Latest / Culture Positive: An Infection Prevention Podcast / Ebola, Funerals and Public Health
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each week, We'll dive into healthcare stories, public health conversations, workplace realities, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. An incredibly important part of public health is understanding different cultures and traditions. You cannot help people if you don't understand where they come from, what is important to them, and how to show respect along the way. When public health experts enter a situation without understanding the traditions and beliefs of the people they are trying to help, or worse, choose not to understand them. It can lead to conflict, mistrust, and resistance. Ultimately, it can undermine the very thing public health is trying to accomplish: protecting people. This idea is at top of mind because of what is happening right now in the Democratic Republic of the Congo, the DRC. In communities across the DRC and elsewhere in Central and West Africa. Funeral practices can center around communal mourning. Of course, these practices vary significantly by community, religion, and region, but gatherings can last for days, with family members and loved ones coming together to share meals, spend time together, and mourn the person who has passed. Relatives may also wash and dress the body as a sign of respect. In many communities, families may want to transport the body back to the deceased person's ancestral home so the individual can be laid to rest. These practices aren't simply customs that can be pushed aside. For many, they are deeply connected to spiritual beliefs, and certain steps must be followed so that the deceased can rest in peace. And this is where public health faces an incredibly difficult challenge during an Ebola outbreak. Ebola can spread through direct contact with the blood or bodily fluids of someone who is infected, including during traditional burial practices involving the body of someone who has died from the disease. With Ebola being so infectious, It is imperative that healthcare workers are provided with proper education on personal protective equipment and how to safely treat patients so they themselves don't get Ebola. There is so much at play in the current Ebola outbreak in the DRC. Public health, politics, healthcare system, community trust, and cultural traditions. This current outbreak is averaging a death every 30 minutes and is on track to be the deadliest Ebola epidemic to date. In order to understand how we got here, we need to start at the beginning. Let's get into it. So when did Ebola first hit the scene? Ebola disease first occurred in nineteen seventy six in two outbreaks that occurred around the same time. One outbreak was of Sudan virus disease in Nazara in what is now South Sudan, and the other outbreak was of Ebola virus disease in Yambuka in what is now the Democratic Republic of the Congo. Fun fact. The outbreak that occurred in the DRC occurred in a village next to the Ebola River. That is how this infectious disease got its name. The average Ebola disease case fatality rate is around 50%. Case fatality rates have varied from 25 to 90% in past outbreaks. Along with having such a high case fatality rate, The likelihood of someone dying when they are infected. The symptoms that Ebola patients suffer are brutal. The incubation period or time from infection to onset of symptoms varies from two to twenty one days. The symptoms of Ebola disease can be sudden and include fever, fatigue, malaise, muscle pain, headache, and sore throat. These are followed by vomiting, Diarrhea, abdominal pain, rash, and symptoms of impaired kidney and liver functions. Some people will go on to develop bruising, bloody diarrhea, or bleeding from the mouth, nose, or eyes. It can also ultimately lead to multiorgan failure and death. What does transmission of the virus look like? Humans can get Ebola if they've had close contact with blood, secretions, organs, or other bodily fluids of an infected animal, such as fruit bats or chimpanzees that have been found to be ill or even dead. People can also get infected with Ebola. Through close contacts of blood or bodily fluids of someone who is sick with Ebola, Or has died from Ebola, along with contaminated surfaces and objects. Notice how I said the virus can be transmitted even from an individual who has passed away. With Ebola, people remain infectious as long as their blood contains the virus. This is a very infectious agent that requires healthcare workers to follow strict protocols and appropriate personal protective equipment. Training of healthcare workers in proper protective equipment, PPE, is crucial when working with Ebola. In my first job as an infection preventionist, I actually helped train frontline workers into how to properly don and doff PPE if they were to encounter a patient who is suspected to have Ebola. I would encourage all healthcare workers to take part in an Ebola preparedness training. Before you even begin the process of putting on PPE, there is a designated observer, someone who is trained in the protocol of correctly putting on PPE, who monitors every step of the individual who is putting on their protective equipment or taking it off. The observer will actually verbalize each step of putting on and taking off PPE to ensure everything is done correctly. No exposed clothing, skin, or hair of the healthcare worker should be visible at the end of the completion of putting on all proper PPE. First, the healthcare worker would change into surgical scrubs and washable footwear in a designated clean area. No personal item should be brought into the patient room. Before PPE is even put on, you must visually inspect the PPE, ensure there are no tears, holes, or issues. The trained observer should review the donning sequence with the healthcare worker before donning begins, and they will read out loud every step of what is expected when donning the PPE. You would put on your first pair of gloves. Put on the gown. Ensure cuffs of the inner gloves are tucked under the sleeve of the gown. Put on an N95 mask and complete a seal check. Over the N95, place a surgical hood that covers all the hair and the ears. Extends past the neck to the shoulders. Ensuring the hood completely covers the ears and the neck. Put on a second pair of gloves. To make sure the gloves go over the gown. The final PPE to don is a face shield. Put on the face shield over the N95 mask and surgical hood