I met Tony Onena in Gulu two weeks ago. Tony just returned from Monrovia in Liberia where he helped combat Ebola as a nurse
Just returned from West Africa in Monrovia City in
Liberia, one of the most experienced Ebola nurses in Africa tells his unique
story about the numerous hemorrhagic outbreaks in Uganda and West Africa.
He helped to stop and shares his powerful but simple
suggestions about global and local preparedness - from a rare practical and
comparative perspective. Among his recommendations are:
· Better selection of health workers.
· Practical training and better managements.
· Sharing of experiences.
· Closer government attention to social practices.
· Gatherings are essentials…..and early preparation for unexpected
hemorrhagic fever that can hit anywhere globally.
Gulu
in Northern Uganda February 2015
Tony
Walter Onena a 63 years’ old, Retired Registered Nurse served for 34 years and
8 months in Uganda Ministry of Health, before getting mandatory retirement
while at Gulu Regional Referral Hospital on January 10, 2012.
Tony
Onena from Northern Uganda in Gulu District is probably yet the only health
worker I have met to have beaten Ebola 6 times: 5 times in Uganda in 2000,
2007, three outbreaks in 2012 and now he beat it in Monrovia, Liberia in West
Africa.
Tony
is a strong hearted personality, he doesn’t fear anything: Ebola, jealous
colleagues, hospital directors, international researchers or presidents.
Gulu
outbreak 2000
When
Ebola struck Gulu in Uganda in 2000 Tony didn’t know at first what it was until
he attended a funeral in a village close to St. Mary’s Hospital Lacor, where
people talked about the disease that would strike and never missed target to
kill as majorities who were infected in Gulu died.
The
following day when he returned to Gulu Regional Referral Hospital on Monday,
October 10, 2000, the Medical Superintendent of Gulu Referral Hospital, Dr.
Felix Ocaka Kaducu cancelled annual leaves to all the Nurses and Doctors and
requested them to return for work to face the deadly Ebola disease in the
medical isolation ward.
Nobody
volunteered at the start except Tony Walter Onena, while other colleagues
reacted negatively for fear of the deadly Ebola disease. Onena walked together
with Dr. Kaducu to face Ebola on the ward. Later, after they left for the
highly infectious ward, other volunteers slowly reported in, when WHO and the
Ministry of Health organized special payments for lining up pockets.
One
of the first World Health Organization (WHO) experts specially trained to fight
Ebola who came to Gulu in Northern Uganda, was Dr. Simon Gardel, whose
practical training, immediately caught Tony’s full attention because his
practical and simple training methods made sense in Gulu.
Tony,
who practiced Journalism and was working with Vision Group in Uganda, during
his free time as a Nurse, secretly recorded WHO expert, Dr. Simon when he was
training Gulu Health workers on how to face Ebola disease. He learned all the
procedures by heart that enables him to carry out nursing procedures for
fighting Ebola.
The
Dr. Simon was particularly keen and strictly sticking to simple routines. Tony
many times saw how Dr. Simon would loudly and promptly criticize anybody who
was sloppy, lazy, dropping injection needles on the ward, or carelessly
handling infective patient material, blood or linen. Tony still remembers Dr.
Simon saying, “Regard any used injection needle left lying on the ward as an
exploded bomb that can kill anybody after accidental prick”.
At
the beginning, before the arrival of WHO expert, Dr. Simon, “We had been
putting on simple gloves and without proper Protective Personal Equipment,
(PPE) and most of us operated under great health risk that lead to many health
workers death in Gulu, particularly at St. Mary’s Hospital Lacor.” said Tony.
Dr.
Simon, the expert from WHO brought in new ideas of putting on triple gloves,
protective suits and basic protective routines of handling patients. Washing
hands with chlorine mixtures that kills the virus of the deadly Ebola was a
must, before touching and after touching the patient to avoid spread of Ebola
infection. .
Follow
the money
Tony
was worried about the payment issue, an issue that would come up again and
again, also in West Africa, Monrovia - Liberia. The introduction of a special
payment for Ebola work tended to attract a type of health workers that were
charmed by the extra salary more than they were dedicated to being careful
health professionals working in a hazardous environment.
Tony remembers how their sloppiness out
everybody at a risk: needles left in patients beds or on the floor, blood drops
left on clothes or unidentified clothes, linen and drip lines left on the
floor. It also attracted people that liked to give orders and get a high pay
for it and that taught Tony two things: separate management from the clinical
team: management should take place outside the clinical setting.
You
train the team, go through the routines until everybody is fearless, safe and
confident and they should work as a uniform team that does not jeopardize each
other’s safety. Some managers tried to interfere and take advantage of Tony’s
team but he learned to separate clinical care of Ebola patients from management
issues. That, he says, gained him a lot of enemies, but his teams have always
beaten Ebola and none of the team members contracted Ebola disease.
