2. Port Loko EVD Survivor Clinic
Baptist Eye
Hospital, Lunsar
3. Central Aims
• To systematically detect and treat
ocular Ebola-sequelae in all Ebola
survivors residing in Port Loko (PL)
and Kambia districts.
• To systematically detect and treat
other medical and psychosocial
sequelae of Ebola among survivors
residing in PL and Kambia districts.
4. Timeline
• Clinic started operations in mid-March
• Through July 20th, a total of 643 unique
survivors seen in clinic
Month # New Patients
March 103
April 200
May 184
June 144
July 12
5. Scope and Activities of Clinic
• Find and reach out to all known Ebola survivors residing in the district and
provide free transport to come to the clinic
• Utilizing PIH’s survivor network and SLAES and for outreach and social mobilization
• Provide eye, general medical and psychosocial care for all EVD survivors
• Vitals signs
• Patient interview/history
• Physical exam
• Ocular exam: visual acuity, slit lamp, dilated fundoscopy
• Medication dispensing and teaching
• Psychosocial assessment/support
• Referrals for chronic care or acute care
6. 9%
19%
22%
12%
26%
15%
61%
16%
75%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Headache
Subjective Fever
Difficulty Sleeping
GERD
Ear/Hearing Symptoms
Uveitis
Eye symptoms
Costochondritis
Arthralgias
Prevalence of Symptoms/Diagnoses on First Visit to Clinic
* Uveitis N=648, costochondritis N=197, all others N=277
7. Accomplishments
• Nearly all survivors in Port Loko and Kambia districts have been seen
• Better understanding of prevalence of various Ebola sequelae
• Of 96 patients diagnosed with uveitis, 51 had improvement with
treatment (treatment for some still ongoing)
• Survivors are very active in implementing the entire program –
outreach, in-clinic support, follow-up
• Opportunities to engage survivors into existing healthcare system for
antenatal care, TB testing, etc.
8. Challenges & Unknowns
• Social outreach
• Absence of complete registry of all survivors in the district
• Survivors and their families have fears about engaging with health care facilities
• Difficult to reach communities-- no phone, poor roads, requires boat ride, etc.
• Many survivors died in community not long after discharge– unclear cause
• Trying to “catch-up”
• Many patients discharged in the fall are getting care months after discharge
• Some interventions are time-sensitive such as for eyes and ears
• Lack of curative treatment for joint pain
• Often, NSAIDs and steroids only relieve pain temporarily. No long term ability to
manage pain. Consider physical therapy?
9. Challenges & Unknowns (cont.)
• Specialty care/diagnostics
• Difficult to get accurate assessment for neurological symptoms
• Ear Symptoms- no ENT; brief window (7-10 days after symptom onset) for
intervention
• Currently, scope of “free care” often very limited in practice
• Eye complications needing surgical intervention
• IPC issue: Presently no way to intervene for survivors who have developed cataracts,
often as a result of inflammatory disease process related to Ebola
• Psychosocial Concerns
• Source of livelihood and finding employment is prominent concern among survivors
• Affects housing, education, nutrition and more
• Major losses in familial support
11. Improving Access to Care and Social Support
for EVD Survivors
• Coordinate community outreach and link Ebola affected individuals
and their households with partner organizations, health facilities, and
government services to complement the efforts of the Ministry of
Social Welfare, Gender, and Children’s Affairs.
• Strengthen the socioeconomic mobility of program participants, esp.
via access to education
• Strengthen the Sierra Leone Association of Ebola Survivors [SLAES] as
a sustainable community-owned platform for self-efficacy, social
support and advocacy among survivors
12. Organizing and Employment
• At its inception in October 2014, the SP program utilized grassroots community
networking by empowering EVD Survivors to recruit fellow survivors while organizing
their own associations at the chiefdom level with weekly meetings.
• These weekly chiefdom level meetings provided a platform of opportunities, services,
and access to care to be strengthened.
• Upon enrollment into the SP program, survivors receive financial assistance,
new/replacement government ID cards, and local bank accounts to support reintegrating
into their communities; along with replacing destroyed household items, and obtaining
personal documents lost during the decontamination of their households.
