Katiko Referral Hospital, Kapoeta, Sør Sudan

Table of Contents

Normeca AS. 1

Table of Contents. 2

How to stop the outbreak of Ebola – Proposal for Action.. 3

The Proposal. 4

Clinics based in flatpack containers. 5

Type A.. 6

Type B. 7

Type C.. 8

Type D.. 9

Type E. 10

Price example - Type E. 11

Staff for the clinics. 12

Available medical staff. 12

Other Personal protective Equipment Normeca AS has available in stock: 15

Mobile Care Unit. 16

 

How to stop the outbreak of Ebola – Proposal for Action

We have been following the outbreak of Ebola in West Africa from the news and we have tried to read our self a bit up on what's going on, how Ebola is transmitted with more. We have not been in these areas, nor we have been working with Ebola earlier, but we had an outbreak of measles in South Sudan during our work there, and we got it stopped quite effectively within very short time without any dead. It was an outbreak of measles six months earlier 150 km away from our hospital, where we were not involved that resulted in 2400 infected of which about 800 died. We therefore have some experience with infection and countermeasures from areas missing most of the infrastructure.

Normeca AS was running a 180 beds hospital with accommodation for 150 staff in South Sudan and when we learned about the measles outbreak we made a decision to send out our own medical teams the same day, they were to go from household to household to try and find possible infected people. At the same time we requested to receive as many vaccines as possible that were available in South Sudan. We got 5,000 doses the next day. Within a week we had vaccinated 5,000 people and transported 30 infected patients to a temporary isolation that we established in tents behind the hospital. We managed to narrow it down to around 30 infected and no one died despite the fact that most lived in Kapoeta one of the largest village in the area with some thousand people. We actually got quite a good recognition in a UN report that was prepared afterwards.

Otherwise we are aware that you maybe cannot compare the disease or the area with the measles outbreak in South Sudan, but still there should be some opportunities to stop or severely limit the extent of the outbreak with targeted actions and work.

 

We have compiled this booklet for information about what Normeca can assist with the current conditions in West Africa. If you find any information missing and/or you would like more information regarding certain things, please do not hesitate to contact us any time at jan.karlsen@normeca.no.

 

The Proposal

We have the following proposal:

1.       Setting up the smaller units where necessary, either in tents or flat packed containers as isolates/ clinics. It is likely that it is not necessary with negative pressure inside with filtration/purification of the air out, as Ebola is not transmitted through the air. It is only transmitted by direct contact with the infected patient or the body.

2.       Train local staff as informants to the families/relatives of the patient so they can get all relevant information both about how diseases is developing in the individual patient and not least the risk of infection and the required precautions. The same informants can also be used to run information sessions with the local community about the risk of infection and the required precautions.

3.       It should be considered whether one or two dependents can visit the patient for a while each day, as this can be done with minimal protection as long as there is no direct contact between the patient and the relatives. This is to avoid discontent and riots while they most likely will get a better understanding of the disease and what is being done for the individual patient.

4.       When fatal, make a special room with glass wall were the family and friends can take farewell with the deceased before the body is taken into the body bag for the funeral. This room for the relatives could be made as a kind of a “Mosque” or a “Church” depend of the religious faiths in each area and for that one who want it an Islamic or Christian Priest could be present too. 

5.       Or as an alternative or both when fatal, offering 2 or 3 relatives to take care of and wash the deceased before the funeral. This requires the creation of a separate place where this work can be carried out under the supervision of a person with the necessary knowledge about the risk of infection. Similarly, conditional on the fact that the relatives are provided with necessary protective suits and other necessary equipment. Obviously, this is a cost, but should be limited to approx. USD 30-50 per. relatives in protection, etc. We did exactly the same in Phuket after the tsunami, as it was very important for many people and especially that people with Islamic faith to be able to wash and take care for their deceased before taking them to the funeral. This is a very important issue. 

