[Field Diary] by Alice Janvrin, Humanitarian Technical Lead, International Planned Parenthood Federation
Each day, Ugandans are watching as the Ebola cases mount at an alarming rate. Thus far, 139 cases have been confirmed, though it is feared that there are likely many more.
Ebola is a deadly virus which spreads through direct physical contact with the body fluids of an infected person with symptoms oftentimes similar to sexual and reproductive health (SRH) concerns and complications, such as a sudden fever, intense weakness, muscle pain, obstetric complications, miscarriages and most famously: bleeding.
I was recently in Uganda, working alongside Reproductive Health Uganda (RHU), IPPF’s Member Association in the country that offers critical and life-saving Sexual and Reproductive Health (SRH) services, including access to modern contraceptives, STI diagnosis and treatment, maternal healthcare, including treatment for complications, and abortion care to thousands of women and girls across Uganda. In the RHU-managed facilities, the presence of blood is very common with hundreds of women seeking care every day for pregnancy complications, miscarriages, abortions, and other bleeding caused by side effects of contraception, sexual abuse, or heavy menstruation.
As this latest Ebola outbreak evolves, we are likely to see this phenomenon become more common and stigmatized. When patients are suspected of having Ebola, they are sent to testing centers, and if their test comes back as positive, they are sent to Ebola Treatment Centers, where, sadly, many go to die. As a result, the population as a whole fear any contact with suspect Ebola cases.
Health workers are particularly at risk. When a patient presents with signs of bleeding to an SRH clinic such as RHUs’, it is for the triage staff and healthcare workers to distinguish whether the bleeding is because of a (reproductive) health issue or Ebola. This type of medical triage presents an impossible conundrum: watch powerlessly the suffering of a patient who may or may not have Ebola while waiting for their referral to the Ebola testing site, or intervene and at times risk their own lives, that of their colleagues, other patients, families. Each medical provider is forced to carry the weight of this decision.
I worked alongside over 20 RHU healthcare workers and staff to reinforce Ebola mitigation measures in three of their clinics, Katego and Bwaise Clinic in Kampala and Mityana Clinic in Mityana - to protect themselves and their clients. This included the reintroduction of triage, refreshers on Infection and Prevention of Infection protocols including the use of Personal Protection Equipment (PPE) (adapted for Ebola), and a briefing on risks facing frontline staff. Understanding and being able to manage the new risks that Ebola presents, I witnessed whole clinics bustling with energy as they reinstated their triage and dusted off their temperature guns.
Following two years of working alongside COVID-19, RHU frontline workers have an advantage: they are no strangers to triage, PPE and epidemiology and have much of the equipment already positioned in the clinics. However, I witnessed the exhaustion at the prospect of having to face yet another epidemic. “But I am not scared, we know what to do and we survived Covid” said the nurse-in-charge of Mityana Clinic, located in the Central Region of the country.
However, Ebola is no COVID-19. Unlike Covid-19, Ebola is not airborne, but rather transmitted through bodily fluids such as blood or saliva. Also, unlike COVID-19, the World Health Organization (WHO) estimates the fatality rate is between 41% and 100% (for comparison, the fatality rate of COVID-19 is thought to be between 0.7% and 2%). The complacency that has set in as we all become accustomed to life with COVID-19 creates a false sense of security, especially in the face of this latest epidemic, Ebola. As such, Ugandan healthcare providers must recondition themselves to become acutely conscious of their exposure to bodily fluids. Equally, after the initial panic of watching COVID-19 cases rise and lockdown measures set-in, we all soon realized that most survived; conversely, as the Ebola case count increases, Ugandans are quickly realizing that they may not be so lucky.
“It is of vital importance that we support and protect SRH healthcare workers and ensure Ebola does not have an indirect impact on maternal health mortality and we do not lose the gains that we have made”, shared with me Jackson Chekweko, the Executive Director of Reproductive Health Uganda.
A message which was echoed by Marie-Evelyne Petrus-Barry the Regional Director of IPPF Africa Region: “ensuring our frontline workers are trained with the skills and equipment to address this new threat and are safe, is integral to ensuring the continuity of essential and lifesaving SRH services to thousands of women throughout Uganda.”
At IPPF, we stand in solidarity with the Government and population of Uganda, and pledge our support to ensure the sustained availability of sexual and reproductive services.
Reproductive Health Uganda (RHU) is a Member Association of the International Planned Parenthood Federation