Fighting Ebola with education Published Dec. 21, 2015 By Kevin M. Hymel Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- A man in an Ebola-stricken area complains to health officials that he feels ill. The officials, clad in full-body protective suits and face masks, guide him to a stretcher and secure him with straps. As they carry him to a health clinic he begins vomiting. Fortunately, the man does not have the Ebola virus, he is merely spitting out water in an exercise to teach medical teams to effectively treat patients in the midst of an outbreak crisis. When the Ebola epidemic struck West Africa in 2014, it killed medical teams as well as unsuspecting civilians, leaving even fewer trained professionals to deal with sick and the dying in an already medically underserved area. The governments of the affected countries reached out to their U.S. Embassies for help. Embassy officials, in turn, contacted their respective combat commands for a solution. It came in the form of the Defense Institute for Medical Operations (DIMO). A Defense Department school, DIMO had already developed a large spectrum of courses on topics such as disaster response, medical administration, public health, infection control, and patient transport. “We use the training to build capacity in our international partners,” said Dr. Matthew Dolan, the director for Academic Development at DIMO and an infectious disease physician, “so that they are better able to address regional problems.” Dolan and Maj. (Dr.) Charla Tully, also an infectious disease physician, developed the Ebola Awareness Training, a two-week medical training program, which included one week of Ebola training and a second week of first responder training. DIMO also selected multiple five-member teams of instructors from the U.S. Air Force, Army, Navy, National Guard and Reserve. In July 2015, DIMO conducted its inaugural course in Accra, Ghana, as part of the West African Disaster Preparedness Initiative (WADPI), a four-month long training event hosted by the Kofi Annan International Peacekeeping Centre and attended by 13 West African countries. Medical teams from 12 of the West African nations rotated two-at-a-time through the training program. Making up the paired countries were Ghana and Benin, Togo and Senegal, Burkina Faso and Ivory Coast, Liberia and Nigeria, and Cameroon and The Gambia. Guinea-Bissau and Mali took solo courses. The training covered all phases of clinical operations, including infection control for Ebola, a first responder training course, and teaching field skills within an Ebola-epidemic environment. “Our goal was to develop administrative planning for Ebola, provide confidence and competence with protective equipment, and address community outreach,” said Dolan. The DIMO team helped the students develop plans for safe performance in clinics and hospitals while providing patient care. Each class included a safety officer who validated that the checklist for safety and compliance procedures was followed properly. “Administrative procedures were the biggest key to safety,” said Dolan, “especially with removing the gear after patient care.” Students learned and practiced Ebola triage, patient movement, and clinical care. They received extensive training in equipment through skills-based training. “The courses were very exercise oriented,” said Dolan. The training emphasized becoming proficient in procedures despite the protective gear and the heat. “We would test them with an ultraviolet dye to test for cross-contamination when they took off their gear.” The students dove into their roles. Medical teams practiced triage and Ebola care, while team members playing Ebola victims carried water containers, which they used to simulate vomit and diarrhea. “Nowhere I have ever been, have I seen so much enthusiasm for an exercise,” said Dolan. As the students progressed the DIMO team picked the best class participants and made them instructors. “Some individuals possessed great skill in presenting,” Dolan explained, “so we just familiarized them with the course.” After 17 weeks of intense training, African instructor cadres were now ready to handle Ebola patients safely and effectively, as well as train a new generation of clinicians to contain the deadly virus. “The countries were very pleased with the work in Ghana and told us they would like to work with us further on their in-country training and program development,” said Dolan. “We left them happy.” Dolan’s team later told him the West Africa trip had been a powerful and moving experience. The way the students embraced their training impressed the DIMO instructors, including Dolan. “We had an Interior Ministry official from Liberia as part of the teaching faculty,” Dolan said. “He went on to teach, and wrote that he plans to teach the course in Liberia.” Dolan believes a combination of motivated new teachers and teaching materials will help “in making Liberia and its healthcare facilities safer.” After hearing from the African medical staffs about how devastating the Ebola virus was for the whole healthcare system, Dolan sees more humanitarian assistance courses in the future. “The time I spent hearing stories about Ebola was very moving,” he said. “And there is a real interest in West and Central Africa to be ready for the next Ebola attack.”