VHF Guideline-MH Issues - MSF OCBA-2006 - EN

MENTAL HEALTH & PSYCHOSOCIAL COMPONENT IN VHF INPUT FOR THE MSF GUIDELINE
Medical department MSF OCBA

Psychosocial Health Technician Zohra Abaakouk
Barcelona, April 2006
MENTAL HEALTH & PSYCHOSOCIAL

COMPONENT
IN VIRAL HAEMORRAGIC FEVER (VHF)
INPUT FOR THE MSF INTERNATIONAL GUIDELINE
In 2005, MSF-OCBA managed a Viral Hemorrhagic Fever outbreak for the first time. As
part of the emergency intervention, the mental health and psychosocial component was
included alongside medical, logistic and watsan activities.
ROLE AND ADDED VALUE OF MENTAL HEALTH AND

PSYCHOSOCIAL
COMPONENT
IN
EMERGENCY
INTERVENTION FOR A VHF OUTBREAK
In this kind of outbreak, the emotional impact affects various levels: individual, family,
community and/or social. Therefore, a mental health and psychosocial package from
the onset of MSF intervention is needed.
The extreme fear induced by the outbreak and its evolution may cause intense
destabilization in the community as well as ongoing MSF operations. To counter or
prevent this fear, targeted information should be given out within the community,
amongst MSF staff and other counter parts in order to improve understanding of the
disease and to encourage acceptance of the activities. For instance, the Marburg
disease obliges the population to change traditional/ritual practices (burial, funeral,
patient care, etc).
The mental health/psychosocial package is included in the following activities:
Watsan activities
The treatment ward
HBRR
Psychosocial kit distribution & psychological follow-up
Community sensitization
MENTAL HEALTH AND PSYCHOSOCIAL COMPONENT MAIN

OBJECTIVES
To facilitate an understanding of the disease within the community and encourage

acceptance of MSF activities
To support affected families by reducing the impact of stress, fear and stigma
To facilitate the psychological process for families throughout various stages :

hospitalization, notification of death, burial and bereavement
Together with the team members, to improve the quality of care for the patient and
the family
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PRESENTATION OF THE MAIN MENTAL HEALTH

PSYCHOSOCIAL ACTIVITIES IN THE DIFFERENT AREAS
AND
Patient flow and mental health/psychosocial activities

see annex 01
Job profile of psychosocial team members
see annex 02
I- WITHIN THE VHF TREATMENT WARD AND THE HOSPITAL

To reduce anxiety and fear in order to have better collaboration with
beneficiaries
To facilitate the psychological process for families throughout various
stages: hospitalization, notification of death, burial and bereavement
Together with team members, to improve the quality of care for the patient
and the family
A psychologist and a socio-cultural mediator together carry out the mental health
activities within the hospital.
Activation of the VHF warning circuit
see annex 08
Admission:
o to provide information: the disease, means of becoming infected, bio
security norms, MSF team duty, care provided for the patient in the
VHF treatment ward, visiting rules, etc
o to provide initial psychological care for patients and their relatives
During hospitalization:
o to give and explain test results to the relatives
o to inform families that their homes may be disinfected by the MSF
team and how this would be done.
o to book the psychosocial kit distribution
o to inform the relatives regarding the medical evolution of the patient
o psychological follow-up of the patient:
o to improve inpatient conditions together with medical staff, and
preserve the dignity of the patient: alleviating suffering, arranging
family visits, switching on the radio, decorating rooms, etc
o psychological follow-up of relatives
o to arrange for the family to be close to the patient at the moment of
his/her death
o to be with the patient at the moment of death if needed.
Discharge :
o to accompany the patient to his/her home
o to provide neighbors with explanations about the patients recovery in
order prevent/reduce possible social stigma from the neighborhood
(rejection, death threats, aggression, destruction of personal
belongings, etc)
o to ensure a home visit for psychological follow-up
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Death:
o
o
o
to notify relatives of the death

to facilitate the bereavement process
to make preparations for the burial: arranging/organizing how it should
be undertaken, taking into consideration the bio-security norms
Information regarding the treatment ward
see annex 03
Recommendations regarding the VHF treatment ward:

If the treatment ward is part of the hospital building, it is important to consider
hospital personnel1 from the start: informing them and making them participants in
order to favor better collaboration and the assumption of responsibility in the control of
the epidemic .
From the beginning, implement three doors of access:
the first provides access to changing rooms for staff2
the second entrance is for patients and families
the third, for the exit of deceased patients.
Attempt to look for communication options between persons who are within the
treatment ward and those who are outside.
Implementation of an appropriate space to provide psychological care to patients
and their families from the initiation of the treatment ward.
Whenever possible, family members of those victims who enter the treatment unit should
have the same protective suits as the teams who work inside. If, for security reasons, these
suits are different, the reasons for these differences should be clearly explained to families.
Security conditions allowing, the psychologist should enter the high risk area of the
hospital from the onset of intervention. This would allow:
the provision of psychological support to the patient
accompaniment and support to be given to families who are fearful of entering the
isolation unit. In this case, the protective suit worn by the psychologist should be
exactly the same as that worn by the family. In case the same suit cannot be
worn, we cannot accompany the family since we can generate more fear if the
family we accompany is protected differently from ourselves.
Create suitable rooms for patients (particularly for children) who are admitted to the
isolation area.
The availability of an indirect light source in the isolation room during the night
can make life easier for the patient and reduce their fears.
The provision of a radio within the isolation unit can help the patient feel less
isolated for the length of their hospital stay.
II- HOME BASED CARE RISK REDUCTION
To reduce anxiety and fear in order to have better collaboration with