Monrovia,
Liberia August 2014
Tony,
through his good recommendations’ record from Gulu Regional Referral Hospital,
to Ugandan Ministry of Health, the World Health Organization, contracted him as
Ebola Case Management Consultant alongside other team from Uganda to go and
help combat the deadly Ebola disease in Liberia.
When
they arrived at night in Monrovia on Friday, August 8, 2014, the following day
on
saturday,
they were assigned to a very big hospital, John Fredrick Kennedy (JFK) Hospital
where MSF had been treating Ebola patients but they shut it down, when some of
their health workers had been infected and died of the deadly Ebola.
At
JFK Ebola treatment Unit, the bed capacity for Ebola patients was only 35, but
shortly after 13 WHO Ebola Case Management consultants team, from Uganda
arrived, the rumor must have spread as he said: “They came with three
ambulances the first day with 12-15 patients in each Ambulance and by the end
of the day, the number of patients were overwhelming the health workers as 70
patients were admitted to a ward with capacity of only 35 bed.
As
in Gulu the Ebola extra pay had attracted types of health workers that were no
dedicated to combatting Ebola but merely looking at Ebola as a financial
Empire. That turned out to become a factor that significantly delayed the Ebola
response in Monrovia.
The
Liberian health workers were less impressed and went on strike because they
claimed their government was a hindrance to the top up money, WHO had planned
to pay for the Ebola fighters in Monrovia.
On
one day, Liberia Speaker of Parliament, and a Member of Parliament for
Mountserrado County came to Island Clinic, Ebola Treatment Unit where Liberian
Health workers engaged them in a hot heated argument about their salary.
That argument about the salary was not so simple and the
two parliamentarians invited Liberian President who came to settle the matter
before it had exploded in to a maximum strike. When the President arrived, she
got the health workers who were angrily charged and wanted the president of
Liberia to dress in the Ebola personal protective Equipment, outfit
and go the wards to get a feeling of how stressful the job was.
“At
one point”, Tony recalls, “I was very worried, because our Liberian colleagues
were so frustrated over the lacking salaries that they decided to wrap up one
of the Ebola victims dead body, to carry the corpse to the Ministry of Health
and dump it there to demonstrate their anger”. They were stopped but only last
minute.
Tony
explains: “People of Monrovia don’t have gardens to dig, they don’t have their
own food, so they have to buy food, and that requires a salary”. Tony is
certain that the salary issue seriously delayed the Ebola response and should have
been dealt with months before.
Fatal
private clinics
An
even more worrying, and ignored, consequence of the lacking salary to health
workers was that health workers in frustration started to open up their private
treatment clinics at home to earn some money for survival. Unfortunately, as
they handled patients in their clinics, they became infected though they were
trained by Ebola Case Management consultants.
Tony’s
gaze becomes distant explaining this; he is almost counting the huge number of
cases that must have followed from this disorganized and dangerous practice
hidden from authorities and the media. He acknowledges that, the health workers
did it for survival that lead to Ebola to infect them.
Tony
remarks “Many of these nurses ended up dying from Ebola themselves in their own
clinics because they lacked skills and equipment and their training was simply
not up to date”. Tony says that one of the experiences he gained during Uganda
outbreaks was physical seeing the patient being treated as part of the training
in the treatment of Ebola. He said theoretical training is very good but that
is not enough for handling the deadly highly infectious disease: “you should
learn by doing, not just by listening”.
Forced
to focus on treatment
Another
factor that Tony keeps mentioning is that practically all health facilities and
works were employed with Ebola management. But patients of course kept coming
with other acute health problems as diarrhea, malaria, tuberculosis, AIDS or
NCDs. These patients were treated as Ebola patients but initially didn’t suffer
from it – they contracted it in hospital.
The
weak health care system in Liberia forced donors and international aid
organisations to focus on treatment and management of cases, while the most
important activity: public messages, were given less priority. That was a huge
mistake but what else could they do under the circumstances?
Ugandans were good
listeners
Comparing the Uganda Ebola
response to the situation of West Africa Ebola, Tony has a lot to say. “For one
thing, Ugandans are good listeners. If we tell them: don’t shake hands and
don’t sit too close in church, forget to grab your lovers for huge on the chest
during Ebola period. Ugandans would listen to the health workers.
That wasn’t the case in Liberia
where the health massages fell on death ears and Ebola could not be fought for
only one month as it had been to many Ebola outbreaks in Uganda. In Uganda
church masses were split up into 8-10 church services per day only allowing
smaller groups to enter at a time, so that attenders could sit with space
between them. Markets were organized better etc.
That was never done in
Liberia – there was poor contact between World Health Organization Ugandan
teams and the Liberian health authorities for planning to contain Ebola within
short time. Had the Liberian Health authorities contacted us to tell them what
we did in Uganda during Ebola, we could have shared this kind of information –
we felt they either ignored or didn’t want know our past experiences in
fighting Ebola”.
