Docs in the dark on Ebola
Kanchana Bandara-Coore, Guest Columnist
Twenty years ago as a medical student, what I learned about Ebola was limited to about two paragraphs in a chapter of a pretty big book - basically that it was a deadly virus which affected people in remote parts of what is now the Democratic Republic of Congo.
Today, I am a general practitioner working on Shortwood Road and seeing patients from Barbican, Constant Spring, Grants Pen and the surrounding areas. Ebola is now almost at my doorstep with the two cases in the United States (US).
I am not prepared to wait until we actually have a case in Jamaica to learn what the protocol is for dealing with a suspected case. I have checked both the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) websites, and found a wealth of useful general information there. Both sites, however, recommend that health-care workers get the specifics on how to manage a suspected case from the local Ministry of Health. Our Jamaican Ministry of Health (MOH) website has no readily available specific guidelines for GPs like myself with regard to a suspected case of Ebola. This is what I want to know:
1. What am I to do with a patient who has a fever, sore throat and a history of travel to the US/Spain/West Africa, when he or she comes to me?
2. Which specific hospitals have isolation units ready to receive such a patient?
3. What advice do I give the patient in terms of how he or she is to be transported to the isolation centre? Is there going to be a special service of vans/ambulances dedicated to transporting suspected cases?
4. What do I tell any patients who were in my waiting room at the time this patient came to see me? Bearing in mind that the person is infectious once they are symptomatic, and that direct contact with body fluids (which includes sweat) is needed to spread the virus.
5. What are the instructions for the relative/friend who accompanied the patient?
6. What specific measures in our Jamaican setting do I now need to start making routine for patients coming to my office, e.g., hand washing on entry to the waiting room, masks for coughing patients?
7. Do we instruct patients with a fever, sore throat and history of travel to call and speak with the doctor first before leaving home?
I think these are reasonable initial questions that our MOH needs to provide answers to as soon as possible before we actually have to deal with a case of Ebola. I imagine doctors working in our overcrowded public health centres may have a different set of questions relevant to their work environment.
learning from thechikungunya outbreak
For those of us in private practice, it is not enough to hear from the MOH that they are stepping up measures to prepare for Ebola. The lesson learned from the still-ongoing chikungunya outbreak is that without open communication (with health-care workers as well as the general public), we all will be at the mercy of the disease, and vainly trying to lock the stable after the horse has escaped.
We cannot afford to make that mistake with the more deadly yet potentially controllable Ebola viral disease. Accurate information and clear communication, aimed at ensuring that every individual in Jamaica, not just the health-care workers, fully understands their role in preventing the spread of this deadly disease is as important as ensuring that we have adequate protective gear and isolation units, and the medical equipment to provide supportive care.
That communication needs to start long before we see our first case of Ebola in Jamaica. Even as we hope and pray that Ebola does not reach Jamaica's shores, please let us thoroughly and meticulously prepare for the worst.