6.       We believe it should been using body bags with window to the funerals, so all relatives can see the deceased. This is to let them be sure that it is the right body in the body bag and everyone can see the face of the deceased.

7.       This means involving the families and relatives in a significantly greater extent through the entire process so that they can learn and inform others in the community about the disease, contagion and the necessary precautions to avoid becoming infected themselves.

8.       We believe strongly after our work especially in Kapoeta in South Sudan, but also in Haiti that it is very important to involve all the local Chiefs in the area in the operation. When need of local workers, let the local Chiefs be agree who should work. Let the local Chiefs put together teams in their own area to be trained. Let these teams go from family to family to seek for possible infected victims and in the same time inform the families what to do if someone get sick. It is very important to get as many as possible of the locals to be a part of the operation in one or another way and to give them a strong feeling of how important their work is to make the operation to be a success.  

 

What it concerns essentially of such a program or commission is a quorum leadership with ability, organization and logistics. We believe the rest will come naturally after some few weeks or months. What might be an equally big challenge is the cost. We assume that the costs for the individual patient with fatal outcomes will remain at a maximum of $ 30-50 for protective gear and body bag with window and by not fatal to a maximum of USD 20-30 in protective slightly depending on the number of days as inpatient, as well as number of visitors. In addition, the delivery time can maybe create some challenges, as the ocean freight will take 40 to 45 days and airfreight cost almost more than the clinics we believe.

Clinics based in flatpack containers
We assume that a clinic with 36 beds with 18 beds for men and 18 beds for women, toilets and showers, reception, waiting area, office, and rest area for staff, a medical clinic, a lab and possibly a small mortuary will be around USD. 5 – 600 000 + / - and up to USD 1 million. We have not calculated specifically about it, but the price will also be depend on the level of equipment and not at least local availability of food, accommodation of staff, laundry, etc. It will of course be some less expensive to set up everything in frame tent.

We have ready proposals on five different types of Ebola clinics in different sizes based in flat pack containers with or without equipment:


Type AProduct page

Type BProduct page

Type CProduct page

Type D Product page

Type E Product page

 

Regardless of everything else, these structures can be used as clinics in the future for the locals if they are built using flat packed containers. These containers may be used for decades if they are maintained properly. Normeca can, if desired, provide complete solutions including the management and all necessary staff independently or in cooperation with other relevant organizations/actors if anyone should require this. The most important thing maybe is that in case we get a mandate from the MOH in the respective countries to work on behalf of the authorities. We can be the link between the MOH and other actors/ organizations to coordinate the efforts and total work in this area of "missions" in each country.

 

This will quickly cost some million USD, but what is the alternative and what will the cost be if the number of infected both increases and spreads inside and outside the current areas. It seems better to use a smaller amount now than a huge amount later when it can be in many ways is too late.

ü  Normeca can within few days put together the necessary management team to run an operation like the description in this document.

ü  We can ship the first clinics around 14 days from order and after that we can ship around 1 to 6 clinics every week depending on the sizes.

ü  The construction time each clinic is around one week, but again, this is depending of the size.

ü  We expect that we can set up at least 3 – 5 clinics each week after 4 – 6 weeks – maybe more if it is taken by air.

Price example - Type E

 

List #

Description

Qty.

Price

Total Price

01-00

Infrastructure

1

376 471

376 471

01-01

Ward - 6 beds

2

8 458

16 916

01-08

Cleaning Ward

1

1 775

1 775

01-10

Office x 2 Workstations

1

3 822

3 822

01-27

Waiting room

1

2 420

2 420

01-28

Reception

1

1 295

1 295

01-30

Doc. Office

2

12 853

25 706

01-34

Laboratory

1

25 755

25 755

01-43

Morgue

1

34 565

34 565

01-44

Personal Protective Gear

1

13 300

13 300

Total price

502 023

1

Freight  to site

1

65 000

65 000

2

Insurance

1

35 000

35 000

Total  price including freight and Insurance

602 023

 

These given prices is based on the possibility to connect to local power and water/waste water sources, if this is not possible there will be an additional cost for power generator and water/waste water system. The building is also without AC to keep the cost down, but including ceiling fans. We will maybe recommend A/C in each room since the humidity is very high most of the time in these countries.  Nobody know for certain, but since you can be infected through sweat and no one knows for certain whether the virus follows hydronic steam that can sit on walls and/or equipment otherwise, you will at least be able to eliminates most of that risk with use of A/C. If you are going for A/C, you have to add USD 15.000 to the price for all rooms.

