Ebola diaries: All in a day’s work

Jose Rovira-Vilaplana

A logistician with 25 years of experience, Jose Rovira-Vilaplana has supported all types of outbreaks and emergency responses, from Marburg fever and Ebola virus outbreaks, to deploying to Mexico before and during the H1N1 pandemic. He was in the first WHO response team to arrive in Guinea in March 2014, when Ebola Zaire was identified there. Logisticians are the “doers” – the ones who make sure that everything is in place so that a response can take hold. Their work requires everything from overseeing construction of treatment centres, to taking swabs from cadavers for laboratory testing, to garnering support for necessary outbreak activities.

Logistician Jose Rovira-Vilaplana overseeing distribution of 2.6 tons of PPE to Conakry's first treatment centres and other locations. WHO/T. Jasarevic

"Along with members of the European Union Mobile Laboratory Consortium and a few WHO colleagues, I was among the first responders to arrive in Conakry. The WHO outbreak response team was one of the first organizations to arrive in Conakry, and the first to arrive and set up an isolation centre at Kipe hospital, the modern hospital that treated the person who brought Ebola to Conakry from Guékédou, via Macenta.

We worked fast. I went with WHO’s clinical team to meet a group of people thought to have Ebola virus disease. We interviewed them to find out how they had come into contact with Conakry’s first case of Ebola. These people included the head of oncology, as well as the very surgeon, nurses and anaesthetist who operated on this first case. Three of these five people later died of Ebola.

Meanwhile, within two days of our arrival, the European Union laboratory team had already deployed to Guékédou to set up the laboratory that would allow for on-site diagnostics, reducing the need for lab sample air transportation.

No one wanted to house Ebola patients

One of my jobs was to identify locations for and build isolation and treatment centres for these affected healthcare workers and other possible Ebola patients. No one wanted to house Ebola patients. Everyone was afraid of Ebola. Some even suggested that we build the Ebola treatment centre 20 kilometres away from Conakry in a landfill.

Finally, we were able to rehabilitate a derelict cholera treatment centre located in Donka hospital, the national reference hospital, into an Ebola treatment centre. Rehabilitation included everything, even installing electricity. Immediately, the infected medical staff from Kipe hospital were transferred to Donka and as the outbreak developed, other Ebola patients were admitted.

The work was non-stop

The extremely limited resources and fear of outbreak expansion, however, pushed WHO and partners to build another treatment centre at Donka hospital, next to the existing one. Then, we had to disinfect Kipe hospital. The work was non-stop. Between Kipe hospital and the new Donka treatment centres, WHO had to go to two facilities every day, in addition to our other work. We were constantly travelling between the two hospitals.

In addition to this work, there was plenty to do to set up response systems.

The library in the WHO country office was transformed into WHO’s Ebola operations centre.

A Ministry of Health operations room was set up as an Ebola call centre to handle calls from people who were sick, or needed transport for sick patients or wanted to report possible Ebola cases.

We worked to develop more efficient means for transporting materials and responders between Conakry and Guékédou, provided support to the national lab, and assessed the safety of current burial techniques and infection and control measures.

"In addition to providing PPE for the ongoing response in Guinea, we had already pre-positioned PPE in Liberia and Sierra Leone from the WHO emergency stockpile in Dubai. We had already anticipated outbreaks there and realized its importance." Jose Rovira-Vilaplana, WHO

In any outbreak, the urgency of the situation means that rapidly identifying the right steps to take and convincing the key people that these approaches are in everybody’s interest is vital. This is a difficult task.

Shortly after our arrival, we also met with the President of Guinea, where we discussed outbreak response strategies. At this time, the outbreak was only known to be in Guékédou. He offered us full support. This was especially helpful because within two days, customs and import procedures for Ebola response equipment were eased, enabling WHO to distribute 2.6 tons of personal protective equipment (PPE), hours after arrival.

By then, the outbreak in Conakry had started and WHO was able to immediately dispatch this PPE to Kipe Hospital as well as to the reference laboratory in Donka hospital and to national central warehouses. By the end of March, in addition to providing PPE for the ongoing response in Guinea, we had already pre-positioned PPE in Liberia and Sierra Leone from the WHO emergency stockpile in Dubai. We had already anticipated outbreaks there and realized its importance.

These tasks are all in a day’s work for the ever changing challenges of emergency response logisticians."