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Ebola epidemic in Africa: Cuban medical experience in this international health emergency (II)
Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (II)
Rafael Rufino Corona Pérez
Villa Clara University of Medical Sciences. Cuba. E- mail:rafaelcorona@infomed.sld.cu
ABSTRACT
At the request of the United Nations and the World Health Organization, the Cuban government decided to send a medical brigade to face the ebola epidemic in West Africa. On September 19, 2014, an advance party was made to study the situation on the ground and prepare the conditions for the reception, safe location, preparation and deployment of the workers who would arrive on October 2. The article outlines the activities carried out to receive the «Henry Reeve» International Specialized Contingency on Disasters and Severe Epidemic Situations the sole one approved at that time. The preparation of the advance group is based on the fundamentals of the logistic assurance for periods of contingencies elaborated to face situations of international sanitary emergency.
MeSH: hemorrhagic fever, ebola, disaster sanitation, disaster emergencias, international assistance in disaster, education, medical.
RESUMEN
A petición de la Organización de Naciones Unidas y la Organización Mundial de la Salud, el gobierno cubano decidió enviar una brigada médica para enfrentar la epidemia de ébola en África Occidental. El 19 de septiembre de 2014 salió una avanzada para estudiar la situación en el terreno y preparar las condiciones para el recibimiento, ubicación segura, preparación y despliegue laboral de los cooperantes que arribarían el 2 de octubre. El artículo expone las actividades realizadas para recibir al Contingente Internacional Especializado en Situaciones de Desastres y Graves Epidemias «Henry Reeve» único aprobado en esos momentos. La preparación del grupo de avanzada se basa en los fundamentos del aseguramiento logístico para períodos de contingencias elaborados para enfrentar situaciones de emergencia sanitaria internacional.
DeCS: enfermedad por el virus de ébola, saneamiento en desastres, emergencias en desastres, asistencia internacional en desastres, educación médica.
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 this issue on, EDUMECENTRO journal will publish 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 mentioned 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 número anterior (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 advance group. Organization of logistics
The organization began with the study Act No.75 of National Security1 and Guideline No. 1 of the National Defense Council for Disaster Reduction.2 The work strategy was based on the experiences gained during the confrontation with disasters in Cuba and on internationalist missions.
Logistics analyzes information on a special situation that includes the study of topographic maps; geographical, medical and military descriptions; historical and current materials relating to the problem in question. It continues with direct exploration in the field to point out specific aspects using different methods and techniques such as photography, video, and interview with community leaders and managers of organizations and institutions involved in tackling the problem. It is important to plan and organize activities, establish objectives and cooperation, prepare the work team while specifying assurances and funding, as well as the safety of staff and institutions. A feedback system should be established with an evaluation schedule to take action in accordance with reality and timely information to the headquarters. The system is prepared for sudden changes in the situation and the contingency of the management approach, since it allows the assessment of external and internal forces, specifying the strengths, opportunities, weaknesses and threats to create new indicators during the campaign.
Beginning September 2014, I commented to Dr. Lorenzo Somarriba in Santa Clara on the experience of cholera in Haiti and the continuity of the Henry Reeve Brigade on what there was uncertainty; days later I was surprised by the request from the UN and WHO to the Cuban government to face the ebola epidemic.
The fact that they turned to Cuba satisfied me greatly for the recognition to the Cuban medicine and the confidence in the people in regard to the capacity for resistance and experience in facing great contingencies. The world's request to Cuba became one of the great historical facts of humanity that did not know how far the threat of the terrible pandemic could reach. The release by the press really showed horrifying scenes.
On September 12, the Provincial Collaboration Department requested my willingness to join the Cuban contingent in West Africa. Immediately I began the preparation in the Central Medical Cooperation Unit as an epidemiologist, but its director proposed to me to assume the logistic assurance of the brigade designated for Sierra Leone. Immediately we clarified the mission, we clarified the tasks and we realized the calculation of the time, really short, because the brigade would arrive on October 2.
Before leaving I reviewed the documents of the agreement that would be taken to the WHO and I knew that on August 8 this organization issued an international public emergency declaration on ebola in West Africa, in which its director asked Cuba for collaboration for the control of the epidemic, and that on August 29 the President of Sierra Leone Ernest Bai Koroma asked for help in a letter to our President Raul Castro.
On September 19 we left for Sierra Leone after an impressive farewell, as it was considered a suicide mission. The minister expressed his confidence and that of the leadership of the country; we feel very honored and committed to our people.
On Saturday 20 we arrived at Barajas airport in Madrid, where we were impressed by the expressions of recognition and applause dedicated to some Doctors without Borders who would face ebola in West Africa. We left Casablanca in Air Morocco, authorized by the international control of the epidemic, arriving from Freetown at dawn on Sunday 21.
