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Ebola epidemic in Africa: Cuban medical experience in this international health emergency (III)
Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (III)
Rafael Rufino Corona Pérez
Villa Clara. University of Medical Sciences. Cuba. Email: rafaelcorona@infomed.sld.cu
ABSTRACT
The Henry Reeve Brigade arrived in Sierra Leone to face Ebola on October 2, 2014 with 162 brigade members and leadership groups as the advanced party of the brigades that would begin in late October in Liberia and Guinea. The Agreement between WHO and MINSAP was signed on October 7. At the reception ceremony, on October 8, representatives of different institutions participated. The Individual Contract for Participation in the Ebola Epidemic Program in West Africa was signed. In view of the death of a Cuban in Guinea Conakry by malaria, the brigade was prepared for its confrontation. The distrust of the population appeared before the protection measures that had to be taken to face Ebola. This determined repressive control by the police and the army with numerous checkpoints.
MeSH: hemorrhagic fever, ebola, disaster sanitation, disaster emergencias, international assistance in disaster, education, medical
RESUMEN
La brigada "Henry Reeve" arribó a Sierra Leona para el enfrentamiento al ébola el 2 de octubre de 2014 con 162 brigadistas y los grupos de dirección como avanzada de otras que comenzarían a fines de octubre en Liberia y Guinea. El 7 de ese mes se refrendó el Acuerdo entre la OMS y el MINSAP. En la ceremonia de recibimiento, el 8 de octubre, participaron representantes de diferentes instituciones. Se firmó el Contrato Individual para la Participación en el Programa de Enfrentamiento a la Epidemia de Ébola en África Occidental. Ante el fallecimiento de un cubano en Guinea Conakry por paludismo, se preparó a la brigada para esa contingencia. Hubo desconfianza entre los pobladores ante las medidas de protección frente al ébola. Esto determinó el control represivo por la policía y el ejército con numerosos puntos de control.
Editorial Note
The participation of Cuban health professionals in the global campaign against ebola was an unprecedented event in the history of humanity, in the history of Cuba, and in particular in the history of Cuban medicine that demands to be studied, researched and divulged. Their contributions and experiences should be introduced in undergraduate and postgraduate study programs not only because of the historical aspects, but also because of their impact in the medical sciences and because it is a serious health problem that is far from being solved, so outbreaks of the deadly disease are possible, since the conditions that originated it remain intact. From volumen 9, No. 2 on, EDUMECENTRO journal has published a group of articles under the title: Epidemic of Ebola in Africa: Cuban medical experience in this international health emergency, authored by Dr. Rafael Rufino Corona Pérez, member of the "Henry Reeve" International Specialized Contingent in Disaster Situations and Severe Epidemics and professor of Villa Clara University of Medical Sciences, who writes his experiences as vivid testimony of what happened in those months, where the intellect, perseverance, courage and struggle for life prevailed facing the health disaster and were proclaimed victorious. In these research paper has been respected the writing in first person by the psychological implication of the facts that are narrated in the personality of the doctor.
Nota editorial
La participación de los profesionales cubanos de la salud en la campaña mundial contra el ébola representó un hecho sin precedentes en la historia de la humanidad, en la historia de Cuba y, en particular, en la historia de la medicina cubana que demanda ser investigada y divulgada. Sus aportes y experiencias deben ser introducidos en los programas de estudio de pregrado y posgrado no solo por los aspectos históricos, sino por su impacto en las ciencias médicas y por ser un grave problema de salud que dista mucho de estar resuelto. Las condiciones que originaron la enfermedad permanecen intactas. A partir del volumen 9, No. 2 de 2017, la revista EDUMECENTRO publica un grupo de artículos bajo el título: Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional, cuyo autor principal es el Dr. Rafael Rufino Corona Pérez, integrante del Contingente Internacional Especializado en Situaciones de Desastres y Graves Epidemias "Henry Reeve" y profesor de la Universidad de Ciencias Médicas de Villa Clara, quien redacta sus experiencias como testimonios vívidos de lo acontecido en esos meses, donde el intelecto, la perseverancia, la valentía y la lucha por la vida se impusieron ante el desastre sanitario y se proclamaron victoriosos. En estas comunicaciones se ha respetado la redacción en primera persona por la implicación psicológica de los hechos que se narran en la personalidad del mencionado doctor.
The arrival
President Raúl Castro gave the farewell to the brigade on October 1st, 2014 and the next day arrived to Free Town, where it was received by the advanced leadership and the head of the permanent brigade. The transportation to the hotels was carried out in a caravan, functioning as a clock the transportation plan agreed with the logistics of the WHO.
The International Humanitarian Partnerships (IHP), designated by WHO to ensure services, played a key role in transportation, light vehicle rental, WHO document preparation, coordination of courses, medical care and assembly of Boxes for isolation of Ebola suspects.
Initially the groups were organized with the resources for their preparation until the certification of each brigade member by a commission of the WHO.
In the Mariam Hotel, the headquarters and part of the brigade were set up; the co-workers selected for the English hospital were accommodated in Compañero, and in Barmoy and Sea Side the rest of the brigade members whose location was not yet defined. The Mariam Hotel, by its characteristics, was the site of the classes, conferences, meetings of the brigade and training place, as seen in figure 1; there we trained with the protection aids.
On October 5, the first meeting of the brigade's headquarters with the WHO's leadership in the country, chaired by Dr. Daniel Kertez, was held to plan and coordinate the brigade's assurances and staff preparation for its future mission; the graphic evidence of this encounter is presented in figure 2. The orientation of the WHO was not to touch the patients. Our role would be to be present in the rooms so that people died with dignity; however we were determined to improve the treatment protocol and save more lives.