to protect the eyes and the face. After completing the donning process, the trained observer verifies the integrity of the protective equipment. The process of donning PPE for Ebola typically takes around 10 minutes. CDC actually provides several checklists that I utilized in my own training. I'll make sure to include that in the show notes. I do hope that this brief overview of donning PPE gives a glimpse into how extensive the process is to care for patients who are a suspected case of Ebola or a confirmed case. Imagine how hot, sweaty, and exhausting this process is. And what I've shared with you is just putting on the PPE, not even taking it off. This might give some insight into the burnout that can occur for taking care of patients in an outbreak situation. And when an outbreak has thousands of cases, I can't even imagine, but that is the reality for those working the current outbreak in the Democratic Republic of the Congo, DRC. Before we go any further, there's an important distinction I want to make. When I say Ebola throughout this episode going forward, the current outbreak in DRC is specifically caused. by the Bundibugyo a species within the Ebola virus genus. The Bone Tibuyou virus currently has no vaccine, which makes this outbreak particularly devastating. The current outbreak in the DRC is in a phase of intense transmission. It is the largest Ebola outbreak ever reported in the country and expanding faster than any previous Ebola outbreak. We continue to see sustained transmission, meaning new cases continue to be reported, and we are not seeing a significant decrease in cases. As of August nineteenth, twenty twenty-six, there are five thousand two hundred and ninety confirmed cases and two thousand five hundred and sixteen confirmed deaths. This is the DRC's most fatal outbreak of Ebola. The largest outbreak of Ebola ever recorded was a different strain, and it was from twenty fourteen to twenty sixteen. It killed eleven thousand three hundred and twenty five individuals over two years. The scale and speed of the current outbreak is unprecedented. This outbreak is moving at a faster pace than any other outbreak. Infections among healthcare workers continue, with at least 155 confirmed cases, including forty five deaths since the beginning of the outbreak. The outbreak is moving at such a fast pace and it's probably due to a number of reasons. One of them being the location of the outbreak, DRC, and the humanitarian crisis taking place. more than two million people live in the areas at risk for Ebola within the DRC. In Eastern DRC, more than a year of escalated conflict has severely impacted. Local infrastructure and healthcare systems. When there is a decrease in humanitarian access. You weaken access to health care. There's also a lot of mistrust with the medical system as well, that has unfortunately led to violence against some healthcare workers. There are reports of frontline workers being attacked. Ambulances have been burned and stoned, and healthcare facilities have been set on fire. One hospital tent was actually set on fire due to what I mentioned. At the beginning of the episode. Remember what I said at the beginning about funeral practices? About washing and dressing the body? Now imagine being a family member who has just lost someone you love and being told you can't touch them, can't wash them, can't take their body home. From a public health perspective, we understand why those precautions exist. But from the family's perspective, Those restrictions can feel like theyare being asked to not honor the person they love. A crowd set fire to a section of a hospital at the epicenter of the Ebola outbreak in the DRC, after friends and family of a young man thought to have died from the virus were prevented from taking his body away for burial. Reports described deep mistrust of Ebola response teams among some community members, including beliefs that the disease was not real or that health authorities were not sharing all of the information. There is fear, unrest, misinformation, and frontline workers showing up in terrible conditions. The burnout, physical and emotional exhaustion of extensive PPE, donning and doffing, and caring for extremely sick patients. and then there is the fear that the healthcare facility where you're fighting to keep people safe could itself be attacked because of the lack of trust in the healthcare system. And on the other side of that are the people of the DRC, people who are scared, grieving, and trying to understand what is happening in their community. Imagine watching strangers enter your community and take away the body of someone you love. You don't fully understand why they are doing it, and then you can't perform the funeral rituals that your family has practiced for generations. To end on a positive note, The DRC will receive 70,000 doses of ervibo vaccine from the UN's International Vaccine Coordination Group, the ICG. This vaccine is effective against other strains of Ebola, but it is unclear if it'll work for this outbreak. The plan is to use 50,000 doses to protect healthcare workers, and then 20,000 in the community. While there is uncertainty on if this vaccine will work, it is the best public health intervention we currently have. A true shot in the dark. For our Huddle Corner, a section for some takeaways before signing off. The Ebola outbreak happening in the DRC is absolutely devastating. The scale and speed of this outbreak is unprecedented in the DRC. More than 2,500 people have already died, and public health officials are warning that if transmission continues at this pace, This outbreak could be the deadliest ever recorded. This outbreak is not all about the virus itself. We must always remember that people are being affected. The misinformation and fear are realities that people are facing every day in the DRC. I hope this outbreak ends quickly, but in the meantime, remember that our ultimate goal in public health and infection prevention is protecting individuals and keeping them safe. And a large part of that is understanding and respecting the people you are protecting. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at CulturePositive Pod at gmail.com. You can also find me on Instagram at CulturePositive Pod. Please like, share, and review the podcast wherever you listen. References for the episode can be found in the notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious, stay compassionate, and keep building a culture that's truly positive.