On the way to Freetown we observe a country in curfew with deserted roads and numerous points of the army and the police for the control of temperature and obligatory washing of the hands. We appreciate the terrible reality of the population and the causes of the proliferation of the disease when passing through the population of Port Loko where the number of sick people grew, becoming a dangerous way of access to the capital.
Upon arrival, we received the stimulating letter from Antonio Guerrero, sent from Marianna Federal Prison, on September 22, that in those moments of uncertainty and commitment, when we were in combat, we were much more committed to the fulfillment of the historic mission:
Dear compatriots who are part of the Cuban medical brigade that helps combat ebola in sister lands in Africa:
From an unjust prison that lasts more than 16 years, I look at you and I am full of strength and pride of being Cuban.
You write another page of the value, dignity and solidarity of our people and our Revolution.
You are an example that a better world is possible.
Get five huge hugs of Gerardo, Ramon, Fernando, René and mine to each one of you in the health trench where you are.
Successes in your difficult missions.
Ever onward to victory!
My role as a logistician was to plan, organize and direct the assurances and to respond especially for the medical supplies of the collaborators that included the daily monitoring of the state of health and everything related to their needs.
Permanent collaborators faced the epidemic without protection. When arriving at Kenema, border with Liberia, we found 3 Cuban doctors in the hospital where 25 workers had died since the month of March. They supported us in everything.
Initially we observed the progressive increase of cases with a tendency to increase in the capital. The WHO predicted in September, 10,000 cases per week for December, which involved about 9,000 deaths per week and uncontrollable transmission. We do not share this criterion because the evolution of the epidemic, of transmission by contact, we relate it to the habits and customs of the population. Although we did not yet have access to the epidemiological analyzes we communicated about that to WHO specialists who offered more conservative forecasts.
I later learned from the work of Adame Cerón3 that the Centers for Disease Control and Prevention in the United States expected that by January 2015, 1,400,000 people could be affected by the deadly ebola virus.
Ubieta4 states that WHO had made a «terrorist» calculation by publishing that by the end of October there would be 10,000 weekly cases of Ebola in Sierra Leone.
The religious rite with the dead was a tradition that included the family bath with the water used to bathe the corpses; that was the main and most dangerous source of transmission, which caused foci with hundreds of affected and increased the spread of Ebola. The majority of the population did not believe in the danger of the epidemic and left the hospitals to exhume the corpses and perform that ritual, which made it difficult to control the disease.
Methods to educate the population were ineffective since illiteracy exceeds 70 %, and poverty limits the use of media such as radio, written press or television.
Mariam, Compañero, Sea Side and Barmoy hotels were hired in Free Town and a pre-contracted contract was made to the Comfort Guest House in Port Loko foreseeing the deployment of a hospital. In the Mariam the position of leadership of the Cuban brigade was located and in Compañero the collaborators designated for the hospital of the English army in Kerry Town were located.
Assurances were coordinated with the WHO logistics manager. The medical assistance determined the daily information of the health status of the collaborators and the hygienic-sanitary control of the brigades as the responsibility of the bosses.
The coordinator of pandemics and epidemics of the WHO, Silvia Bryant, suggested the disinfection of the hands with alcohol gel due to the inconveniences of chlorine, as top priority provision was made for all collaborators.
The UN clinic and the Italian NGO «Emergency» would ensure the urgent care of the volunteers and the consultations of specialties in the (Conaught) National Hospital of the Health Ministry by doctors of the brigade and by Patrick don Davies, odontologist graduated in Cuba whom I met while he was a student at the Odontology Faculty of Villa Clara University of Medical Sciences, who agreed to portray with the author, as shown in the picture.
The advanced group of the Cuban brigade «Henry Reeve» carried out the medical examination, and coordination for the logistic assurance, the location and the operation of the units according to the possible deployment of the hospitals.
Declaration of interests
The author declares not to have any conflict of interest.
BIBLIOGRAPHIC REFERENCES
1. Cuba. Ley No. 75 de la Seguridad Nacional. La Habana: Oficina del Estado Cubano; 1994.
2. Cuba. Directiva No. 1 del Consejo de Defensa Nacional para la Reducción de Desastres. La Habana: Oficina del Estado Cubano; 2005.
3. Adame Cerón MA. Ébola y la mundialización epidémica. Ecorporeidad, geopolítica y biomedicina dominante. México: Ediciones Navarra; 2014.
4. Ubieta Gómez E. Zona Roja. La experiencia Cubana del Ébola. La Habana: Ediciones Abril; 2016.
Submitted: March 13 2017.
Accepted: March 17 2017.
Rafael Rufino Corona Pérez.Villa Clara University of Medical Sciences. Cuba. E-
mail: rafaelcorona@infomed.sld.cu
Copyright (c) 2017 EDUMECENTRO