 

 

Staff for the clinics
We can offer turnkey solution inclusive necessary staff for each 12 beds clinic Type E.

 

Estimated staff each clinic;

Position

No.:

USD Monthly

Clinic manager

1

To be quoted separately

Adm/Accounting

1

To be quoted separately

Reception

1

To be quoted separately

Doctors

3

To be quoted separately

Nurses

6

To be quoted separately

Nurse Assistant

6

To be quoted separately

Cleaning + 1 Driver

3

To be quoted separately

Total

21

 

 

Screening teams with MCU

Position

No.:

USD Monthly

Nurse (Team Manager)

1

To be quoted separately

Assistant + 1 Driver

3

To be quoted separately

Total each Team

3

 

 

Screening teams without MCU

Position

No.:

USD Monthly

Doctor

1

To be quoted separately

Nurse

1

To be quoted separately

Assistant + 1 Driver

2

To be quoted separately

Total each Team

4

 

 

The monthly cost will includes training, insurance, travelling/air tickets, food, accommodation and daily personal protection equipment.

 

These prices are based on at least five clinics each country and three screening teams each clinic.

 

Available medical staff

Regarding deployment of doctors and nurses to West Africa, we can offer the following:

 

 

After 7 – 10 days

After 15 – 20 days

After 30 days

Total

Weekly rate USD

Doctors

20

20

30

70

To be quoted separately

Nurses

100

100

100

300

To be quoted separately

 

We can maybe increase the number of staff after 40 - 50 days with 50 more doctors and up to 200 to 300 more nurses or maybe even more. Tis might make it possible to have up to 150 doctors and close to 1.000 nurses ready within 50 - 60 days in total.

The prices will include round trip air ticket, personal protection equipment every day, insurance/ evacuation of our own staff if they get infected of Ebola and including food and accommodation.

 

The prices will be based on at least 100 nurses and doctors all together.

 

Most of the staff can do both screening and treatment of Ebola patients.

 

The staff is from different countries in Asia like Japan, the Philippines, Thailand, India and different countries in Middle-East, Europe and Africa. All staff is checked and approved by Normeca and they will all have to sign a Code of Conduct and a Confidential Agreement before they start working.


We can also offer management staff with experience in the medical field from disasters and wars in different countries around the world to co-ordinate the work, especially the screening. 

 

All our medical and other staff going for fight against Ebola has to go through a 2 days training program in Dubai before departure to the final destination. We will especially have focus on how to protect our self against Ebola, how to use the different kind of protection equipment and - how to take of the protection equipment again without be infected. We will also have focus on how to co-operate with the local communities and how to get the local community to work together with us against Ebola - please see the draft to program below. We can arrange this training session for other organization too.


FIRST DRAFT

PROGRAM FOR MEDICAL STAFF GOING TO WEST-AFRICA  INFORMATION ABOUT OPERATION EBOLA

 

DAY I.

09.00 – 09.10 Welcome – Introduction about “Operation Ebola”.

