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Surviving Ebola is only part of the story. Many patients experience "post-Ebola" symptoms -- joint pain, dizziness, blurred vision, inability to concentrate, headaches. The Ebola Survivors Clinic, opened recently at the Redemption Hospital in Monrovia, Liberia, not only offers treatment, support and training for Ebola survivors, but also helps healthcare workers better understand this disease.
A Liberian doctor, Moses Soka, runs the Ebola Survivors Clinic that opened recently at the Redemption Hospital in Monrovia. Photo courtesy of WHO/C. Bailey
The line around Redemption Hospital in Monrovia was already stretching around the street corner when Dr. Moses Soka arrived. The Ebola Survivors' Clinic had only been open a week, but word had spread and patients were beginning to come in numbers, patients of all ages and from across the city.
This is a new chapter in the Ebola story for Soka. At the height of the epidemic, Soka, a young Liberian doctor, took on one of the toughest jobs in the country. He was made the clinical director of the Ministry of Defence Ebola treatment centre (ETC) in Monrovia, where he worked through the darkest days of the epidemic.
Eventually patient numbers began to dwindle and the tide turned toward zero cases. However, it became apparent that the effects of Ebola do not end when the infection is cleared.
Staff of the Ebola Survivors Clinic at work, Redemption Hospital in Monrovia. Photo courtesy of WHO/C. Bailey
"But once cured," Soka explains, "patients began to develop symptoms, such as joint pain, dizziness, blurred vision, lack of ability to concentrate; sometimes so bad patients have difficulty returning to work."
According to World Health Organization (WHO) statistics, Liberia may have as many as 5,000 Ebola survivors. Currently, there are four such survivors’ clinics in Monrovia, with more opening in the next few weeks around Liberia. Gradually, the entire country will be covered.
The end goal is to integrate survivor care into the Ministry of Health essential package of health services as part of restoring and expanding basic health services, with WHO providing technical and logistic support, including validation of guidelines and supporting clinics with basic drugs and supplies.
At the Redemption Survivors’ clinic, patients receive treatment for these symptoms as well as training and advice on how to keep vigilant by maintaining proper hand hygiene and other practices of ensuring that Ebola, if it is the environment, does not get transmitted.
Alex Gasasira, the WHO Representative in Liberia, explains further: "Beyond treatment of the symptoms, there are many things we simply do not understand about what happens to these patients after they are cured. These clinics not only provide support for the patients, but provide valuable research data to help us determine the cause and best course of treatment."
In addition to addressing these symptoms more generally, the Ebola Survivors Clinic in Redemption is also hosting its men’s health screening program where free semen testing for Ebola virus is offered to willing male survivors who are sexually active, as well as sexual health counselling and condom distribution.
The goal is to enable them to make informed choices about their sexual health and be able to protect their partners from possible sexual transmission of Ebola. This work is also critical for research to see precisely how long remnants of the virus may survive in semen and in the eyes, as viral sanctuaries. It is thought that transmission of the virus by survivors is a very rare event but it is important to understand how long the virus persists and to ensure that survivors practise safe sex.
"Judging by the small number of cases we are aware of, it is probably not easy to transmit, but we hope to have more evidence soon to give more concrete guidance. In the meantime, we are advising patients to continue to practise safe sex for the time being until we know more," explains Soka. The previous guidance was to abstain from sex or to practice safe sex for 90 days after being declared Ebola-free.
The patients filed onto the benches in the clinic, walls brightly painted with Ebola prevention messages. As Soka turned to make his rounds, children and their mothers were guided towards a special area set aside for them while other adults were called into private consultation rooms at the end of the hall.
How did so many survivors know where to go to get help when this clinic has only been open for a week?
"We have a very strong community outreach. We are working through networks of survivors to ensure they are aware of the clinic and the free services offered in a safe environment. When in-patient wards of the hospital closed down during the height of the epidemic, WHO came in and gave us the training and the equipment to create and maintain proper infection prevention and control procedures" says Soka.
"They have helped in too many ways to mention, everything from personal protection equipment, to sharp boxes, and disinfection procedures. When the hospital reopened, the community was part of that process. What we see here in the survivors’ clinic is a sign of trust from the community that this place is a safe place of healing and they are welcome here."