experience with another infectious disease, Lassa fever. It was Dr. Khan, the renowned Sierra Leonean Lassa fever specialist who died of Ebola in July, who inspired him to become involved in infectious disease control. Dr. Khan had treated over 100 Ebola patients in Sierra Leone when he caught the virus himself.
“He was a friend so I was very sad when I learned of his death. Only God knows what happened. He used to joke a lot, but he was very careful, disciplined and very intelligent.”
Wilmot, Hannah and Augustine each have a passion for helping the sick. They are using their skills, expertise and experience in the fight against Ebola despite concerns of their loved ones and their own worries. “I am worried and I am well aware of the risks,” says Augustine, “but this is my profession. I can’t just abandon my patients.”
