Comprehensive Care for Ebola Survivors

in Sierra Leone

September 2015

Port Loko EVD Survivor Clinic

Baptist Eye Hospital, Lunsar

Central Aims

• To systematically detect and treat ocular Ebola-sequelae in all Ebola survivors residing in Port Loko (PL) and Kambia districts.

• To systematically detect and treat other medical and psychosocial sequelae of Ebola among survivors residing in PL and Kambia districts.

Timeline

• Clinic started operations in mid-March

• Through July 20th, a total of 643 unique survivors seen in clinic

Month # New Patients

March 103

April 200

May 184

June 144

July 12

Scope and Activities of Clinic

• Find and reach out to all known Ebola survivors residing in the district and provide free transport to come to the clinic• Utilizing PIH’s survivor network and SLAES and for outreach and social mobilization

• Provide eye, general medical and psychosocial care for all EVD survivors• Vitals signs

• Patient interview/history

• Physical exam

• Ocular exam: visual acuity, slit lamp, dilated fundoscopy

• Medication dispensing and teaching

• Psychosocial assessment/support

• Referrals for chronic care or acute care

9%

19%

22%

12%

26%

15%

61%

16%

75%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Headache

Subjective Fever

Difficulty Sleeping

GERD

Ear/Hearing Symptoms

Uveitis

Eye symptoms

Costochondritis

Arthralgias

Prevalence of Symptoms/Diagnoses on First Visit to Clinic

* Uveitis N=648, costochondritis N=197, all others N=277

Accomplishments

• Nearly all survivors in Port Loko and Kambia districts have been seen• Better understanding of prevalence of various Ebola sequelae

• Of 96 patients diagnosed with uveitis, 51 had improvement with treatment (treatment for some still ongoing)

• Survivors are very active in implementing the entire program –outreach, in-clinic support, follow-up

• Opportunities to engage survivors into existing healthcare system for antenatal care, TB testing, etc.

Challenges & Unknowns

• Social outreach• Absence of complete registry of all survivors in the district• Survivors and their families have fears about engaging with health care facilities• Difficult to reach communities-- no phone, poor roads, requires boat ride, etc.

• Many survivors died in community not long after discharge– unclear cause

• Trying to “catch-up”• Many patients discharged in the fall are getting care months after discharge• Some interventions are time-sensitive such as for eyes and ears

• Lack of curative treatment for joint pain• Often, NSAIDs and steroids only relieve pain temporarily. No long term ability to

manage pain. Consider physical therapy?

Challenges & Unknowns (cont.)

• Specialty care/diagnostics• Difficult to get accurate assessment for neurological symptoms• Ear Symptoms- no ENT; brief window (7-10 days after symptom onset) for

intervention

• Currently, scope of “free care” often very limited in practice

• Eye complications needing surgical intervention• IPC issue: Presently no way to intervene for survivors who have developed cataracts,

often as a result of inflammatory disease process related to Ebola

• Psychosocial Concerns• Source of livelihood and finding employment is prominent concern among survivors

• Affects housing, education, nutrition and more

• Major losses in familial support

Social Protection Program

Improving Access to Care and Social Support for EVD Survivors

• Coordinate community outreach and link Ebola affected individuals and their households with partner organizations, health facilities, and government services to complement the efforts of the Ministry of Social Welfare, Gender, and Children’s Affairs.

• Strengthen the socioeconomic mobility of program participants, esp. via access to education

• Strengthen the Sierra Leone Association of Ebola Survivors [SLAES] as a sustainable community-owned platform for self-efficacy, social support and advocacy among survivors

Organizing and Employment

• At its inception in October 2014, the SP program utilized grassroots community networking by empowering EVD Survivors to recruit fellow survivors while organizing their own associations at the chiefdom level with weekly meetings.

• These weekly chiefdom level meetings provided a platform of opportunities, services, and access to care to be strengthened.

• Upon enrollment into the SP program, survivors receive financial assistance, new/replacement government ID cards, and local bank accounts to support reintegrating into their communities; along with replacing destroyed household items, and obtaining personal documents lost during the decontamination of their households.