The experienced Ebola expert
lists his suggestions for future outbreaks, some of them are controversial he
admits, but necessary he says:
1. Better protective gear should be
provided. Protective suit should have oxygen and better ventilation so health
workers can work for longer periods and not be interrupted by fatigue as
often.
2. Transparent body bags for safe
but (more) culturally appropriate funerals.
3. Cameras should be installed to
observe management and for training of new staff. It also serves to minimize
physical patient contact while maintaining emotional support.
4. Money should not be the sole
criteria for attracting health workers: they should be carefully selected.
Incompetent sloppy health workers put the other team members at a high risk.
5. Experienced Ebola management
teams should always be called in and their experience should be collected and
used after careful local adaptation. An international unit should secure that
previous experience is made available to local response teams and
authorities.
6. Church services should be
organized to minimize physical contact. Public messages about greetings
should be in place. Schools and markets should be re-organized to minimize
contact.
7. Issues of salary should be dealt
with promptly before they jeopardize safety and delay management.
8. Fleeing doctors and nurses and
abandoned health facilities can be avoided by better training and constant
supervision. The three weeks closure of the MSF hospital in Monrovia is
likely to have delayed the response.
9. Morning briefing meetings should
be held every day with all stakeholders’ incl. bus services, market place
managements, police, religious leaders and school leaders. Normal information
systems are not working and many counterproductive rumors can be dealt with
at these meetings.
10. Public messages should be prioritized but it
requires that health workers are well trained for emergencies.
11. This thing (Ebola) can happen anywhere – so
prepare for the event, don’t wait for it to happen
12. Tony believes that there should be scientific
intervention in the production of personal protective equipment for fighting
Ebola by use of hydrogen peroxide to produce oxygen for the health workers
during their services on the ward.
|
A strong elephant
Tony
observed huge differences in death rates between different hospitals in Monrovia.
Every day these data would be published, but nobody seemed to react to them,
Tony recalls: “We (the Ugandan team) had very low death rates because we had
routines and good training, but the other hospitals did not perform as well”.
Some
health workers even became jealous and asked “why don’t the Ugandans contract
Ebola, die and go home in a coffin?” He was proud of the fact that it was
their experience from Uganda, and meticulous routines that did the trick – not
some kind of magic – and he didn’t bother about the wickedness of the remarks.
“I am a strong willed man confident that Uganda routines will combat Ebola”, he
concluded.
When
Tony finished his 4½ month assignment in Monrovia, Liberia, his Liberian
colleagues gave him a walking stick with a handle in the shape of an elephant.
You are strong as an elephant they told him. He had confronted administrative
mismanagements, fear, jealousy and he beat Ebola for the sixth time.
“I
have great optimisms to change Personal Protective Equipment (PPE) that can
make Ebola fighters to stay longer than two hours on the Ebola highly
infectious ward. If I could be given chances to plan with the medical
scientists on what to do, in the manufacture of PPE.
Secondly,
use of cameras on Ebola ward can help very much for training health workers on
how to fight Ebola. The relatives and journalists who come to Ebola treatment
units for news and relative also can be able to see their Ebola patients on
ward by tactful means of using such cameras on the ward.” Said
Tony.
Morten
Sodemann, below is the correct contacts that can reach me (Tony Walter Onena).
I am therefore requesting you for update of my contacts because the one you
released has an error. This means that, those who want to contact me will never
go through. I hope I will be very grateful if for that correction of the
contacts.
Lastly,
I am reminding you if you could organize with the authorities concerned there,
to give me a chance to come for one of the health meetings around THE WORLD and I talk to the medical scientists,
about improving PPE for longer use on Ebola ward.
For
contact to Tony Walter Onena:
EMAIL:
tony.onena@gmail.com
SKYPE:
twonena.
PHONE:
+256 772 961 615 / +256 794 895 658 / +256 716
961615
For
media and other accounts of the 2000 Ebola outbreak and its heavy toll on
heroic health workers:
Associate
Express: http://www.ugandamission.net/health/news/ebola.html#01-1008
Bulletin
of the WHO: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560656/pdf/11196502.pdf
Fighting
Ebola in 2000 at Gulu Regional Referral Hospital IN Northern Uganda, where I
retired as Senior Registered Nurse, and that time I had already practiced
journalism since 1995 while serving under Uganda Ministry of Health.
ENDS………………………………………….
--
TONY WALTER ONENA.
UGANDA PHONE:+256 772 961
615
UGANDA PHONE:+256 711 961 615
UGANDA PHONE:+256 794 895 658
LIBERIA PHONE:+231 880 034
193
SKYPE: twonena.
Photo: Tony shakes hands with President Museveni (Photo: Tony Onena)
