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Ebola epidemic in Africa: Cuban medical experience in this international health emergency (VI)
Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (VI)
Rafael Rufino Corona Pérez
Villa Clara University of Medical Sciences. Cuba.
ABSTRACT
After the preparation of the Cuban professionals with the evaluation of the World Health Organization that authorized the work in the hospitals for the treatment of Ebola and with the termination of the English hospital of Kerry Town, the brigade began to fight the epidemic on the 5th of November 2014; progressively more compatriots were added as other hospitals were completed. At the end of December, the entire brigade was working together with the native staff, without any other foreign participation. The cooperation among the World Health Organization, the Ministry of Health of Sierra Leone, the decisive support of the Cuban embassy, the Ebola confrontation center of the Ministry of Public Health of Cuba and the organization of its communist Party is presented for the benefit of efficient comprehensive attention that would allow the successful fulfillment of the mission proposed by humanity in times of contingency.
MeSH: hemorrhagic fever, ebola, disaster sanitation, disaster emergencias, international assistance in disaster, education, medical.
RESUMEN
Concluida la preparación de los profesionales cubanos con la evaluación de la Organización Mundial de la Salud que autorizaba el trabajo en los hospitales para el tratamiento del ébola y con la terminación del hospital inglés de Kerry Town, comenzó la brigada a combatir la epidemia el 5 de noviembre 2014; progresivamente se fueron sumando compatriotas a medida que se terminaban otros hospitales. Finalizado diciembre toda la brigada se encontraba laborando junto al personal nativo, sin otra participación extranjera. Se expone la cooperación entre la Organización Mundial de la Salud, el Ministerio de Salud de Sierra Leona, el decisivo apoyo de la embajada cubana, del centro de dirección para el enfrentamiento al ébola del Ministerio de Salud Pública de Cuba y la organización de su Partido Comunista en beneficio de una eficiente atención integral que permitiera el exitoso cumplimiento de la misión planteada por la humanidad en tiempos de contingencia.
DeSC: enfermedad por el virus de ébola, saneamiento en desastres, emergencias en desastres, asistencia internacional en desastres, educación médica.
Editorial Note
The participation of Cuban health professionals in the global campaign against ebola was an unprecedented event in the history of humanity, in the history of Cuba, and in particular in the history of Cuban medicine that demands to be studied, researched and divulged. Their contributions and experiences should be introduced in undergraduate and postgraduate study programs not only because of the historical aspects, but also because of their impact in the medical sciences and because it is a serious health problem that is far from being solved, so outbreaks of the deadly disease are possible, since the conditions that originated it remain intact. From volumen 9, No. 2 on, EDUMECENTRO journal has published a group of articles under the title: Epidemic of Ebola in Africa: Cuban medical experience in this international health emergency, authored by Dr. Rafael Rufino Corona Perez, member of the "Henry Reeve" International Specialized Contingent in Disaster Situations and Severe Epidemics and professor of Villa Clara University of Medical Sciences, who writes his experiences as vivid testimony of what happened in those months, where the intellect, perseverance, courage and struggle for life prevailed facing the health disaster and were proclaimed victorious. In these research paper has been respected the writing in first person by the psychological implication of the facts that are narrated in the personality of the mentioned doctor.
Nota editorial
La participación de los profesionales cubanos de la salud en la campaña mundial contra el ébola representó un hecho sin precedentes en la historia de la humanidad, en la historia de Cuba y, en particular, en la historia de la medicina cubana que demanda ser investigada y divulgada. Sus aportes y experiencias deben ser introducidos en los programas de estudio de pregrado y posgrado no solo por los aspectos históricos, sino por su impacto en las ciencias médicas y por ser un grave problema de salud que dista mucho de estar resuelto. Las condiciones que originaron la enfermedad permanecen intactas. A partir del volumen 9, No. 2 de 2017, la revista EDUMECENTRO publica un grupo de artículos bajo el título: Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional, cuyo autor principal es el Dr. Rafael Rufino Corona Pérez, integrante del Contingente Internacional Especializado en Situaciones de Desastres y Graves Epidemias "Henry Reeve" y profesor de la Universidad de Ciencias Médicas de Villa Clara, quien redacta sus experiencias como testimonios vívidos de lo acontecido en esos meses, donde el intelecto, la perseverancia, la valentía y la lucha por la vida se impusieron ante el desastre sanitario y se proclamaron victoriosos. En estas comunicaciones se ha respetado la redacción en primera persona por la implicación psicológica de los hechos que se narran en la personalidad del mencionado doctor.
