Table of Contents
How to stop the outbreak of Ebola – Proposal for Action
Clinics based in flatpack containers
Other Personal protective Equipment Normeca International AS has available in stock:
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 International 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:
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 International 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