09.10 – 10.00 Introduction about Normeca and our different services

10.00 – 10.30 Ebola – back ground - when was the first infected diagnosed – some statistics

10.30 – 10.45 Coffee breaks

10.45 – 11.30 How to treat Ebola patients – what can we do

11.30 – 12.00 How to protect us self from not be infected

12.00 – 13.00 Lunch

13.00 – 13.20 Different types of protection equipment/decontamination

13.20 – 13.40 How to clean/disinfect beds, equipment and other things after use

13.40 – 14.00 How to handle/make destruction of infected blood and body fluids in a safe way

14.00 – 14.30 How to handle/inform the relatives to the patient

14.30 – 15.00 Coffee break

15.00 – 15.30 How to clean the bodies before the funerals - use of body bags

15.30 – 16.30 Summary/discussion

19.00              Dinner

DAY II

08.30 – 09.00 Questions from the day before

09.00 – 09.45 How to screen the area for possible infected patients

09.45 – 10.30 How to inform the local community and how to get them to co-operate with you

10.30 – 10.45 Coffee breaks

11.00 – 11.30 Insurance – how to handle own staff if infected – medical evacuation

11.30 – 12.00 Code of Conduct/Confidentiality Agreement

12.00 – 13.00 Lunch

13.00 – 14.00 How is the work in the field – experience shared/good to know

14.00 – 15.00 Basic information about the countries affected by Ebola

15.00 – 15.30 Coffee breaks

15.30 – 16.00 Normeca rules – use of Normeca uniform during work and travelling

16.00 – 17.30 Summary/discussion

19.30              Dinner

 

This is the first draft to a program for medical staff going to Africa for working with Ebola patients. The program can be changed and we reserve the right that the program can be extended to three days.

It will be used both internal and external speakers.

It will be used speakers with experience from work with Ebola patients

The personal security to not be infected during the work will be in focus.

These two days will also have focus on team building

All Normeca staff going to work in West Africa has to go though this information meeting in Dubai or Abu Dhabi before departure.

 

For safety reasons we will rotate the staff every 3 weeks to prevent the medical personnel to get carless in any way when it comes to the personal protection . It means three weeks on and one week of.


All prices are based on a six months contract minimum and with at least 50 % mobilization payment. The remaining payment is ten weeks after the work has started at the site. The payment will be calculated from the day the staffs are leaving their country to the day they are back in

 

Other Personal protective Equipment Normeca AS has available in stock:

No.

Picture

Product Name

Description

1

PPE Bpl Kit

A set of disposable suit, goggle, N95

mask, groves and shoes cover.

2

PPE Bpl Light

The disposable gown is worn on top

of the disposable suit (no,1) to be

sure to be protected from the virus.

3

Face shield

To wear this face shield on top of the

goggle and masks will give you more

safety to protect your eyes, nose and

mouth.

4

N-95 Mask

A package of N95 mask

(20pcs/box)

5

Surgical Mask

A package of surgical mask

(50pcs/box)

6

DIF Transbag

Disinfection transportation bag can

be used with positive and negative

for transporting infected

patients. It can be placed on

stretchers and wheel chairs.

7

DIF Hood

A protection hood with ULPA filter

cuts 99.9995% particles of size

0.1μm.

8

Body Bag

Disposable transport bag with a

window for dead bodies.

Size: W800xL2250mm

Weight capacity: 160kg


Normeca can supply any kind of protection equipment and body bags quite quickly to very reasonable prices from one of our many partners around the world and all of them factories without any expensive middlemen between - please ask for offer today.

 

Mobile Care Unit

The Mobile Care Unit (MCU) is a unique standalone multidevice examination system for portable or stationary use, controlled by a dedicated touch screen user interface.
"It integrates modern communication tools making telemedicine operation reliable and affordable.

ü  Recommended for Screening, Telemedicine and eHealth projects

ü  Wide range of examinations: ECG, SP02, NIBP, Spirometry, Urine Analysis, Blood Glucose, Cholesterol.

ü  User friendly operation via touch screen commands; no medical background necessary

ü  Ultrasound available for examinations of abdomen, obstetric…

ü  Easy to customize and interface with existing telemedicine platforms

ü  Ideal for remote areas, emergency, primary care and prevention

ü  Video consultation, Second opinion

ü  Secured operating system, remote service & support