The "Henry Reeve" Brigade in Sierra Leone faces the epidemic in the red zones
One month after the arrival of the brigade to Sierra Leone, the cooperators located in the Compañero Hotel had already fulfilled the requirements demanded by the World Health Organization (WHO)1 and were satisfactorily evaluated to begin working in the hospitals where they were fighting Ebola. After the construction and provisioning of the English army hospital in Kerry Town, it was inaugurated on November 4, 2014, with the presence of Dr. Ernest Bai Koroma, president of Sierra Leone, representatives of the United Nations Organization, WHO, "Save the Children", English diplomats and military men, the Cuban ambassador and the leaders of the "Henry Reeve" Brigade, as shown in figures 1 and 2.
In the Compañero Hotel resided the staff that started working on November 5th. The Ebola sufferers came from the collection centers in the capital and several hospitals. Due to the attention and quality of the services, the prestige of Cuban health professionals grew, and especially due to the success of Dr. Felix Báez's cure. As a result, the distrust of the population generated by poor hospital care in the African country began to disappear.
The preparation of the brigade members prioritized the handling of the personal protection equipment that included the suit of a piece, facial mask, glasses, boots and gloves.2 The safety rules and the conduct to be followed in the reception and classification areas and in the patient care ward known as the red zone, were the basis of the preparation; the steps for entering and leaving it were exercised, the requirements for final disinfection and the way of removing the individual protection equipment. Communication with local staff required training due to poor command of the English language.
The medical care personnel during November and December was exclusively Cuban and the senior doctor of the hospital was Dr. Ramiro Guedes, an internist of the Revolutionary Armed Forces (FAR) who was also at the head of the Compañero Hotel.
In the Mariam hotel was the head of the brigade and the group designated for the pediatric hospital "Ola Düring" located in the city center, which was transformed into a (Holding Center) to classify and provide emergency care for children that later they were sent to the national hospital or to Kerry Town.
The Ebola Treatment Center (CTE) of Waterloo / Addra, with 66 beds, began its work on December 20, 2014; there children and adults received medical care, and their medical collaborators resided in the Fat Lee hotel and in the Yamasokro, in this last one also a part of the workers of Kerry Town lodged. In Port Loko there were 43 employees in the Comfort Guest House hotel who worked with the US organization "Partners in Health" in the 106-bed CTE Maforqui New, which opened on December 15, 2014. In figure 3 You can see Cubans and Americans together in the humanitarian mission entrusted.
Near the Mariam, Compañero and Maforqui New hotels, special isolation rooms were set up for feverish Ebola suspects, not Fat Lee and Yamasokro, near the Compañero Hotel. Figure 4 shows one of them.
On May 3, 2015, the Granma newspaper published, on its front page, a story that can be read in figure 5, a reason for immense joy for the entire brigade:
The distribution in distant centers made it difficult to attend to the collaborators, so the board of directors of the brigade took advantage of all the opportunities for joint or duo visits, in which exploration was always present, control of material resources, supply of medicines and medical aids and partisan-political work based on permanent communication with the militancy, with the bosses and with the collaborators. A monthly economic accountability was established whose responsible was the specialist of each area.
