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← Contact tracers need multiple skills FactPod #14 starring Mosoka Fallah

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Showing Revision 3 created 12/28/2014 by Henri Willox.

  1. Au centre opérationnel d'urgence
    du Liberia, de lutte contre Ebola

  2. en compagnie de mon collègue
    Mosaka Fallah.
  3. Votre lutte contre Ebola est primordiale
    puisque vous êtes aujourd'hui responsable
  4. des traceurs de contacts ici à Moravia
    - Oui.
  5. Alors dites nous... Pourquoi est-ce
    si difficile de suivre ces contacts ?
  6. Pour deux raisons principales.
  7. La première est une question de confiance.
  8. De confiance dans les traceurs eux-mêmes
  9. Ils ont de moins en moins confiance en nous
    et c'est dû au fait que
  10. to them in time.
    also there is an issue of... our non-Ebola
  11. health services is not developed , in case
    they don't have Ebola, how do they get the
  12. best treatment?
    That means if they have malaria, pneumonia
  13. or other sorts of diarrhea... they can't find
    any treatment.
  14. Exactly. Since Ebola our health care system
    collapsed on the wake of the emergency
  15. So they don't have an alternative to go
    So they see their relatives go before... they don't
  16. have any alternative, so they are distrustful.
    Why should they tell us? They don't have an
  17. alternative.
    And the third thing is the issue of feedback.
  18. They have seen their relatives go to ETUs
    and maybe die
  19. and they didn't have the feedback in a timely
  20. And ETU is the abbreviation for the Ebola
    Treatment Units
  21. that are the hospitals or tent hospitals specially
    for Ebola.
  22. Yes, Dr. Hans.
    But I mean... is it 8 monitors you have now?
  23. Oui.
    Qui supervise cela…
  24. They are really wise.
    When I have been in the morning meetings,
  25. they understand all the dynamics
    and realities of people. Some of which are
  26. very poor.
    So when you now became in charge of this;
  27. What is the most important? I know that you
    are fixing the food now.
  28. Yes.
    Because they need food the same day that they
  29. became a case, a contact,
    so they can't go out and buy themselves.
  30. How are you planning to change or improve
    the system?
  31. Because it's already good!
    Because you took it from a catastrophe.
  32. You took it from a 100 a day down to 10 a
  33. What are the next things you want to change
  34. First I want to restore the confidence and
    I hope in building trust.
  35. Engaging local communities.
  36. Engaging lots of stakeholders. And ensuring
    that they'll have a response
  37. in a timely fashion.
    And we are talking about making
  38. practical field decisions.
    Moving case-investigators, contact-tracers,
  39. psychosocial together.
    Generate full list.
  40. Have the full list returned to the family
    in a timely fashion.
  41. Providing the psychosocial support.
    Working with local leaders.
  42. Supporting the local leaders building the
  43. Working on a feedback system where we now
    gonna have
  44. case investigators working closer with us
    and a data unit
  45. ensuring that they'll feedback in a timely
  46. As of the status of; their relatives;
    those in the ETU; and the lab results.
  47. Your people, the tracers, how many are they?
    How many people do you have who go and visit
  48. these contacts?
    In Montserrado county we have 305 tracers
  49. 22 supervisors
    currently in the two zones of the Montserrado
  50. county.
    And they have to be like detectives almost.
  51. But then you say they have to be kind also.
    They have to think about the family.
  52. Yes, so it's always a critical issue, because
    they see them as representing the system.
  53. Because they are the ones that the first time,
    if there is a death in the family, someone
  54. has to come see them first,
    and they have to be the ones who go there
  55. everyday for 21 days.
    So, yes they have to be empathetic.
  56. But also they have to be detectives.
    They have to be able to see through them
  57. and know; those who have been honest
    and those who are not saying the truth
  58. and after follow up investigation to find
    all contacts.
  59. In this epidemic there is no room for errors.
    You need to find 100% contacts.
  60. So they have to do the both.
    Be kind, at the same time as being a detective,
  61. to find out all of the contacts.
    And you never use force?
  62. I mean you don't threaten people.
    It's just their free will?
  63. Yes, Sir! We encourage the free will,
    even when deciding the concept of quarantine.
  64. We always say quarantine should be done by
    the communities.
  65. You shouldn't get the police involved.
    It should be done... it should be involved
  66. for discussion.
    There's a consensus building.
  67. It's so important because the fear we always
    have is that:
  68. if we use force, they could escape.
    If we put them under huge pressure.
  69. It has to be a friendly approach; a comunity-based
  70. You look like a very tough guy! That's what
    has impressed me you know.
  71. I've seen you almost rush out from the morning
  72. And then when you argue, you talk like a nun.
    You are very kind to people!
  73. This is probably the most important
    to be empathetic, you say?
  74. I think so. Yes!
    But you have two types of problems. One is
  75. that you don't get the contacts listed.
    They are hidden some of them.
  76. And the other is that the contacts who get
    sick, they leave
  77. because they don't want to be identified as
  78. What is the reason why they don't get listed
    in the beginning?
  79. In the beginning of the epidemic there was
    a couple of factors.
  80. One of them was that the burial team picked
  81. the body and we would not have the contacts
    coming to us in a timely fashion.
  82. Some of them road commercial vehicles probably
    ambulances, and went to ETUs.
  83. And those who did that without collecting send
    back as a feedback
  84. and line then was sent to begin contact tracing.
    That means that the list for them…
  85. and of course when they had someone who had
    died at home
  86. that was a very emotional, and very sad moment
    it's not an easy time to remember them.
  87. Exactly, and the exam of contacts and all
    those kind of questions.
  88. It's an emotional period. That stage is critical
    you can build friendship, you can build empathy
  89. and then they can reveal to you, by that time
    when they are in the though period.
  90. So now you are going to have a system where
  91. those which we call "case investigators",
    who just take care of the information of the
  92. sick
    and your contact tracer, with a list of contacts
  93. and ambulances and the burial cars
    they will be one system?
  94. Yes, we're hoping yes.
    So there can practical field decision.
  95. Because most of the time we lost a contact
    in the time past when the case investigator
  96. does the investigation and line listing,
    between that and the data unit and coming
  97. back to the tracer,
    there was a delay in time.
  98. So some of the contact listing got lost.
    If there is a field level decision
  99. where the investigator does the investigation
    the contact tracer takes the line listing
  100. and initiates investigation immediately.
    In that case I'll be very confident that every
  101. case we've seen,
    we've gone through that. We have the contacts
  102. listed and that we have followed up!