Supporting the response and rebuilding affected health systems
At LSTM, research, teaching and in-country activity are inter-related providing a collective strength that makes LSTM staff leading experts in their respective fields. It is this expertise that governments and international agencies call upon to help respond to humanitarian emergencies and rebuild decimated health systems.
In March 2014, in the early stages of the Ebola outbreak in West Africa, LSTM Honorary Lecturer and Research Training Fellow, Dr Tom Fletcher, was seconded to WHO, due to the urgent requirement for infectious disease specialists. Before long he was sent to Conakry in Guinea, where he was involved in setting up isolation facilities and managing cases with the Ministry of Health and Médecins Sans Frontiers (MSF). Within weeks teams of clinicians were able to significantly reduce fatalities rates, from 70-90% to 40-50%. Returning to Geneva, Dr Fletcher coordinated the wider WHO clinical response and by June 2014 he was landing in Sierra Leone, where he quickly recommended that his former supervisor at LSTM, Senior Lecturer Dr Tim O’Dempsey lead the WHO clinical response at the government’s main Ebola treatment centre in Kenema, eastern Sierra Leone.
Upon arrival, Dr O’Dempsey was immediately confronted with high caseloads and limited resources that restricted the ability to deliver the required level of care. Medical and nursing staff numbers had been significantly reduced due to Ebola related deaths and fear of infection. Patients suffering from other illnesses were avoiding the hospital and community-level health services were completely over-stretched.
Given the global reach of LSTM teaching programmes, it was no surprise that while at Kenema, Dr O’Dempsey encountered two of his former students from LSTM’s Diploma in Tropical Medicine & Hygiene: Dr Takuya Adachi and Dr Catherine Houlihan. He also visited the MSF Ebola treatment centre in Kailahun where he met Anya Wolz, a 2013 graduate of LSTM’s Diploma in Humanitarian Assistance, who was coordinating the MSF response to the outbreak.
As the outbreak reached its peak, NHS doctors and nurses were volunteering to help with the UK’s response. LSTM’s travel health subsidiary, Well Travelled Clinics (WTC), coordinated the health screenings for 236 NHS staff who were seconded to Ebola treatment centres in Sierra Leone, via the DFID funded organisation UK-Med. WTC set-up a temporary clinic at the Army Medical Service Training Centre in Strensall, England, to conduct health screenings and ensure the rapid deployment of the volunteer medics. WTC staff also conducted the health screenings for many of those volunteers returning to the UK following their secondment.
During the April 2015 update of the Best Practice Series on Ebola virus infection, the BMJ invited LSTM senior clinical lecturer Dr Nick Beeching to be a co-author of the online platform providing an interactive reference for clinicians interested in all aspects of the presentation, diagnosis and management of people with Ebola virus disease.
More LSTM clinicians and technicians volunteered to support the UK response, including Senior Lecturer Dr Derek Sloan, who travelled to Sierra Leone, where he became UK-Med’s Clinical Lead for the Quality Monitoring Team, providing oversight to Ebola treatment centres, including those in Kerrytown, Makeni, Port Loko and Moyamba. Sophie Dunkley, from LSTM’s Vector Biology Department, volunteered to undertake a placement with MSF to work as an Epidemiologist, based at an Ebola Management Centre in Guinea’s capital Conakry.
The impact of Ebola on fragile health systems goes beyond a direct effect on morbidity and mortality, it has also affected the overall level of access to healthcare. In a widely cited commentary LSTM’s Senior Professorial Fellow David Molyneux pointed to the lessons Neglected Tropical Diseases (NTD) programmes could provide in dealing with the Ebola outbreak. With NTDs being markers, agents and drivers of poverty of over a billion of the poorest, their control and elimination approach are very dependent on community health workers to reach those most in need.
During the Ebola outbreak the number of women dying in childbirth in Sierra Leone increased to one in every seven. These complications were largely due to the lack of resources and maternity services available. LSTM’s Centre for Maternal and Newborn Health (CMNH) has been working in Sierra Leone with the Ministry of Health and Sanitation (MoHS) to improve maternal and newborn health services through different training programmes including the Making it Happen (MiH) programme.
CMNH, in consultation with MoHS, reluctantly took the decision to suspend these training programmes in August 2014, though the team continued to work with MoHS to combat the epidemic and supply infection control supplies to the main maternity hospital. By March 2015 the situation had improved to the extent that CMNH was able to resume its work with the MoHS to rebuild the maternity services and measure how much Ebola has affected maternity services and medical staff across Sierra Leone.
The ongoing Ebola outbreak is unprecedented, both in size and complexity and requires a sustained regional and international response. It needs to ensure that health services become strong enough to meet the needs of vulnerable populations. Health systems development can only become effective if recommended evidence-based approaches are adopted by governments and organisations responsible for delivering pro-poor health and development goals.
The ReBUILD Consortium, led by LSTM, is working with countries affected by humanitarian emergencies, including Sierra Leone, to strengthen policy and practice related to health financing and staffing. While another LSTM led research consortium, REACHOUT, has been contributing to the UK All Party Parliamentary Group on Africa, guidance to those grappling with health systems strengthening in Ebola-affected countries.
More than ever, community-based healthcare provision has the greatest potential to improve health system functioning and health outcomes in Ebola-affected countries and beyond.