Commissioned Corps of the U.S. Public Health Service Monrovian
Medical Unit (MMU) Mission at Camp Eason (Margibi County,
Liberia)
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Obligatory Disclaimer This presentation is solely from a
personal experience perspective; and does not represent the
official positions or policies of the U.S. Public Health Services
or U.S. Department of Health and Human Service.
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Presentation Outline Share Ebola Response to Liberia A personal
perspective Update on Global Movement to Preparedness Lessons are
being learned Things are changing
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U.S. Public Health Service Who Are We? A Uniformed Service
comprised of 6,800 Officers under the direction of the U.S. Surgeon
General, Dr. Vivek Murthy Comprised of: Physicians, Dentists,
Nurses, Therapists, Pharmacists, Health Services, Environmental
Health, Dietitians, Engineers, Veterinarians and Scientists.
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U.S. Public Health Service The mission of the U.S. Public
Health Service Commissioned Corps is to protect, promote, and
advance the health and safety of our Nation. As America's uniformed
service of public health professionals, the Commissioned Corps
achieves its mission through: Rapid and effective response to
public health needs Leadership and excellence in public health
practices Advancement of public health science
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Ebola The Background The 2014 Ebola outbreak is the largest in
history and the first Ebola outbreak in West Africa. This
unprecedented outbreak has affected multiple countries in and
around West Africa, with the countries of Sierra Leone, Liberia and
Guinea having been the hardest hit. Recognizing that the only way
to eradicate the threat of Ebola in America and the world is to
defeat it at its source, the U.S. has significantly ramped up
efforts to fight the virus in West Africa.
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United States Response U.S. Strategy POTUS: Ebola epidemic in
W. Africa and the humanitarian crisis there is a top national
security priority for the United States Strategy is predicated on
four key goals: Strategy is predicated on four key goals:
1.Controlling the epidemic at its source in West Africa;
2.Mitigating second-order impacts, including blunting the economic,
social, and political tolls in the region; 3.Engaging and
coordinating with a broader global audience; and 4.Fortifying
global health security infrastructure in the region and
beyond.
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Prior to Departure 65 Officers completed an intense 7-day
training conducted by the Center for Disease Control and Prevention
at FEMAs Center for Domestic Preparedness in Anniston, Alabama. A
Total of 4 Teams deployed between Oct 2014 and May 2015. The MMU is
now operated by the Liberian Government.
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Monrovia Medical Unit Our mission was to provide hope through
care to health care workers in Liberia who may have the Ebola virus
disease and continue efforts with the Liberian and international
partners to build capacity for additional care.
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Monrovia Medical Unit (MMU) The MMU is a 25-bed Ebola Treatment
Unit specifically designed to treat infected health care workers
such as doctors and nurses who are at higher risk of infection,
because they are in close, sustained contact with Ebola patients
who are symptomatic and infectious.
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Reference to the MMU Video Tour is available at:
https://www.youtube.com/watch?v=bmyUb3 N5gAk
https://www.youtube.com/watch?v=bmyUb3 N5gAk
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Early Clinical Presentation Acute onset; typically 810 days
after exposure (range 221 days) Signs and symptoms Initial: Fever,
chills, myalgias, malaise, anorexia After 5 days: GI symptoms, such
as nausea, vomiting, watery diarrhea, abdominal pain Other:
Headache, conjunctivitis, hiccups, rash, chest pain, shortness of
breath, confusion, seizures Hemorrhagic symptoms in 18% of cases
Other possible infectious causes of symptoms Malaria, typhoid
fever, meningococcemia, Lassa fever and other bacterial infections
(e.g., pneumonia) all very common in Africa 14
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Clinical Features Nonspecific early symptoms progress to:
Hypovolemic shock and multi-organ failure Hemorrhagic disease Death
Non-fatal cases typically improve 611 days after symptoms onset
Fatal disease associated with more severe early symptoms Fatality
rates of 70% have been reported in rural Africa Intensive care,
especially early intravenous and electrolyte management, may
increase the survival rate 15
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Clinical Manifestations by Organ System in West African Ebola
Outbreak Organ SystemClinical Manifestation GeneralFever (87%),
fatigue (76%), arthralgia (39%), myalgia (39%) NeurologicalHeadache
(53%), confusion (13%), eye pain (8%), coma (6%)
CardiovascularChest pain (37%), PulmonaryCough (30%), dyspnea
(23%), sore throat (22%), hiccups (11%) GastrointestinalVomiting
(68%), diarrhea (66%), anorexia (65%), abdominal pain (44%),
dysphagia (33%), jaundice (10%) HematologicalAny unexplained
bleeding (18%), melena/hematochezia (6%), hematemesis (4%), vaginal
bleeding (3%), gingival bleeding (2%), hemoptysis (2%), epistaxis
(2%), bleeding at injection site (2%), hematuria (1%),
petechiae/ecchymoses (1%) IntegumentaryConjunctivitis (21%), rash
(6%) WHO Ebola Response team. NEJM. 2014 16
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Examples of Hemorrhagic Signs Bleeding at IV Site Hematemesis
Gingival bleeding 17
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Laboratory Findings Thrombocytopenia (50,000100,000/ L range)
Leukopenia followed by neutrophilia Transaminase elevation:
elevation serum aspartate amino- transferase (AST) > alanine
transferase (ALT) Electrolyte abnormalities from fluid shifts
Coagulation: PT and PTT prolonged Renal: proteinuria, increased
creatinine 18
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EVD Summary The 2014 Ebola outbreak in West Africa is the
largest in history and has affected multiple countries Think Ebola:
U.S. healthcare providers should be aware of clinical presentation
and risk factors for EVD Human-to-human transmission by direct
contact No human-to-human transmission via inhalation (aerosols) No
transmission before symptom onset Early case identification,
isolation, treatment and effective infection control are essential
to prevent Ebola transmission 19
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MMU Team 1: Challenges Never been done before a U.S. Government
asset transforming an Army MASH tent unit into an ebola treatment
center. Difficult diagnosis without lab test results. Lack of a
ready supply stream and equipment. Learning who the response
partners were in country and how to work with them. Adjusting
medical care standards based on environment and resources.
