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Table 3 Health protection measures before-, during and post-deployment

From: Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study

Measures Example citation
 Health measures 1. To carefully select team members
2. To provide PPE of high quality and make standard protocols for PPE use
3. To organize 1.5 month intensive training on procedures of Ebola diagnosis and treatment, PPE use, prevention and surveillance as well as English
4. To provide mental health support to relieve anxiety
5. To provide vaccine, medicine to increase the immunity, health surveillance for all team members
6.To strengthen physical exercise
Firstly, the medical team had been carefully selected and over two-thirds had previous experience with infectious diseases and Africa. Secondly, we took active prevention such as taking vaccines, taking drugs to prevent cholera, yellow fever and malaria- and so on. Besides, physical exercise was strengthened for all medical teams. (Deputy director of ETC) We modified PPE and developed more stringent PPE protocols and procedures based on suggestions and guidelines from WHO and the CDC of China.(Leader in public health group in ETC)
 Social measures To provide help with family life events and care for team member’s children and the elderly if necessary Leaders in our institute see our families to learn about any need of health which helped to sooth their concerns about their families (Public health personnel)
 Health diplomacy 1. To visit the stadium in Monrovia and existing ETCs from other countries, and to consult with personnel in NECC and local Liberian who had study experience in China to learn more about the local physical and social environment, epidemic, health system and culture Liberia
2. To consult with Chinese peacekeepers back from or still in Liberia to learn local epidemic
A group with 5 experts from this PLA medical team visited the stadium in Monrovia, contacted with local government, the presidents and NECC in Liberia to learn the situation of Ebola control. (Leader of foreign affairs office in ETC)
We also invited Chinese peacekeepers who worked in Liberia before and Chinese experts from CDC to give lectures about Liberia to all medical team (Leader of logistics support group in ETC)
 Health measures 1. To construct ETC with strict layout of three zones and two routes and to equip it with advanced a distinctive communication system(audio loud speakers, video monitoring system and ward calling system)
2. To establish and implement a three-level safety supervision program (the first level supervision---mutual supervision between paired members; the second-level supervision ---daily supervision by the medical personals on duty; the third-level supervision---hospital-level supervision by a 10-member expert team) for all staff
3. To implement strict environmental cleanness and disinfection
4. To set up expert team to provide health service for all team members
5. To recruit the experienced local people and local people who can speak Chinese to help with communication
6. To train the newly recruited local people and group them with PLA medical team
7. To provide lectures about doctor-patient communication before receiving patients in ETC
8. To continue training on procedures of diseasediagnosis and treatment, prevention and surveillance and PEE use
9. To wear PEE, diagnose and treatment patients following the strict protocol
10. To give professional psychological counselling and health care for team member if necessary
Red zone (contaminated zone) and green zone (clean zone) were required internationally for ETC construction. We constructed ETC with one more zone, the semi-contaminated zone marked with yellow. We equipped ETC with video system to monitor operation during care for patients which could prevent HCWs infection. We recruited and trained local skilled people work in China ETC. We also recruited one local people who can speak Chinese, had background of medical education and could help HCWs to communicate with patients. (Foreign affairs official in ETC)
Unique health protection measures included strict protocol for PPE use, paired work group, daily supervision by on duty medical professionals, video and voice monitor system. The whole process of PPE dressing was watched and guided by professionals through video and voice system to minimize the opportunities of HCW exposure to Ebola. (Deputy director of ETC)
Medical team need some time to adapt to local environment at the beginning. We provide psychological service to relax them. Lectures about doctor-patient communication before receiving patients were provided for medical team. We refined ETC ventilation and disinfection measures. (Psychological experts in ETC)
 Social measures 1. To import food, equip ETC with air conditioners and mosquito killer, to purify drinking water by self
2. To have security team to ensure safety and reduce exposure to Ebola outside of workplace
3. To set up Weichat and telephone for team member communication with colleagues and families
4. To abide by the strict daily working and living schedule to ensure good rest
5. To provide care for team member’s children and the elderly if necessary
6. To launch paperless office to reduce contact with patients
We imported food for our medical team. We provided air conditioners and mosquito killer, drinking water through digging a well by ourselves and clean the water by machine we brought with. We controlled contact with local people in order to prevent from infection of infectious diseases. (Leader of logistics support group in ETC)
We set 3 approaches for medical team including (such as Weichat, telephone) to help them with communication. (Psychological experts in ETC)
We launched paperless office, for example, all patients’ diagnosis and treatment were recorded in the medical information system which prevented infection from patient’s contact. ( Senior medical technicians)
Health diplomacy 1. To join the joint command system to get diseases surveillance information
2. To apply some essential supplies from the United Nations or local government
3. To coordinate with embassy, local Chinese enterprises to mitigate supplies shortage
4. To communicate with ETCs from other countries
We join the joint command system to get diseases surveillance information. This system would release updated information about local epidemics. (Deputy director of ETC)
We applied essential supplies from UN or local Chinese enterprises through Chinese Embassy in Liberia. We also applied many essential supplies from local government. We also coordinate local Customs and Foreign affairs. (Leader of logistics support group in ETC)
Managers actively participated in communication with ETC s from other countries. (Leader of foreign affairs office in ETC)
 Health measures 1. To isolate all team members for 21 days
2. To organize experts to observe sign and symptoms
3. To provide nutritional diet
4. To provide psychological counsellors when necessary
5. To strengthen physical exercise
We could not contact with families, friends in the 21-day’s observation. We were provided with daily monitoring for signs and symptoms of Ebola or other infectious diseases. We have diet separately and the food is very good and nutritional. (Clinic doctor in ETC)
During 21-day’s observation, we recover from fatigue due to hard work in Liberia. …There were nurses and doctors monitored our health every day. (Nurse in ETC)
A lots of entertainments and psychological counsellors were provided for us. (Leader of logistics support group in ETC).
 Social measures 1. To provide comfortable rest and living conditions
2. To provide internet which would help with communication with friends and family
During observation, good living and rest conditions were provide for all medical team members. For this observation, we prepared a lot of things ahead of their come back from Liberia. (General head nurse in ETC)
Internet was provided for everyone and they could access to internet anytime. Internet helped them to communicate with families and friends (Public health personnel).
  1. Notes: HCWs refers to health care workers, PPE refers to personal protection equipment, WHO refers to World Health organization, CDC refers to centre of disease control and prevention, PLA refers to People’s Liberation Army, NECC refers to National Ebola Command Centre, EVD refers to Ebola virus disease, HIV refers to Human Immunodeficiency Virus, TB refers to tuberculosis, ETC refers to Ebola treatment centre. UN refers to united nation