Wednesday, 7 January 2015

End of the middle?

Sorry for the delay in posting my next blog. I’ve been getting wrapped up in all sort of things but actually mostly non-ebola work and starting to think about the post-ebola transition... I'm not sure I've got the balance of writing blog entries vs working in the unit quite right yet.

So I stand corrected… maybe ‘The Surge’ is making a difference. In the last couple of weeks there has definitely been an increase in the number of holding beds (in isolation units where ebola suspects are taken) available. Many of the beds are being filled with suspects rounded up by the community teams who are going door to door looking for sick people in confirmed ebola hotspots of the city. There were some initial suspicions that the community teams were just isolating the elderly, the infirm and the homeless but if this was the case then the proportion of suspects testing negative would have increased and that, as far as I am aware, hasn’t occurred. In fact, in eastern parts of the city, which is generally more crowded and poorer and consequentially more ebola-ridden, the proportion of suspects testing positive is about 50% - higher than in most areas. These diseases are always the same – Paul Farmer wrote a compelling diary entry back in October about structural violence and health inequality relating to ebola.

Even the scale-up in laboratory testing is filtering down to real improvements on the ground.  We now have three collection times for blood tests in a day from Connaught’s Isolation Unit: 8:30am, 12:30pm and 4:30pm. Yesterday, we had patients admitted in the morning whose bloods were sent by 12:30pm and amazingly the results were back by 7pm. This meant we were able to discharge four negative patients home in the evening without them having to stay any longer in our unit, minimising their exposure to possible positive patients.  It also meant we could isolate the two remaining suspects in the holding tent rather than sending them home to the community. What a win-win situation J
So it looks like things are starting to turn around; maybe this is the beginning of the end or more likely the end of the middle. What happens next in looking to the post ebola phase of health system strengthening will be the subject of another blog entry. It certainly was and continues to be the focus of the Kings Sierra Leone Partnership to make long-term positive impact on the structure and quality of the health system and I’m excited to get involved in a few projects that have a longer outlook and non-ebola focus.

A little disclaimer – it’s very hard to get accurate information about how the epidemic is progressing here. I suppose I am at an advantage about not having the media cloud my perspective but the above assessment is simply based upon discussions with colleagues and a general feeling within the team rather than facts and figures that I have personally have opportunity to see.

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