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Innovation Required !!
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MMU Team 1: Schedule Worked 2 months straight except for 2 days
Hour 1 awake and get ready for commute Hour 2 Commute to MMU Hour
4-16 for 12-hour shift Hour 18 Commute to Lodging Hour 19 Fall
asleep for a 5 hour nap Start all over again!
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18 Guys in a tent
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What did CAPT Bates do? Logistics Team Whatever the task of the
moment demanded. Supply and Inventory control Infection control
Safety Medical Lab Housekeeping Pharmacy Facilities and Supply
Dietary Bug Control
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Ebola Buster
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Infection Control
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1000 pounds of 65% HTH used
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Biohazard Waste Process
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How We Protected Ourselves Donning and Doffing Video Reference:
https://www.youtube.com/watch?v=mfT9ipzt g5Y
https://www.youtube.com/watch?v=mfT9ipzt g5Y
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PPE Personal Protection Equipment
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PPE
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MMU Team 1: Outcomes The USPHS sent 65 clinicians,
administrators, and support staff to assist in the response effort.
Health care providers in Liberia now had a place to go if they
contracted the ebola virus. The efforts of USAID, DoD, USPHS,
Government of Liberia, International Partners, and NGOs built
capacity for additional care in Liberia Over 100 providers from
Africa were reported to have joined the effort in Liberia during
our tour.
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A Successful Mission and Safe Return
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The Global Movement to Preparedness Lessons Learned Countries
with weak health systems and few basic public health
infrastructures cannot withstand sudden shocks to their society
Preparedness swift action makes the difference No single control
intervention is sufficient Community engagement is the linchpin for
successful control
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More Lessons Learned Operations: Put the needs of patients and
communities at the core of any response. Evaluate and practice
surge capacity Governance and Accountability A fast response will
not happen without leadership. Set priorities based on what is
needed on the ground. Research and Development Strengthen research
and development systems focused on outcomes for the global public
good.
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Department of Health and Human Services July 1, 2015 DHHS
launched a National Ebola Training and Education Center and funded
3 hospitals to train, prepare U.S. health care facilities for Ebola
and other emerging threats. Regional Ebola treatments centers have
been established. Evaluation of the national response planning,
surge capacity, and supply stockpiles is ongoing.
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Most Importantly Reactions and Responses must not be fear based
!!
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We Cant Rely on Batman
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Future Challenges Focus science based public health over
politics Global collaboration and commitments to strengthening
public health infrastructures Commitment to collaborative and
coordinated surge capacity Understanding the multi-factorial
influencers of global public health challenges (political,
economic, cultural, social determinants of health, funding,
transportation, food/water, etc.) Reconciling health care responses
with cultural and societal influencers Moving beyond disease
specific preparedness to a global infectious and communicable
disease preparedness and response capacity
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A Patient Perspective
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Recovery from Ebola Returning to the healthcare workforce
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Other Information Link to news Article in Gazette Record, Saint
Maries ID; regarding deployment to Liberia:
http://www.stmariesid.com/fighting-ebola/ Web link to the
Presidents recent update on the Ebola outbreak activities.
http://www.c-span.org/video/?324305-
1/president-obama-remarks-combating-ebola
http://www.c-span.org/video/?324305-
1/president-obama-remarks-combating-ebola
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Contact Information CAPT Dale M. Bates U.S. Public Health
Service Phone: 206-615-2497 (office in Seattle) Email:
[email protected]@hrsa.gov Address: 23920 N Teddy Loop Rathdrum
ID 83858