Duty of care and health worker protections in the age of Ebola: lessons from Médecins Sans Frontières

McDiarmid, Melissa; Crestani, Rosa

analySeS oF HealTH rISkS relaTed To THe job propoSed Months before the WHO declared the Ebola outbreak an international public health emergency in August 2014, MSF teams were already deployed to multiple sites in the affected West Africa region, providing patient care, contact tracing, community outreach and logistical support to the Ebola response. At the height of the agency's involvement, MSF had 14 different Ebola treatment projects across Guinea, Liberia and Sierra Leone, ultimately caring for about one-third of the total patients affected by the crisis. 7 Prior to undertaking any of these new missions, experienced MSF staff conduct a health risk analysis (Action 1). Using a checklist to assess context, political background, health risks and population beliefs and behaviours, a general profile is determined for any new mission being considered. For Ebola missions, the availability of protective clothing, the circuit or layout of the treatment building and the training level of the staff is assessed. The overall risk is graded with a specific tool to determine if the risk is acceptable to undertake. If the mission is undertaken, monthly biosafety expert visitors from headquarters augment baseline safety assessments by performing monthly monitoring, again using checklists and a colour scale (green, yellow, red) for each performance element. This is shared with the local staff at the site level to encourage improvement over time. The health focal point also addresses ongoing health worker risk management and the 'wash' supervisor (water, sanitation and hygiene) reviews and provides feedback for the wash staff (staff who perform decontamination, laundry and burial duties).