GUIDE FOR HEALTH CARE WORKERS ON EBOLA CONTROL by Gbemisola Leigh

Ebola virus disease is a severe illness in humans caused by infection with the Ebola virus. It is transmitted in human populations through person to person transmission from contact with body fluids, secretions of infected and symptmatic cases of the disease.

Health care workers are at a high risk of getting infected and have frequently been infected while caring for patients and can also spread it to other patients and family members.  

This is a simple Ebola control guide for EVERYONE who works in a health care setting and has the potential for exposure to patients or infectious materials including body fluids, contaminated equipment and contaminated environment. These include Physicians, Nurses, Laboratory scientists, Pharmacists, Nursing assistants, Therapists, Technicians, Students, Clerks, Laundry, Security, Maintenance, Volunteers, Cleaners, Mortuary attendants etc.

Simple ABCD guide for Health care workers on Ebola Control
A        ALERT
B        BARRIER
C        CLEAN
D        DISPOSE

ALERT

• Be alert to any case of Fever and History of Contact (where contact is sleeping in the same household with someone who has Ebola, contact with a case of Ebola whether dead or alive or touching his/her clothing or body fluids) or Travel/visit history from places where there is Ebola outbreak.
•  High Fever and symptoms: Headache, Vomiting, Loss of appetite, Diarrhoea ,Weakness(patient may be unable to sit, talk, stand, eat) ,Abdominal pain, Body aches, sore-throat
•  Unexplained bleeding of any kind 
• Any unexplained death

 If you detect any suspected case, isolate immediately, and contact the nearest Ebola response centre in your state.  

BARRIER

• Always practice universal precautions and standard infection control measures as you do not know who has the infection 
• Use of Personal protective equipment (PPE): The PPE to be used depends on risk assessment. For every day clinical consultations, ensure gloves are worn and hand hygiene performed before and after contact with patients. For handling of patients with Ebola, the full PPE recommended for their care should be used: clean non-sterile gloves, clean gown and head cover, mask and eye protection or a face shield and boots.
•  Follow proper procedures for use of PPE’s. Risk of infection is high when they are not used correctly.

CLEAN

• HAND WASHING is very important. This should be done with soap and water. Wet hands and apply soap, rub all surfaces with soap for about 40-60 seconds. Rinse with water. Alcohol based hand sanitizers can also be used. 
• Hand washing should be done before and after any contact with patients, also after removing gloves and PPE. It should also be done after touching any object near your patient. 
• ENVIRONMENT: routine cleaning and disinfection of the environment and surfaces should be done. (Remember everyone needs to be protected, including the cleaners). 
• LAUNDRY: do not handle soaked or used linen with bare hands; always wear protective clothing and gloves. Handle them in a way that it doesn’t contaminate other patients on the ward.

DISPOSE

• Adequate sanitation and safe disposal of sharps in designated sharp bins Ensure safe waste management to prevent reinfection.
• Waste handlers need to be trained on safe waste disposal, practicing of hand hygiene, disinfection and wearing of PPE to prevent contamination.
•  For mortuary attendants: it is important to note that dead bodies of persons who had Ebola are highly infectious, dispose of bodies in a safe manner that will prevent direct contact with the body or secretions. 

Protect yourself and others around you, together we can stop the spread.    

Dr. Gbemisola Leigh is a Community Medicine Resident Doctor in the University College Hospital, Ibadan. She has a DTM&H from the University of Liverpool.She writes on health issues through her page www.facebook.com/plainhealthtalk .

WHAT YOU NEED TO KNOW ABOUT THE PROSTATE GLAND

What is the Prostate gland?

It is a gland that ONLY men have. Its main job is to make some of the semen (the fluid) that carries sperm. It is normally the size and shape of a walnut.

Where is the Prostate gland?

The prostate gland lies under the bladder and surrounds the urethra (the tube that carries urine and semen. (Refer to the picture below)

Prostate gland

What are the common prostate health problems?

•   The most common is 'Benign Prostate Hypertrophy (BPH)', which basically means an enlargement of the prostate gland. It is caused by the prostate gland growing in size with age. It is not cancerous and can be treated. It commonly affects men from the age of 50yrs
• Prostatitis: It is caused by Infection or Inflammation of the prostate. This can affect men of any age, but its commoner between 30 and 50years
•  Prostate Cancer- this is the most common cancer in men in Nigeria. Some men have symptoms of prostate disease, others may have no symptoms. It develops when cells in the prostate grow in an uncontrolled way.

