The Kenema Government Hospital's Outreach team plays a crucial role in the containment of Lassa Fever. Due to the highly contagious nature of the disease, identifying cases before they have the opportunity to transmit the disease and cause large scale outbreaks is an important part of the Lassa Fever Programs battle against this deadly virus. Their work consists of conducting case investigations, contact tracing and sensitization campaigns targeted at health workers as well as the general public.
The Outreach team currently consists of team Supervisor Richard Fonnie and Outreach team Officer Lansana Kanneh.
Within 24 hours of a Lassa positive patient being admitted to the ward, the team will visit the community from where the patient was transferred. The purpose of their visit is two-fold. Firstly they want to determine whether the patient contracted the disease from a primary or secondary source of infection. In other words, was the virus transmitted to the patient directly from a contaminated rodent, or from another individual carrying the disease. They will also conduct a household hygiene assessment in order to identify any risk factors that may indicate the presence of rodent infestation. They work closely with the Ecology team who if required will trap rodents in a bid to destroy the rodent population. Secondly they must establish whether anyone may have been at risk of contracting the disease through close contact with the patient. Anyone displaying symptoms of Lassa Fever will be tested and the general health of those individuals who have been in close contact with the patient is monitored for 21 days, which is the duration of the incubation period. This may include having their temperature taken at a local health clinic on a daily basis and ensuring that any changes in general health are reported as soon as they appear.
Sometimes a patient may have traveled hundreds of miles to reach the Lassa ward. Piecing together a travel history required a fair amount of detective work and travel from the Outreach team. A clear understanding of the time and location of infection is vital if any existing spread is to be contained and further outbreaks are to be avoided. For every patient that is admitted to the Lassa ward, the team will compile a detailed account of their movements and interactions. Sometimes this information is accessible from another hospital or clinic, but most often it will require traveling to a patient’s village and interviewing family and community members.
While new tools to diagnose, treat and prevent are necessary to combat Lassa Fever, it is equally important to educate healthcare professionals on the dynamics of the disease. The Outreach team conduct sensitization campaigns where they hope to disprove some commonly held misconceptions of the disease. When talking with health workers they rely on scientific arguments to teach their audience about the symptoms and transmission of Lassa. In rural community settings where illiteracy rates are high, they focus instead on ways of engaging people through the use of videos and illustrations. The most powerful way of altering misunderstandings however, is when someone who has received treatment at the hospital is able to share their experiences with their peers.
In addition to the logistical challenges of traveling to remote villages on hazardous roads and dealing with frequent vehicle breakdowns, the Outreach team need to overcome hurdles in communication between the Lassa Fever Program and medical staff in the field. Ensuring that workers in the village health centers collect the necessary information from the Lassa patient when they first seek medical assistance is crucial to the research being conducted by the Lassa Fever Program. A thorough travel history makes it easier for the team to piece together the full story of each patient, from the first sign of symptoms to admittance to the Lassa ward. For ethical and research purposes it is also imperative that each sample that is sent to the Lassa laboratory is accompanied by a consent form in which the patient gives the Program permission to use their blood for research. Naturally a patient can opt-out of participating in the study, in which case they will get tested for Lassa and receive treatment, but their sample will not be used for any other purposes.