• At the programs onset, qualified program participants of working age were offered
employment opportunities as social mobilizers, case managers, and OICC
• Engaging survivors in the Ebola response provided employment while significantly
reducing stigma for survivors in their communities and adding value to Ebola messaging.
13. Reintegration Efforts To Date
• Back-to-School Packages – 300
• Discharge Packages – 449
• Employment – 835
• Clinical Care – 946
• ID Cards – 517
• Bank Accounts – 490
• Adult Literacy – 450
• Vocational Support – 250
• Educational Accompaniment – 340
14. Building Back Better
0
200
400
600
800
1000
1200
1400
Partners In Health Survivor Program Activity Breakdown
Hired Coordinated Employment Providing Support
Month Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16
Hired 15 52 225 586 637 688 209 165 118 86 91 106 106 91 91 76 76 76 76
Coordinated
Employment 0 58 95 121 147 0 0 0 0 0 0 0 0 0 0 25 50 100 200
Providing
Support 0 0 0 0 537 612 271 191 444 124 167 1040 1210 1210 1000 1000 750 750 750
16. Program objective:
To urgently detect and treat uveitis in Ebola survivors, in
order to prevent long-term permanent vision loss.
This program builds on the pilot work achieved at Baptist
Lunsar Eye Hospital, where 600+ survivors have been screened
and over 100 survivors have been treated for uveitis, led by
MOHS, DHMT, BEHL, Partners In Health, GOAL, and IMC.
17. Program Approach:
1) Establish partnerships
2) Support existing eye care facilities
3) Establish new strategic points of care throughout SL
4) Collaborate with DHMT’s and Ebola survivor networks
5) Partners to provide operational support
6) Refer survivors into pathways for non-eye care support
7) Transition the program into the long-term strengthening
of the MOHS National Eye Care Program
18. Supplies:
Medication and equipment for identified facilities has
been provided to the MOHS through Partners In Health
and a grant from the Paul G. Allen Family Foundation.
Clinical Staff:
Clinical staff to be provided through MOHS National
Eye Health Programme and private facility staff.
Additional auxiliary staff to be provided by partners.
19. Clinical Training:
MOHS, in coordination with Sightsavers and other
partners, including Emory University, will provide
ongoing training for staff.
Harmonized Data & Database:
Partners will provide Data Clerks to collect data at the
point of care. Data will be collected using the MOHS
harmonized form, which will be inputted into a
spreadsheet, which will later feed into the harmonized
database when it goes live.
20. Survivor Health Advocates (SHA’s):
SHA’s are the link between survivors and eye care facilities
The SHA’s will ideally be survivors themselves
They will be chosen following a 3-day training/exam period
The SHA’s are responsible for identifying, organizing, and
accompanying survivors to eye-care facilities for screening
Once diagnosed, the SHA will support the patient through
their course of treatment by weekly home visits to ensure
adherence to treatment, monitor for side-effects, and
provide a link to other support
21. District Facility Partner(s) Status
Bo Bo Govt. Hosp. GOAL TBD
Kenema Kenema Govt. Hosp. GOAL TBD
Kono Kono Govt. Hosp. PIH Referring
Tonkolili TBD MSF - Holland Referring
Port Loko Baptist Eye Hospital Lunsar GOAL/PIH/IMC Ongoing
Kambia Baptist Eye Hospital Lunsar GOAL/PIH/IMC Ongoing
Koinadugu TBD Medicos de Mundo? TBD
Bombali Makeni Govt. Hosp. GOAL TBD
Moyamba TBD Medicos de Mundo? TBD
W. Urban &
Rural UMC Kissy & Connaught GOAL/PIH
PIH – Ongoing
GOAL – TBD
22. Referral pathways:
Help connect and refer survivors to venues for comprehensive
care as they are established.
Long term strengthening:
When uveitis screening and eye treatment is complete for
survivors, transition capacity to supporting the broader
National Eye Health Program.
23. Dr. Kerry Dierberg
Executive Director, Partners In Health Sierra Leone
Kdierberg@pih.org
Katie Bollbach
Director of Policy and Partnerships, Partners In Health Sierra Leone
Kbollbach@pih.org
Gabriel Warren
Survivor Program Manager, Partners In Health Sierra Leone
Gwarren@pih.org