• At the programs onset, qualified program participants of working age were offered employment opportunities as social mobilizers, case managers, and OICC

• Engaging survivors in the Ebola response provided employment while significantly reducing stigma for survivors in their communities and adding value to Ebola messaging.

Reintegration Efforts To Date

• Back-to-School Packages – 300

• Discharge Packages – 449

• Employment – 835

• Clinical Care – 946

• ID Cards – 517

• Bank Accounts – 490

• Adult Literacy – 450

• Vocational Support – 250

• Educational Accompaniment – 340

Building Back Better

0

200

400

600

800

1000

1200

1400

Partners In Health Survivor Program Activity Breakdown

Hired Coordinated Employment Providing Support

Month Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16

Hired 15 52 225 586 637 688 209 165 118 86 91 106 106 91 91 76 76 76 76Coordinated Employment 0 58 95 121 147 0 0 0 0 0 0 0 0 0 0 25 50 100 200Providing Support 0 0 0 0 537 612 271 191 444 124 167 1040 1210 1210 1000 1000 750 750 750

National Eye Screening and Uveitis Treatment for Ebola Survivors

Program objective:

To urgently detect and treat uveitis in Ebola survivors, in order to prevent long-term permanent vision loss.

This program builds on the pilot work achieved at Baptist Lunsar Eye Hospital, where 600+ survivors have been screened and over 100 survivors have been treated for uveitis, led by MOHS, DHMT, BEHL, Partners In Health, GOAL, and IMC.

Program Approach:

1) Establish partnerships2) Support existing eye care facilities3) Establish new strategic points of care throughout SL4) Collaborate with DHMT’s and Ebola survivor networks5) Partners to provide operational support6) Refer survivors into pathways for non-eye care support7) Transition the program into the long-term strengthening

of the MOHS National Eye Care Program

Supplies:Medication and equipment for identified facilities has been provided to the MOHS through Partners In Health and a grant from the Paul G. Allen Family Foundation.

Clinical Staff:Clinical staff to be provided through MOHS National Eye Health Programme and private facility staff.

Additional auxiliary staff to be provided by partners.

Clinical Training:MOHS, in coordination with Sightsavers and other partners, including Emory University, will provide ongoing training for staff.

Harmonized Data & Database:Partners will provide Data Clerks to collect data at the point of care. Data will be collected using the MOHS harmonized form, which will be inputted into a spreadsheet, which will later feed into the harmonized database when it goes live.

Survivor Health Advocates (SHA’s):

SHA’s are the link between survivors and eye care facilities

The SHA’s will ideally be survivors themselves

They will be chosen following a 3-day training/exam period

The SHA’s are responsible for identifying, organizing, and accompanying survivors to eye-care facilities for screening

Once diagnosed, the SHA will support the patient through their course of treatment by weekly home visits to ensure adherence to treatment, monitor for side-effects, and provide a link to other support

District Facility Partner(s) Status

Bo Bo Govt. Hosp. GOAL TBD

Kenema Kenema Govt. Hosp. GOAL TBD

Kono Kono Govt. Hosp. PIH Referring

Tonkolili TBD MSF - Holland Referring

Port Loko Baptist Eye Hospital Lunsar GOAL/PIH/IMC Ongoing

Kambia Baptist Eye Hospital Lunsar GOAL/PIH/IMC Ongoing

Koinadugu TBD Medicos de Mundo? TBD

Bombali Makeni Govt. Hosp. GOAL TBD

Moyamba TBD Medicos de Mundo? TBDW. Urban & Rural UMC Kissy & Connaught GOAL/PIH

PIH – OngoingGOAL – TBD

Referral pathways:

Help connect and refer survivors to venues for comprehensive care as they are established.

Long term strengthening:

When uveitis screening and eye treatment is complete for survivors, transition capacity to supporting the broader National Eye Health Program.

Dr. Kerry DierbergExecutive Director, Partners In Health Sierra LeoneKdierberg@pih.org

Katie BollbachDirector of Policy and Partnerships, Partners In Health Sierra LeoneKbollbach@pih.org

Gabriel WarrenSurvivor Program Manager, Partners In Health Sierra LeoneGwarren@pih.org