A member of the Ugandan Medical staff of the Ebola Treatment Unit stands inside the ward in Personal Protective Equipment (PPE) at Mubende Regional Referral Hospital in Uganda on September 24, 2022. PHOTO/AFP
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Five doctors and an anaesthetic officer have been taken into isolation for treatment after contracting Ebola Virus Disease (EVD) in the line of duty, officials confirmed yesterday.
The EVD taskforce in Mubende District, the epicentre of the outbreak, and Uganda Medical Association (UMA), the national umbrella grouping for doctors, separately said the health workers caught the infectious disease from patients.
They did not explain whether the transmission resulted from lack or inappropriate use of protective gear, without which UMA asked its rank-and-file to stay away from work, or care lapse due to exhaustion.
The government, on September 20, confirmed the outbreak of EVD in Mubende after samples taken from a resident, who died at the regional referral hospital a day earlier, turned out positive for Sudan strain during a test at Uganda Virus Research Institute (UVRI).
This is the fifth Ebola outbreak in the country, the first and most deadly being in Gulu in 2000, which killed the lead doctor Matthew Lukwiya.
The latest wave has so far killed five out of 24 infected persons, the Ministry of Health said, and the Sudan Ebola virus fatality is between 40 and 90 percent, according to World Health Organisation (WHO). This is several times higher than the case fatality rate of Covid-19, the pandemic that shut down the world for more than a year, which is around three percent.
In Mubende, the Resident District Commissioner (RDC), Ms Rosemary Byabashaija, who as district disaster preparedness head leads the anti-EVD taskforce, said as of yesterday, 26 of the admitted 42 Ebola patients were in emergency care.
Sixteen others in an isolation facility, she disclosed, tested positive.
“The six health workers, who are among the sixteen confirmed Ebola cases, are responding to treatment at the isolation facility. These are our frontline workers and we pray that they get well soon,” Ms Byabashaija said.
In Kampala, Dr Herbert Luswata, the UMA secretary general, confirmed that five of those infected are doctors.
“There is one intern doctor, and then three senior house officers (doctors pursuing Master’s degree) and one third-year medical student who tested positive,” he said.
We could not independently verify his claims linking the infections to shortage of protective gear and low infection prevention knowledge.
“Initially, there were issues with personal protective equipment (PPEs). In the areas where the patients reached first, the health workers there were not having PPEs,” he said.
UMA president Samuel Oledo, himself a medical officer, asked colleagues without protective equipment to stay away.
“You should be covered from head to toes. You must have a mask, face shield, goggles, apron, and gumboots and you must have gloves –both surgical and disposal. Ebola is not a joke,” he said.
The shortage of PPEs was one of the major issues during Covid-19, a problem which contributed to the infection and death of health workers.
Ms Sheila Nduhukire, the spokesperson of the National Medical Stores, the agency that procures medicines and health commodities for government, told this newspaper last Saturday that they supplied adequate PPE stocks to Mubende Regional Referral Hospital, where most cases are booked.
Dr Henry Kyobe, the Ebola incident commander at the Health ministry, said: “We have sufficient amounts of PPEs for the health workers”.
“WHO deployed Ebola kits, but we also have leftover PPEs from Covid-19 response that we are still using,” he added.
Dr Musa Lumumba, the head of medical interns, said in the meeting between their members, the Health ministry and UMA, on September 27, they agreed to be screened for Ebola infection before the resumption of duty and those found to be positive s treated.
“It was also agreed that sufficient PPEs should be provided and training on infection prevention and control be provided. [Interns should] not be evacuated to other internship sites,” he said in a statement yesterday.
However, Dr Luswata said the Ministry of Health should reverse the decision of keeping interns at the Mubende Regional Referral Hospital, the facility at the epicentre.
“Mubende hospital is no longer a good place for students to go for their training and if they are allowing them, that is very bad. The Ministry of Health should distribute these students to other training sites. Those interns are not yet well grounded in infection prevention and control,” he said.
Supervisors of the interns are more involved in treating Ebola cases, leaving them without guidance and other patients without care, as the impact of manpower shortage starts to bite.
Dr Oledo said according to their statistics, the health staff coverage is at 40 percent. He said this means the patients will experience delays in accessing services. The interns have been supplementing the limited health workforce.
“We have 2,000 unemployed doctors on the streets and yet when you go to Mubende, you have less than 40 doctors, the medical director included. We are starving amid plenty…,” he said.
There are 57,207 health workers in health facilities across the country, who are less than the required 76,948, according to the 2020/2021 Health Sector Performance Report.
Dr Luswata said patients are also running away from the hospital for fear of infection, so whatever the interns are doing will be “more of risking their lives, not internship.”
“They are also not eligible for risk allowance. [The] ministry should rethink their position and let them go,” he added.
Contact tracing
Meanwhile, the list of contact persons being traced rose to 300 yesterday, up from 230 a day earlier.
The Ebola taskforce in Mubende said it was awaiting results of tests of samples extracted from a person who presented with Ebola-like symptoms, but had escaped from an isolation facility, before showing up at Masaka Regional Referral Hospital.
Officials said they were to set up an isolation unit that can accommodate 100 suspected or confirmed Ebola patients at Mubende hospital.
Elsewhere, the district taskforce and Health ministry officials have asked the population to remain calm but vigilant and adhere to preventive measures.
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