The agreement signed on October 7 between WHO and the Ministry of Public Health of Cuba (MINSAP) clearly states in article 6 No. 30 (recorded in the author's file): "... the professionals deployed, as employees of the Ministry, they will not be considered in any way as employees or officials of WHO or the United Nations, and they will not be considered to have any contractual relationship with WHO or the United Nations as well."
Representatives of the UN and WHO, government and national and international institutions, Ambassador Jorge Lefebre and the Emerging and Permanent Brigades participated in the reception ceremony on 8 October. On that day, the Individual Contract for Participation in the Ebola Epidemic Program in West Africa was signed, expressing our voluntary disposition while committing ourselves to observe sanitary measures such as:
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"If I am sick, I will not be able to travel to Cuba until four months after the clinical epidemiological discharge."
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"I will remain in quarantine for up to 30 days before traveling to Cuba and will be quarantined for a period of 30 days upon arrival."
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"In case of death due to illness, my mortal remains cannot be repatriated until after the five-year term established for it".
In mid-October we paid a visit to the Chinese hospital "Jui", built two years ago and adapted as Ebola Treatment Center (ETC). The Chinese specialists began to work in the confrontation to Ebola on October 1st. with 30 members in a team of 4 doctors, one translator and 25 nurses. The clothes and accessories were of Chinese production. The protective suit was similar to those used in our preparation. They did not use intravenous route and their experience came from the combat against Severe Acute Respiratory Syndrome.
Due to the uncertain situation in those days, the difficult situation faced by the population and the lack of integration of the forces that faced the epidemic, we welcomed the news of the beginning of the Extraordinary Summit of the Bolivarian Alliance for the Peoples of America Commerce treaty of the Peoples (ALBA-TCP) that among its objectives was to take a diligent stance before the call of the Secretary General of the United Nations and the WHO to face the dangerous disease.
Cuban President Raul Castro said:1 "... tomorrow, October 21, two more brigades will be heading to Liberia and Guinea, whose advanced party are already in both countries to join the first group that left the first of this month to Sierra Leone and The Special Envoy of the Secretary General of the United Nations, David Nabarro, said in his words of recognition: "... I want to thank the people of Cuba for sending some of their best doctors and nurses to fight against Ebola in West Africa. 3
On October 27, the Granma newspaper published an information note from the Ministry of Public Health that stated: "... On yesterday, October 26, at 2:09 p.m. Cuba time and 6:09 p.m. Guinea Conakry time, died collaborator Jorge Juan Guerra Rodríguez, at the age of 60 years, Bachelor of Economics, Sancti Spíritus province, as a result of malaria with cerebral complication.4 The fall of the first Cuban collaborator generated a deep feeling of solidarity and forced us to comply with the measures of anti-malarial protection. That day, at the beginning of the activities, we keep a minute of silence. We all intoned, for the first time before an adverse situation, our National Anthem, expressing our decision to fulfill the mission. In a general sense, our revolutionary and internationalist convictions and patriotic sentiment were always encouraging us, as can be seen in figure 3.
On November 21, our ambassador sends us by e-mail the statements of Dr. Gao Fu, director of the Chinese CDC, which were very enlightening at the time. "Dear all, I am including statements from the Director of the Chinese CDC. I beg you to see them in the context of the meetings held by the Cuban Medical Brigade with the authorities of S. Leone in recent days". In his statements, Dr. Gao Fu said: "... there are many organizations and agencies working, but most do not trust the government or the local population and that is not good. The government should be in charge of the fight against the virus. "The Chinese official insists on the lack of confidence in his government by the people. It is the reason why it continues to deny the existence of the disease and does not comply with preventive measures. It recommends that the government impose its authority and carry out the fight against the virus by making appropriate decisions and measures to eliminate this scourge. He stated that he did not find the same coordination in Sierra Leone as in Liberia and Guinea. As expressed in the previous research paper,2 the population did not believe in Ebola and frequently escaped from hospitals.
This situation led to repressive control by the police and the army, with numerous checkpoints on highways, at key points in cities, and at ports and airports. They frequently decreed curfews prohibiting the departure from houses and conducting research on febrile diseases permanently. The government ordered the control of temperature and the compulsory washing of hands with chlorinated water in all shops, hotels and health centers. The headquarters of the brigade established hygienic and epidemiological measures of mandatory compliance for all its facilities.
At the end of October the collaborators were certified to work in the red areas and on November 4 the English Army Hospital in Kerry Town was inaugurated; the staff of Compañero Hotel began working on the 5th.
The confidence placed in Cuban medical personnel was expressed by the appointment of Dr. Ramiro Guedes, Internal Medicine Specialist who was at the head of the Compañero Hotel. Thus the most difficult task for the brigade began: the confrontation to Ebola in the red zones.
Declaration of interest
The author declares no conflict of interest.
BIBLIOGRAPHIC REFERENCES
1. Castro Ruz R. Discurso en la en la inauguración de la cumbre extraordinaria del ALBA-TCP sobre el ébola. La Habana: Oficina del Consejo de Estado; 2014.
2. Corona Pérez RR. Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (I). EDUMECENTRO [Internet]. 2017 [citado 20 Jun 2017];9(2):[aprox. 6 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2077-28742017000200016&lng=es
Submitted: July 19 2017.
Accepted: July 19 2017.
Rafael Rufino Corona Pérez. Villa Clara. University of Medical Sciences. Cuba.
Email: rafaelcorona@infomed.sld.cu
Copyright (c) 2017 EDUMECENTRO