Assured the units with the means of work, communications, transport, the transfer to hospitals and the periodic control of the stock and the state of the equipment, the main mission of the leading group was to take care of the health of the collaborators and the supply of medical resources.
Health care reports were notified daily from permanent locations and bosses were held responsible. A clinician and an epidemiologist were appointed in each place. The main functions of the epidemiologist were: the daily screening of febrile and any appreciable pathology, the control of food quality, the supply of sufficient and quality water, the obligatory washing of the hands, demanding the daily cleaning and disinfection of the rooms, the control of the personnel of the hotels through their owners, the daily report of diseases including the Ebola report, the environmental control and the process of work in the hospitals; On the other hand, the clinicians attended to every collaborator suspected of illness and reported daily name, age, profession, criteria on the patient's condition and treatment regimen or need of cooperation with other institutions for medical care. They assumed the delivery and medicine control in the area and the weekly information on consumption, stocks and needs according to the diagnoses made and the treatments imposed.
The urgent attention was coordinated with the clinic of the United Nations Organization and with the Italian NGO "Emergency". Its effectiveness was proven very soon because on a Saturday morning the collaborator Emmanuel Vigil, lodged in the "Sea Side", hotel moved to the Italian hospital where he was operated urgently for acute appendicitis; The surgical act and its evolution were successful. The doctors who assumed the surgery were Dr. Illionis and Dr. Segura, surgeon and anesthetist of the brigade.
The specialties consultations were carried out in the national hospital of the Minsa (Conaught) coordinated by Patrick Don Davies, a dentist graduated in Cuba, who also cared for all our dentistry needs, and by the physiotherapist Ismael, also graduated in Cuba. The cases of Dermatology were attended by the head of the permanent brigade; those of ENT, Psychiatry and Psychology were attended by specialists of the Cuban medical brigade.
With the Cuban Ministry of Public Health leading group for Ebola there was a permanent communication about the health status of the collaborators; and the consumption, stocks and needs of medicines were managed monthly until all the demand was met, since the satisfaction of needs was optimal. Only lonard-DS (arthemeter-pyrimethamine) was purchased, very effective in the treatment of malaria which is non-existent in Cuba. Its distribution was made weekly or by emergency and responded to the particular needs of each residence where they had the necessary resources according to their clinical picture.
Malaria decreased by prophylaxis with doxycycline, sometimes replaced by fansidar or mefloquine when diarrhea caused by dysbacteriosis due to prolonged effect of doxycycline. Occasionally there were feverish cases with respiratory or digestive symptoms which were not responsive to usual treatments and had an atypical behavior that responded quickly by treating them with lonard-DS, so we value these symptoms as forms of presentation of malaria.
Throughout the campaign, the conviction of commitment to the Cuban people was a constant sentiment, as we were inspired by its historical and daily heroism. We could not do more than comply with the mandate of the Homeland guided by the historical direction of the Revolution and the Communist Party of Cuba.
Declaration of interests
The author declares no conflict of interest.
BIBLIOGRAPHIC REFERENCES
1. OMS. Enfermedad por el virus del ábola: preparación y respuesta para la introducción en las Américas. [Internet]. 2014 [citado 14 Abr 2018; actualizado 5 Sep 2014]. Disponible en: http://www.who.int/csr/disease/ebola/preparacion-respuesta-ebola-americas.pdf
2. OMS. Enfermedad por el virus del Ebola: Seguridad y Salud en el Trabajo - Nota informativa conjunta OMS/OIT dirigida a los trabajadores y a los empleadores. [Internet] 2014 [citado 14 Abr 2018; actualizado 9 Oct 2014]. Disponible en: http://www.who.int/occupational_health/publications/ebola_osh/es/
Submitted: May 3 2018.
Accepted:
May 4 2018.
Rafael Rufino Corona Pérez. Villa
Clara University of Medical Sciences. Cuba. E- mail: rafaelcorona@infomed.sld.cu
Copyright (c) 2018 EDUMECENTRO
