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Victoria Knott

Victoria Knott

Save the Children International, UK

Title: Palliative care in an Ebola treatment centre: Challenges from the front line

Biography

Victoria Knott completed her MBCHB in 2011 and DTMH in 2014. She has recently spent 4 months working in the Ebola response at Kerry Town Ebola Treatment Centre in Sierra Leone. During this time she was actively involved in clinical case management of patients with EVD and has a keen research interest.

Abstract

Background: The current outbreak of Ebola virus disease has claimed over 11,000 lives1. Little dialogue exists on care of the dying patient in an Ebola setting. Here we consider demographic data, and discuss our experiences of delivering palliative care at a flagship Ebola Treatment Centre (ETC) in Sierra Leone.

Results: The data collection period was 8th December 2014 to 9th January 2015. Case fatality rate was 34.7% (41/118). Of those who died, the mean age was 30.3 years and 19.5 % (8/14) under 16 years. The mean time from symptom onset to death of 9.1 days (sd 4.4) with a mean time from admission onset to death of 3.7 days (sd 3.2). 2

Discussion: Patient infectivity in life and death and necessary infection control procedures delay symptom management, limit clinician time onwards and present physical barriers to non-verbal communication. Clinician inexperience and short admission time makes diagnosis of death challenging in this young cohort, while patient isolation prevents contact with relatives and restricted burial practices cause bereavement upset.

Conclusions: Introduction of pre emptive medication preparation, employment of a clinical psychologist, 24 hour clinician presence, palliation decisions made by the senior physician and body bags with viewing panels appears to improve palliative care provision reducing patient distress and improving acceptance of death by relatives.

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