Opinion

CDC workers and the fight against Ebola in West Africa
Tom Frieden, M.D., just returned from West Africa. These photos highlight the work done by the International Infection Control Team. 

Supervisor Training

Guinea’s frontline health care workers are receiving practical training in identifying, isolating, and caring for suspect Ebola patients and protecting themselves while doing so. Here a trainer is going over the proper use of personal protective equipment (PPE) while two students model full PPE. CDC is providing technical assistance for the training sponsor, Catholic Relief Services, which has received funding from USAID to support national infection prevention and control efforts. The students include doctors, nurses, pharmacists, lab technicians, students in training, and cleaners. Up until now, most training has been for healthcare workers in Ebola Treatment Units, or ETUs. “For health care workers in ETUs, every patient is a confirmed or suspect case. But the health care workers we’re training are working with everyone from the community, so they must determine for each patient whether they pose a risk and how they will respond,” says CDC’s Lindsey Horton.
(Lindsey Horton)

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“The first day of our training we had 80 students registered, but close to 250 people showed up eager to learn. That first crowd included 10 doctors and nurses who drove 40 kilometers from the nearby prefecture of Lola hoping to get a spot. It was exciting to see this much enthusiasm, and we quickly registered the additional healthcare workers for upcoming classes,” said Lindsey. Each class can accommodate 80 students who are preregistered, selecting a few from each hospital or clinic so as to avoid emptying a health facility for the duration of the two-day training.
(Lindsey Horton )

Doctors

Local trainer Bienvenu Houndjo (far left) works with a student on properly removing the last parts of their personal protective equipment. Heidi notes that being there representing CDC and providing technical assistance allows the participants to ask questions and have confidence in the answers they receive. “As they hear we’re from CDC and we’re scientists, they feel we’re good people to ask about whether something they’ve heard in the community is true.”
(Heidi Soeters )

Classroom

The training is both classroom, as shown here, and hands-on and ranges from Ebola 101 to how to decontaminate and clean up body fluids. The trainers are mostly recently graduated medical doctors who are hired by Catholic Relief Services with funding from USAID and trained by infection control specialists from CDC, WHO, and the Guinea Ministry of Health. “There’s a pre-test and a post-test and we’re seeing great improvements in knowledge. The students are so excited, they can’t wait to tell us and show us how much they’ve learned,” says CDC EIS Officer Heidi Soeters.
(Lindsey Horton )

Supervisor Training

Here Lindsey Horton demonstrates how to clean up infected body fluids using simulated vomit. She’s not wearing personal protective equipment in order to save the limited supplies of PPE for the students. The two students are wearing the correct equipment for cleaning. Recommendations for personal protective equipment in West Africa differ somewhat from those for health care workers in the United States.
(Ellen Dotson )

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CDC team members rotate in for one- to two-month assignments. Here is CDC team lead Ellen Dotson demonstrating how to put on a piece of personal protective equipment. Ellen and the others working in Guinea are all volunteers, putting their public health and French language skills to work. “This class is critical because these healthcare workers are truly on the front lines. It’s so exciting to see this training happening. CDC and our partners have been working for three months to get us to this point,” she says.
(Heidi Soeters )

Night classes

The training doesn’t stop when the sun goes down. The students are so anxious to practice what they’ve learned that they stay late into the evening using flashlights and the lights from their cell phones. “The training runs from 8 to 5 and we thought the students would be anxious to leave. Instead, they stay until they have all their questions answered and their time to practice,” says Heidi.
(Heidi Soeters )

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Here, a master trainer, Professor Lamine Koivogui from the Institute National de Santé Publique, reinforces the principles of proper use of personal protective equipment and proper hand washing for those who will serve as infection control supervisors. Recommendations for personal protective equipment in West Africa differ somewhat from those for health care workers in the United States. These infection control supervisors will either work in a hospital or rotate between a number of smaller clinics to support infection control improvements. Their job includes overseeing patient triage, use of isolation zones, and use and availability of personal protective equipment.
(Lindsey Horton )

Macenta - Burial Team

Training is provided not just for those who work in health care settings. In Macenta, a special session was held for Red Cross volunteers who work on burial teams, removing bodies from homes and safely and respectfully burying them. Their personal protective equipment is different from that of health care workers since the Ebola virus is at its most dangerous on the bodies of the deceased. Here, Guinean Professor Lamine Koivogui, is doing their hands-on training.
(Lindsey Horton )

Field Work

Infection control supervisor Simone Loua (left) reinforces proper hand washing techniques during a field supervision visit to a small clinic in N'Zérékoré. Lindsey says, “It’s been very rewarding to hear how much health care workers appreciate the training, and then to see them using their new skills once they return to their clinics.”
(Lindsey Horton )

Macenta

One of the challenges of training in Guinea is the mix of languages used across the country. This class of midwives and cleaners from Macenta received their training in the language of the Malinke people since they do not speak French, the official language of Guinea.
(Lindsey Horton )

Heidi Soeters washing hands

Hand washing stations filled with a diluted solution of chlorine are widely prevalent, especially at the entrance to health facilities. Heidi washes her hands at the Regional Hospital of N’Zérékoré, as she gets ready to perform a facility assessment.
(Lindsey Horton )

Field Work

One of the prefectures most heavily affected by Ebola cases is N’Zérékoré. Until recently, suspect and probable Ebola cases had to be transported long distances to Macenta or Guéckédou for laboratory testing and treatment. The CDC team was able to visit the site of a new Ebola treatment unit (ETU) being constructed in N'Zérékoré, designed to provide care for 40 patients at a time. The ETU began accepting patients on December 1.
(Heidi Soeters )

Work Tent

In this photograph from inside one of the newly constructed Ebola treatment unit (ETU) tents, it’s possible to see that the space for this unit has been cleared from what was once tropical jungle. Though the ETU is meant to be a temporary structure, the CDC team hopes that their trainings leave behind a permanent improvement in infection control knowledge and practice that will continue to protect Guinea’s healthcare workers against all types of infections for years to come.
(Heidi Soeters )

CDC workers and the fight against Ebola in West Africa

Tom Frieden, M.D., just returned from West Africa. These photos highlight the work done by the International Infection Control Team. 

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