Palliative care community must respond to the “desperate” situation on the front line of the Ebola crisis

Categories: Community Engagement.

‘Initially we shied away from Ebola, but now Ebola has come to us and we have to do something’. Gabriel Madiye, The Shepherd’s Hospice, Freetown, Sierra Leone.

The Shepherd’s Hospice in Sierra Leone is the only dedicated palliative care service in a country of 6 million people. They have a staff team of just 35. To their credit though, their reach and scope goes far as they successfully engage communities and district health teams to join them in delivering palliative care in the community and providing education about health care.

This work in recent months has taken on a new challenge as the latest Ebola crisis grips the country.

The hospice team are still carrying out this work, visiting patients and families living with HIV, cancer and other life-limiting illnesses. But now, they are doing it with the knowledge that Ebola poses a huge threat to not just the health system in which they work and the services to which they refer patients but also to their lives.

Before the latest Ebola crisis struck we faced a situation where in Sierra Leone family members of patients often distrust the professional health services and so prefer to keep their sick at home, treating with traditional remedies.

Now though, even if patients approach a clinic, it may well simply be closed. At the time of writing an estimated 200 health clinics have closed due to the fear of infecting their staff, or seen as spreading Ebola infection in their work.

The structure of health system that existed before the latest Ebola crisis has been bought to its knees.

With this in mind it is possible to see why people are dying of Ebola in the streets, outside clinics that have no available beds, and others are remaining at home where they are infecting their caregivers.

Dead bodies may remain uncollected from homes by burial teams for three or more days.

Current education measures to raise awareness of Ebola and to help change behaviour are yet to have the impact that we all need it to. Families continue to handle dead bodies, care for their sick relatives or patients without the proper use of personal protective equipment and contribute to the spread of Ebola. Often, they have no choice.

Partly as a result of this, the epidemic has continued to double in incidence every 30 days all the time reaching new communities and families. 

Sierra Leone is in desperate need of more treatment and isolation centres, a task that in itself may take weeks. As the situation stands, home-care and community education is the only option we have.

Integrating palliative care skills into this response is essential as it will help to reach out to families with information and education on Ebola teaching them how to protect themselves and their families.

The hospice staff and volunteers are uniquely placed to assist in this response as they are known and trusted in the community. Equally, palliative care teams are used to dealing with and addressing community stigma and fear. They are used also to supporting families and communities through the loss, bereavement and grief process – something which should not be underestimated in relation to latest Ebola outbreak.

The hospice staff can also provide a key inroad into hard to reach communities, and can be a first point of detection, and referral for testing and treatment. They can distribute protection kits and hygiene/sanitation kits. They can also alert the District Health Management Teams (DHMTs) to cases, so that they can take patients to isolation centres.

To do this though they need training, equipment and supplies. Hospice UK, the WHPCA, UK Friends of The Shepherd’s Hospice, and individual supporters are all looking for ways to support the hospice get the training and resources they need to join the Ebola fight, and keep themselves and their communities safe.

We are grateful to the WHPCA for launching an appeal to support us in these efforts.

There is a desperate need for more funding, training and equipment that will enable the teams to reach out to people in 2 districts (Bo and Western Area) with prevention education and information, psychosocial support and early detection/referral. In partnership with the DHMTs their response could reach 350,000 people.

The international palliative care community can and must play their role in tackling the Ebola in crisis in West Africa. The staff and volunteers at The Shepherd’s Hospice are uniquely placed to help play part of this role but to do so need to support of the international community.

The initial target is to fundraise £50,000 – please donate if you can by clicking here.  

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