What are the symptoms of prostate problems?

A lot of prostate symptoms can be explained by where it can be found in the body, surrounding the urethra(the pipe that carries urine), so if it becomes bigger (in BPH, prostatitis or prostate cancer), it will compress on the urethra and slow down flow of urine. They include:

• ·         Needing to urinate more often than usual
• ·         Difficulty in starting to pass urine
• ·         Difficulty in stopping urine flow
• ·         Straining while passing urine
• ·         Taking a long time to finish urinating
• ·         Feeling of incomplete bladder emptying after urination
• ·         Poor urine flow
• ·         Needing to rush to the toilet to urinate, urine may leak before getting to the toilet

Others are

• ·         pain on passing urine
• ·         pain when ejaculating
• ·         blood in the urine or semen

What to do

1.       If you have any of the symptoms above, visit your doctor for further assessment (a urinary tract infection can also cause the above symptoms).

2.       Remember that Prostate cancer may show no symptoms, it’s advised that men above the age of 40years get a yearly prostate cancer screening. This involves a Digital rectal examination where the doctor will feel your prostate for any hard or irregular areas or to know if it is enlarged and a PSA (prostate specific antigen) blood test.

Reference

1.       www.prostate-cancer.org.uk

2.       Picture credit: Google images (www.webmd.com)

NUTRITION FOR NURSING MOTHERS

While preparing to write this article, I asked a nursing mother friend of mine what advice she had gotten from people on what to eat while nursing her baby and she said 'most of the advice we get is about what to eat during pregnancy, many people don't talk about what to eat while nursing a baby'. Another mother said, 'A lot of advice given is to drink a lot of pap everyday to increase flow of breast milk and avoid sugary things to prevent 'jedi-jedi' in the child'. Some mothers are forced to drink pap (corn meal) many times a day and some get tired after a while.

At every stage in a person's life, its always important to be on a healthy diet; whether in infancy, pregnancy, while nursing a baby or throughout life. The importance of eating good food cannot be over emphasized; as it provides the body with energy and nutrients to function maximally and remain healthy.No single food contains all the essential nutrients. Diet should contain variety from the different groups listed below

• Grains,Bread and Cereals group
• Meat, Poultry and Fish group with Other sources of Protein
• Vegetables
• Fruits
• Dairy products

Healthy options in each of the food groups include:

• Grain, Bread and Cereals group: whole wheatdproducts (bread, pasta), cereal, oatmeal, brown rice (e.g ofada rice)

• Meat, Poultry and Fish group: Lean meat, poultry without skin, fish (boil or roast rather than fry). Other sources of protein: beans, peanut, almonds, eggs, peanut butter

• Dairy products: low fat milk, low fat cheese

• Use low fat vegetable oil to cook eg soy oil, canola, olive oil

• fruits and vegetables

During breastfeeding, a lot of energy is expended as the body works round the clock to produce breast milk. Also a lot of fluid goes into the breast milk. Every nursing mother needs to ensure that her food intake is regular. You don't need any major changes to your diet as long as you are eating a healthy balanced diet.

Its also important to stay hydrated. This is the reason why many women are adviced to drink a lot of 'pap'. Whether its pap you're taking or water, the important thing is to stay hydrated. Signs that your body is not getting enough water are thirst, concentrated urine ( very yellow urine), dry mucous membrane. If you notice any of these, you need to increase your fluid intake. Be careful about taking sugary drinks as it can cause weight gain. Remember that Pap is made from ground maize, which is mainly starch so taking large quantities can also contribute to weight gain. There should be a balance, don't eat too much of anything.

There's also a need for vitamins. This can be gotten from food or by taking nutritional supplements. Rich sources of vitamins are fruits and vegetables. Calcium can be gotten from low fat milk. Check with your health care worker on what nutritional supplements to take.

Avoid regular intake of alcohol if breastfeeding as it can be passed into the breastmilk. Also make sure you don't take any medications that havent been prescribed by your physician. Smoking should also be avoided.

If you have weight loss concerns, you can see a dietician who can work out a diet that'll still provide all the essential nutrients you need but help with weight loss.

In Conclusion, eating a balanced diet and staying hydrated is important while nursing your baby. Variety is the spice of life, don't stick to only one food, chose different foods within the different food groups and make sure you stay healthy during this beautiful period of nursing your baby.




