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IDPH Epidemiologist Returns from Sierra Leone

Many challenges to overcome, says Dr. Samir Koirala

September 17, 2014
From: Iowa Department of Health , Toledo Chronicle, Tama News-Herald

Dr. Samir Koirala, an epidemiologist working with the Iowa Department of Public Health (IDPH), who recently returned from assisting CDC Ebola Outbreak efforts in Sierra Leone shared his experiences today during a press conference in Des Moines. Dr. Koirala was in Sierra Leone for 25 days, based in one of the three most affected districts in the country. His work centered on improving their surveillance system.

"One of the many challenges in West Africa is a lack of patient tracing," said Dr. Koirala. "Far too many times a patient is tested in one district (an area similar to a county), but transferred to another district for treatment if the test is positive. In the transfer process some patients die; others die at the treatment center, and still others recover. Whatever the outcome, the patient's loved ones may not know what happened because the patient's paperwork does not follow them from one facility to the next."

Koirala and his team implemented a database, trained people to use the database, do the data entry and data management. They provided training to the contact tracers and supervisors on contact tracing, collecting information from contacts, and filling up the contact tracing forms and reporting them. He also assisted in finding missing people and worked at the national level to develop a system to keep records of each and every person that was being transferred to the treatment centers from all over the country.

According to Koirala, there are many challenges and issues in regards to the Ebola outbreak apart from a poor surveillance system:

* Poor healthcare system and infrastructures

* Inadequate treatment centers and diagnostic facilities

* Poor patient care

* Fear among healthcare workers and reluctant to treat patients with Ebola

* Lack of trust between healthcare providers and communities

* Inadequate manpower and resources

* Fear among communities to go to the hospital to seek medical care for any illness

* Lack of knowledge and awareness about the disease and lack of communication between hospital and local people

* Stigma associated with Ebola

The local government and international partners like WHO, CDC, UNICEF, and MSF (Doctors Without Borders) are doing their best to overcome these challenges in order to stop this outbreak.

Dr. Koirala is from Nepal and completed medical school there, working as a physician in a Nepal hospital for nearly six years. He received his Master's in Public Health from the University of Oxford, London. He then returned to Nepal and worked as a clinical research fellow, doing clinical research in infectious diseases. While at Oxford, Dr. Koirala learned of the Epidemic Intelligence Service (EIS) fellowship program at CDC and was fascinated with the skills he could gain from the program, including investigating outbreaks, conducting epidemiologic investigations or public health research, conducting or evaluating public health surveillance, responding to emerging public health threats, and more. He applied to this fellowship program and was accepted. Dr. Koirala wanted experience working with a state health department and after interviewing with several states, he was matched with IDPH for a two year term. He will be with IDPH until June 2015.



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