Two University of Wisconsin-Madison Department of Medicine faculty members—Dawd Siraj, MD, MPH, professor (CHS), Infectious Disease, and Daniel Shirley, MD, MS, assistant professor (CHS), Infectious Disease —traveled to Ethiopia this summer to advise public-health leaders on ways to improve preparedness for a potential Ebola outbreak. 

Although the largest Ebola outbreak in history, which took place in West Africa from 2014 to 2016, did not impact Ethiopia, the East African country is the second-largest on the continent and home to the most extensive network of airline connections in Africa.

Currently, there is an Ebola outbreak in eastern Democratic Republic of the Congo (DRC), which is adjacent to South Sudan, a country with a large refugee population and a shared border with Ethiopia.

“There is always a fear that Ebola will travel to Ethiopia and there will be an outbreak there,” explained Dr. Siraj.

Ebola screening and treatment infrastructure 

On the request of Ethiopia’s vice minister of health, Drs. Siraj and Shirley met with the leader and staff members of the Ethiopian Public Health Institute on July 10, 2019, to assess the Ebola screening and treatment infrastructure at Addis Ababa Bole International Airport.

During the tour, they observed how all arriving passengers are first screened with thermal scanners to determine body temperature. Passengers with suspected fever are moved to a separate quarantined area and questioned to determine whether they came from a high-risk area, and whether they have any symptoms. Those deemed at risk are then moved to a special Ebola treatment unit, also at the airport, until a final diagnosis can be made.

Drs. Siraj and Shirley agreed that the overall infrastructure was well-run, and offered suggestions for improving patient flow, communication, risk identification and safe removal of personal protective equipment.

“We felt like we could give this feedback, because we had worked through similar issues on how to make that type of infrastructure work in a fixed space,” said Dr. Shirley, who since 2014 has been the physician lead for UW Health’s Special Pathogens Care Team, an interdisciplinary team of volunteer healthcare providers and staff trained to care for patients with highly pathogenic infections, including Ebola.

“UW Health is still a CDC-designated state treatment center,” he continued. “We keep up our training and protocols, and hold quarterly simulations at the UW Health Clinical Simulation Program to maintain the infrastructure.”

A need for ongoing training

Drs. Siraj and Shirley hope to continue collaborations to enhance Ebola screening at Addis Ababa airport, and also to tackle the challenge of screening at Ethiopia’s many land crossings, especially those shared with South Sudan.

They also hope to work with Ethiopian partners to develop a training program on the management of highly transmittable pathogens—possibly building on their work at UW.

The day before their tour, Dr. Shirley had co-moderated a session, “Pressing Issues in Infectious Disease,” at the 4th Annual Current Issues in Medicine and Surgery: Update 2019, held at Tikur Anbessa Specialized Hospital, the main teaching hospital of Addis Ababa University’s College of Health Sciences.

The event was presented by the Ethiopian Federal Ministry of Health and Ethio-American Doctors Fund, in partnership with the American College of Surgeons. Dr. Siraj and Girma Tefera, MD, FACS, a professor in the UW Department of Surgery’s Division of Vascular Surgery, were the course directors.

“There is a need for a well-trained group of health care providers in Ethiopia who are ready to act if there are cases or an outbreak of Ebola,” shared Dr. Siraj. 

“Over the last five to 10 years, it’s been shown that this issue comes up every few years,” concluded Dr. Shirley. “The attention goes away, but the training needs to happen on an ongoing basis.”

Resources:

• Ebola: 2018 Eastern Democratic Republic of the Congo Outbreak (ongoing). CDC.gov, Accessed September 9, 2019. 
• “UW Health Designated by State Health Services to Care for Confirmed Ebola Patients,”uwhealth.org, Published November 2, 2014. Accessed September 9, 2019. 
• UW Health Clinical Simulation Program. Accessed September 9, 2019.

Banner: Drs. Dawd Siraj, MD, MPH, right, and Daniel Shirley, MD, MS, on left. Credit: Clint Thayer/Department of Medicine.