Escobio, Favila

Nouvet, Elysée

English

Scholarship@Western

Western University Scholarship@Western Health Studies Publications Health Studies Program 3-16-2019 Ebola virus disease and palliative care in humanitarian crises Favila Escobio Medecins Sans Froniteres Elysée Nouvet The University of Western Ontario Follow this and additional works at: https://ir.lib.uwo.ca/healthstudiespub  Part of the Medicine and Health Sciences Commons Citation of this paper: Escobio, Favila and Nouvet, Elysée, "Ebola virus disease and palliative care in humanitarian crises" (2019). Health Studies Publications. 93. https://ir.lib.uwo.ca/healthstudiespub/93 Correspondence1100 www.thelancet.com   Vol 393   March 16, 2019Ebola virus disease and palliative care in humanitarian crisesDR Congo is currently facing its tenth outbreak of Ebola virus disease (EVD) since the virus was discovered in 1976. As of March 3, 2019, there were 897 confirmed cases, with 563 deaths (including confirmed and probable deaths).1 Although potentially effective ring vaccination trials have been integrated into the response against EVD, the risk of further propagation of the outbreak remains high. The virus has spread to densely populated urban areas, and parts of the country where optimal surveillance and health­care delivery are dangerous and sometimes interrupted due to the presence of armed groups.Since the mortality in individuals with EVD is high (around 50%)2,3 and no effective pharmacological treatments have been identified, many patients with EVD will die, even in the best circumstances. In October, 2017, the Lancet Commission on palliative care4 pointed out that palliative care has been largely ignored, especially for the most vulnerable populations and those living in humanitarian crises. In The Lancet, François Lamontagne and colleagues5 highlighted just how entrenched the problem is.Although Lamontagne and col­leagues’ guidelines stress the impor­tance of supportive and psychosocial care to alleviate the burden of suffering and severe distress associated with EVD, these guidelines do not acknowledge the value of this care for all patients regardless of outcome, even death. This is consistent with other published recommendations for EVD patient management.5,6The value of these guidelines is clear: to facilitate faster and more standardised care informed by a synthesis of existing (albeit limited) evidence on what is most likely to help patients affected by EVD. Nevertheless, until curative treatments for the management of EVD are available, clinical guidelines and specific protocols for EVD must include clear recommendations and instructions on the integration of palliative care into the delivery of optimum care for patients with suspected and confirmed EVD.Guidelines on palliative care for EVD need to be clearly defined so that its value and place in high­fatality humanitarian crises can begin to gain practical traction and acceptability. Clearly defined guidelines on palliative care would also legitimise training and dialogue on palliative care in contexts where staff have no previous experience treating patients with EVD.6Palliative care and pain relief are essential elements of universal health coverage,4 but much more should be done to make it part of any health intervention. A first step is to ensure that health professionals, patients, and families understand that palliative care can improve patient quality of life and prevent and alleviate suffering. Ensuring that palliative care gets explicitly integrated into guidelines for care of critically ill people, including but not limited to patients with EVD, is of equal importance.EN report grants from Elrha Research for Health in Humanitarian Crises. FE declares no competing interests.*Favila Escobio, Elysée Nouvetp.favila@gmail.comMedecins Sans Froniteres, Rome 00185, Italy (FE); and School of Health Studies, Western University, London, ON, Canada (EN)1 WHO Regional Office for Africa. Ebola virus disease. Democratic Republic of the Congo. External situation report 31. https://apps.who.int/iris/bitstream/handle/10665/311104/SITREP_EVD_DRC_20190305­eng.pdf?ua=1 (accessed March 6, 2019).2 WHO. Ebola virus disease. Fact sheet. 2018. http://www.who.int/mediacentre/factsheets/fs103/en/ (accessed Nov 20, 2018).3 Shultz JM, Espinel Z, Espinola M, Rechkemmer A. Distinguishing epidemiological features of the 2013–2016 West Africa Ebola Virus disease outbreak. Disaster Health 2016; 3: 78–88.4 Knaul FM, Farmer PE, Krakauer EL, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet 2018; 391: 1391–454.5 Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence­based guidelines for supportive care of patients with Ebola virus disease. Lancet 2017; 391: 700–08.6 Dhillon P, McCarthy S, Gibbs M, et al. Palliative care conundrums in an Ebola treatment centre. BMJ Case Rep 2015; published online Aug 21. DOI:10.1136/bcr­2015­211384. Department of ErrorOvadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019; 393: 899–909—In this Article, the correct author name is Chiara Di Ilio; Prof Laura Bull highest degree is PhD, not MD; and, in the Summary, under Results, stillbirth occurred in 0·91% of pregnancies, not in 0·83% of pregnancies. These corrections have been made as of March 14, 2019.Cameron D, Piccart-Gebhart MJ, Gelber RD, et al. 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial. Lancet 2017; 389: 1195-205—In the Declaration of interests section of this Article, statements have been corrected for Jose Baselga, Mitch Dowsett, Christian Jackisch, Martine J Piccart­Gebhart, Luca Gianni, Michael Untch, and David Cameron. These corrections have been made to the online version as of March 14, 2019.Lamb N. E-cigarettes. Lancet 2019; 393: 876—In this Correspondence, the wording of the first sentence of the second paragraph has been corrected to: “The House of Commons Science and Technology Select Committee recommended that the UK Government take an evidence­based approach to reviewing the regulatory environment for e­cigarettes and snus oral tobacco.” The third paragraph has been corrected to: “We also called on Public Health England to support a long­term, independent research programme to strengthen the e­cigarette research base and help ensure that health­related evidence is not dependent solely on the tobacco industry.” These corrections have been made to the online version as of March 7, 2019.Published Online March 7, 2019 http://dx.doi.org/10.1016/S0140­6736(19)30539­2Molins L. Patient follow-up after tissue-engineered airway transplantation. Lancet 2019; 393: 1099—In this Correspondence, the corresponding author’s email address has been corrected to lmolins@clinic.ub.es. This correction has been made to the online version as of March 5, 2019, and the printed version is correct.Published Online March 5, 2019 http://dx.doi.org/10.1016/S0140­6736(19)30535­5

Ebola virus disease and palliative care in humanitarian crises

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Ebola virus disease and palliative care in humanitarian crises

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