Pap: A traditional Nigerian porridge made from maize
Jedi-Jedi: Yoruba term for Pile

References:

1.  A Stewart Trusswell. ABC of Nutrition 2003
2. DASH eating plan

BURN INJURY

Burns occur when there is contact between the skin and fire, or heat from the sun, or corrosive chemicals, or electricity. A scald is caused by something wet, such as hot water or steam¹.

They lead to damage to the skin and can develop blisters and scalding. Although adults can get burn injuries, it’s very common with children

Tips on how to prevent Burn Injuries

• Do not carry a pot, container filled with hot water or hot liquid with children around
• Use a kitchen cloths to handle hot pans and pots and don’t carry them with your bare hands
• Clean promptly spilled fluids on the kitchen floor , as this can predispose to slips and falls and burns if the person is handling a hot object
• Keep hot objects out of reach of your children and away from the edge of tables
• Create boundaries in your home: don’t let your children wander around cooking stoves, or burners, or naked flame and wires.
• Keep chemicals in well labeled bottles and far from the reach of children. I’ve seen cases where corrosive chemicals are placed in a soft drink bottle or other harmless looking containers and handled by unsuspecting people.
• If in areas with high temperatures where you can be prone to skin burns, protect your skin with a sunscreen and wear protective clothing
• It’s important to train your house help on all these tips, because a lot of times they spend hours alone with the children

What to do in Burn Injury before presenting in a health facility

• Remove the person immediately from the source of the burn injury
• Apply cool or lukewarm water to the burn for some minutes for cooling. Avoid using iced water or creams on the burn area.
• Cover the burn with cling film (if available) and remove clothing and jewelry around the burn area. Take care not to rub anything against the burn area

• If in pain, you can administer pain killers like paracetamol
• Take the person to the nearest health facility

 

References

• http://www.nhs.uk/conditions/Burns-and-scalds/Pages/Introduction.aspx?url=Pages/what-is-it.aspx

FIRE

How prepared are you if there’s a fire in your home, office, or car? Do you have fire extinguishers that are functioning? Do you know how to operate them? Fires extinguishers are best for small contained fires and the best time to learn how to use one is now (before a fire). Nobody prays for a fire to happen where we live or work, but we need to be prepared in the event of a fire to ensure safety.

If you are looking to buy or rent a house; one of the things you should consider is fire safety; are there escape routes? If it’s a story building, is there a safety staircase or fire escape?

Tips for preventing fire accidents

1. Always switch off electrical appliances at the main socket when not in use
2. Cultivate the habit of maintenance; Do not use faulty electrical appliances and make sure they are fixed promptly
3. Avoid overloading of electrical circuits
4. Candles are commonly used in many homes in this environment; make sure it’s placed in a candle holder, far from curtains, furniture and reach of children. When leaving the room, snuff out the light of the candle and don’t sleep off with a candle on.
5. Do not use insecticides, body sprays near naked flame.
6. Ensure that burners are turned off
7. Do not keep inflammable fluids like petrol, kerosene near burners, or stove

If a fire accident occurs

8. Don’t stop to pick anything and don’t try to hide in a closet, try and get out as fast as you can
9. Cover your mouth and nose with a piece of clothing while trying to get out to prevent inhaling the smoke and suffocating
10. Stay at low to the ground as possible as smoke always rises and crawl on the ground
11. Don’t stop to take personal belongings, your safety should be first
12. Never go back into a burning building once safely outside
13. Stop, drop on the ground, and roll to extinguish flames if an article of clothing catches on fire

Practice fire drills at home, even with your children. Fire drills are a simulation of how everyone will respond if there’s a fire and the alarm goes off. Teach your children these safety tips, teach them how to prevent fires, what to do if they are somewhere and there’s a fire accident whether at home or in school.

The Little things matter

One of the things that I find surprising when watching home videos is that if a person collapses, whoever is around just starts crying immediately and assumes they are dead, but they are rarely taken to the hospital. You’d say that’s a movie script; but I also see it commonly in real life. I once witnessed an accident, where a bus hit a motorcycle and the motorcycle driver and passenger were seriously injured. The accident happened a few metres away from a nearby hospital, but nobody felt those first few minutes after the accident were important. People gathered around the injured men and started shouting for some minutes; I managed to move closer and started shouting that there was a hospital nearby and they should be taken there but nobody listened and they just kept on screaming and wailing. 

  The little things you do in an emergency situation might just be what will save a person’s life. Accidents come up unexpectedly and a lot of times we feel, ‘God forbid’ it can never happen to me; but this is not about whether something negative will happen to you or not, it’s about equipping yourself with the knowledge and skill needed to save someone’s life if you are in a position to do so.

