Stephen Mugo: Kenya might repeat Liberia's mistakes in handling Ebola

 

Mugo was among 15 Kenyan health workers who volunteered to help Liberia respond to the outbreak. [Mercy Kahenda, Standard]

A single case of Ebola has stirred painful memories for Stephen Mureithi Mugo, who fought the disease during the devastating 2014 outbreak in Liberia.

For the Clinical Officer, Kenya’s first imported case of Ebola Bundibugyo virus disease is a reminder of what can happen when a deadly virus gains a foothold in a community.

He remembers seeing the bodies of people who had died from Ebola lying along roads as the disease ravaged villages and towns in Liberia.

“It was ravaging villages and towns. I came across bodies of people who had died on the streets,” recalls Mugo. “People were running away.”

Mugo was among 15 Kenyan health workers who volunteered to help Liberia respond to the outbreak.

In 2015, then Health Cabinet Secretary James Macharia placed an advertisement inviting Kenyan health workers willing to volunteer in the fight against Ebola, which had been declared a public health emergency.

Mugo applied and on January 9, 2015, flew to Liberia.

Supportive care

On arrival, he underwent two weeks of intensive training before being deployed to Monrovia, where he worked at the Ebola Treatment Unit at Samuel K Doe Sports Complex.

The experience would leave him with memories he has never forgotten.

At the treatment unit, there was no specific cure available to the patients.

Patient care involved controlling symptoms and replacing what patients lost through the disease.

Here, patients suffering from diarrhoea and vomiting were rehydrated, while those who lost blood received transfusions.

Mugo was among 15 Kenyan health workers who volunteered to help Liberia respond to the outbreak. [Mercy Kahenda, Standard]

Temperatures were also controlled while being given fluids, multivitamins, fruits and psychological support.

“With Ebola you replace what the body loses, but not fighting the virus,” he says.

“Supportive care involves fluids, making patients comfortable, to allow the body to fight back, because there’s no drug that cures Ebola,” he adds.

Some patients developed psychiatric complications, adding to the emotional burden on healthcare workers.

“The most depressing thing is sometimes watching somebody die without much help,” says Mugo

One devastating night remains raw in the Clinical Officer’s memory.

Mugo worked in a 100-bed ward that, at the height of the outbreak, was filled with patients.

“My experience was working in a 100-bed capacity ward. The worst day, the ward was full and after a four-hour shift, I went home. The next day, 68 patients were dead, and new patients were admitted. This is how serious this thing can be,” says Mugo.

He estimates that only about 30 per cent of patients at the Ebola Treatment Unit survived.

“At least seven out of 10 patients infected with Ebola died,” recalls the clinical officer.

Mugo says one of the biggest lessons from Liberia was the importance of breaking the chain of transmission.

This involved limiting contact with infected people, tracing contacts, educating communities and ensuring safe burial practices. At first, he says, communities were suspicious of healthcare workers and resisted efforts to contain the disease.

“There was denial at first. Later they were trained, and they understood,” adds Mugo.

Some communities believed healthcare workers were spreading the disease. “They thought healthcare workers were a problem, and they had been sent to bring the disease to them,” he recalls.

Burial practices also contributed to transmission, particularly where families wanted to observe traditional rites.

The current case should prompt questions about how the patient travelled from the Democratic Republic of Congo through Uganda and eventually reached Nairobi. [AFP]

Amid dozens of deaths, the Liberian government, WHO and other partners introduced safer burial practices, with trained public health workers handling bodies and educating families on the risks.

“One of the biggest ways of fighting Ebola is sharing information. Information must be spread without inducing panic, and be very factual,” observes Mugo.

Liberia also had dedicated communication teams, including community leaders and other trusted opinion leaders, who visited villages to educate residents.

According to Mugo, protecting healthcare workers was critical.

The training he received covered patient management, infection prevention and the correct use of Personal Protective Equipment (PPEs), including how to put on and remove the equipment without contaminating themselves.

“A healthcare provider cannot handle a patient without PPEs. Everything you do must be under PPEs. This is what protects you from being infected,” he cautions.

Emotional scars

He says strict movement protocols were also followed inside Ebola Treatment Units to prevent contamination.

International organisations supported the response, including through provision of protective equipment and use of disinfectants such as sodium hypochlorite.

“These were good procedures on how to break the cycle of infection. This is how we survived, and Kenyans came back home. We tried and God was on our side,” he says.

Recovery for those who survived generally took between seven and 21 days. But even with patients’ recovery, the emotional scars he says, have remained.

“You see mothers losing their children. It doesn’t discriminate between children and adults. You see children left without parents, see entire families being swept by Ebola,” says the clinical officer.

Mugo returned to Kenya after the mission and was received by President Uhuru Kenyatta, who awarded all the volunteers with state recognition for their service.

About 10 years later, the memories have returned.

Kenya’s first imported Ebola case has left him worried about the country’s preparedness and the safety of healthcare workers who will be expected to respond.

“This wakes up old memories, but I do not want my people to go that route. I am ready to be at the forefront to save lives,” he says.

Mugo says Kenya should learn from Liberia and ensure healthcare workers are properly trained and equipped before more cases emerge.

He underwent a refresher training in June and says health workers need regular training and simulation exercises to prepare them for Ebola.

Missed cases

Preparedness includes training of healthcare providers, and equipping hospitals, isolation centres and hospitals with the right quality PPEs.

“The government has to commit to making sure they are available. It is nowhere close to Covid-19. You use PPE once; it is not reused,” notes Mugo.

At the same time, he warns that inadequate preparation could put healthcare workers at risk.

“A lot of health workers have died because of not being properly trained and not using the right equipment. This is the gap the government should make sure it does not occur,” he says.

He also says laboratories and other response facilities must have the capacity to test samples quickly.

The biggest concern for him, however, is the possibility of missed cases and extensive contact tracing.

The biggest lessons from Liberia is the importance of breaking the chain of transmission. [AFP]

Mugo says the current case should prompt questions about how the patient travelled from the Democratic Republic of Congo through Uganda and eventually reached Nairobi.

“From my experience, this is something that could have been prevented,” he observes.

The patient travelled from DRC by road to Kampala before flying to Nairobi and eventually seeking care at Nairobi Hospital.

“If surveillance was strong enough, we should have suspected this early. Ebola has been ravaging the region, we shouldn’t have let our guard down. Tracing this number of people is a nightmare that could have been avoided,” says Mugo.

According to him, the patient should have been identified and isolated much earlier, particularly at a point of entry.

Mugo says Ebola is primarily spread through contact with infected bodily fluids, making limiting contact one of the most important ways of controlling transmission.

“The best way to deal with the disease is to avoid and limit the number of contacts,” he says.