General principles of managing emergency situations include;

1. DON’T PANIC  :The easiest thing to do in any strange and fearful/deadly situation is to panic, but it is more helpful to control your emotions or horror, pause and think fast; ask yourself what is happening and what can I do?
2. SAFETY FIRST : if the situation is unsafe for you, do not endanger yourself; wait for experts to intervene
3. CALL FOR HELP: have an emergency number you can call in case of emergencies; make sure it’s a reliable one/ call a professional who can run you through on what to do 
4. ACT: in case of emergency situations where you have the skill to administer first aid eg stop active bleeding; act fast to save the person's life.

Watch this space as i start a new series on my blog in the next few weeks on what to do when faced with some common medical emergencies. It will also feature how to prevent these accidents from occurring.

Follow on twitter @gbemileigh

What to eat when you're expecting

Pregnancy is a time in a womans' life that comes with a lot of changes; physically, emotionally and socially. Every pregnancy is different; and people have a whole range of varied experiences with food; from wanting to eat peppery food, to loss of appetite, to craving sweets and chocolates, to getting easily nauseated by the smell of food. Some women have a normal appetite throughout and don't even feel like they are pregnant at all. Others have several episodes of vomiting for months that makes it hard to keep food down; in situations like these, eating small regular meals might help with the nutrients you need. Eating healthy is a very important investment to make during your pregnancy as it helps you to stay healthy and is also important for your baby's growth and development.

An interesting part of my consultation with pregnant women during their antenatal care is hearing a lot of questions about they should eat or avoid eating; questions that stem from cultural food taboos. A lot of these food taboos suggest that some particular foods have direct effects on the baby. When food is eaten,it is digested in the gut and nutrients are absorbed into the bloodstream of the mother. The baby gets nutrients from the mother through the blood exchanged in the placenta; so technically its not the 'rice or beans' literally eaten that gets to the child but nutrients from them. Some common false food taboos in this environment include

• staying away from eating snails to prevent excess spit in the child and having a child that is slow in learning : Snail is actually a good source of protein for the mother and growing baby

• Pregnant women are told not to drink cold water as this can lead to early Labor and give the child epilepsy

• Eating meat is said to cause the swollen legs seen in pregnant women

• Eating plantain causes the baby to have 'awka' or anterior fontanelle. which is a natural space in the skull of newborns.

• Eating egg (especially fried) causes early contraction

• Boiled groundnut and coconut will cause the baby to vomit a whitish substance

• Sugary drinks will lead to 'Jedi-Jedi in the baby

So what should your diet consist of when you are expecting the birth of your baby? Generally, the principles of eating healthy in the normal population are the same as in pregnancy. Diet varies according to your preference and family eating pattern and
should consist of the following:

• Fluids: take a lot of fluids daily to keep well hydrated. Avoid caffeinated beverages. Be careful with sugar containing drinks so as not to have excessive weight gain. Water is preferrable to other fluids.

• Fruits and vegetables

•  Milk and dairy products

• Protein

• Whole grains, cereal and Carbohydrate

• Alcohol should be avoided as it can be harmful to the baby

Overeating should be avoided, as this can lead to obesity and cause problems for the baby.
It is important to avoid eating raw vegetables,raw eggs,unpasteurised dairy products eg 'wara'as this can predispose to having bacterial food poisoning. Ensure that all foods eated are properly cooked

Also, the following are a list of vital nutrients a pregnant mother needs

• Folate: folate requirement increases during pregnancy and a woman requires  about 400ug of folate/day for supplementation. It is more important in the first 28days post conception to prevent some malformations in the baby and since most women do not know they are pregnant until weeks after conception, it is adviceable to start supplementing before conception. It is also important in the last trimester. It can be taken as supplements or in  dietary sources which include leafy green vegetables, citrus fruits, beans, peanuts. It is destroyed by prolonged cooking.

• Iron; Iron requirements increase in pregnancy and during lactation.Meat is a good source of absorbed iron, however iron is usually also supplemented in pregnancy with pills.

• calcium: a good way of getting calcium needed for placenta and lactation is by drinking milk. 0.5litre supplies about 600mg of calcium.

Women with special health needs in pregnancy like diabetes, obesity, hypertension might have special dietary needs and will need to discuss with a dietician for a suitable diet.






References
1.A Stewart Trusswell. ABC of Nutrition 2003