beneficiaries and promote acceptance of the MSF medical service
To facilitate an understanding of the disease and promote acceptance of MSF
activities within the community.
Together with the team members, to improve the quality of care for the
patient and the family
A psychologist and a socio-cultural mediator provide psychological follow-up together.
A trained socio-cultural mediator could carry this out alone.
1
2
Directors, professionals who work (informal leaders) in the hospital, etc.

Health workers, watsan, cleaners, launderers, etc.
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to assist in selecting a care-giver

to provide psychological support to the family while there is a patient in the house
to offer the possibility of admission to the VHF treatment ward
to sensitize the neighborhood and the community
III- TARGET COMMUNITY

III.1- Participation in WATSAN activities
To facilitate an understanding of the disease within the community and

encourage acceptance of MSF activities
Together with the team members, to improve the quality of care for the
patient and the family
A psychologist and a socio-cultural mediator should assist beneficiaries in the
understanding and acceptance of burials, house disinfection and transfer of the patient
to hospital.
Burial
o To ensure that the family is fully involved in preparation for the burial
guarantee a degree of respect for traditions (time of ceremony, songs,
dances, ) without affecting the bio-security norms
allow relatives to put personal belongings with the corpse (in the bag)
House disinfection
o to provide emotional support and information to families during house
disinfection
o to identify one relative who could assist the MSF team during
disinfection in order to reduce rumors and facilitate his/her
understanding and acceptance.
o to support the watsan team: during the disinfection the psychosocial
team members provide information to the community and explain
reasons for disinfection.
o to manage potential conflict
Patient transfer to the hospital

o to provide explanations for the neighbors about the recovery of the
patient in order to prevent/reduce possible social stigma within the
neighborhood
III.2-
Psychological follow-up
psychosocial kit
through
distribution
of
the
To ensure psychological follow-up,

To facilitate contact-tracing
To monitor the impact of MSF activities within the community
Psychosocial kit distribution (for adults and for children)
Proposal and list for psychosocial kit
see annex 04
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Psychological support of patients

Psychological support of relatives
Recommendations for the logistic team
see annex 05
IV- COMMUNITY SENSITIZATION

To provide information regarding the outbreak in order to improve work
conditions and what is understood about MSF intervention
To facilitate an understanding of the disease within the community and
encourage acceptance of MSF activities
to train staff (NGOs, public institutions, etc)

to organize information/education sessions with key persons (community
leaders, traditional healers, etc) and with the community
to put a network into place
Plan and summary of Marburg sensitization
see annex 06
Recommendations:
formal community sensitization should be managed and performed by an IEC3
professional or anthropologist and a Socio-cultural mediator.
anthropological knowledge is indispensable from the beginning in order to put
MSF intervention into place.
Search for anthropological aspects to be considered
see annex 07
For further information, please contact:

zohra.abaakouk@barcelona.msf.org
Information-Education-Communication
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ANNEX
Annex 01
Patient flow and mental health/psychosocial activities
Annex 02
Job profile of psychosocial team members

02.1. Hospital activities
02.2. Community activities
02.3. Community communication and sensitization
02.4. Coordination component
02.5. Local culture mediator
Annex 03
Information regarding the treatment ward
Annex 04
Psychosocial proposal- distribution of humanitarian aid kit.
Annex 05
Recommendations for logistic teams in VHF interventions.
Annex 06
Plan and summary of Marburg sensitization
Annex 07
Search for anthropological aspects to consider
Annex 08
Activation of the VHF warning circuit
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ANNEX 01
PATIENT FLOW AND MENTAL HEALTH/ PSYCHOSOCIAL ACTIVITIES
VHF Patient
Transfer to Hospital
HBRR
House disinfection
Patient Deceased
Patient alive
House desinfection
Patient deceased
Patient alive
Kit distribution
Burial
Accompany patient home
Kit distribution
Burial
Accompany patient home
follow-up for patient, relatives and/or

community
follow-up for patient, relatives

and/or community
Death in the house

Burial
House desinfection
Kit distribution
Psychological follow-up for patient, relatives and/or community
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ANNEX 02
JOB PROFILE OF PSYCHOSOCIAL TEAM MEMBERS
02.1 PSYCHOLOGIST FOR HOSPITAL ACTIVITIES: Job description
Emergency intervention-VHF Epidemic
Mental health team component

General Information:
Name of position:
Project /Mission:
Duration:
Psychologist for Inpatient Activities

VHF Emergency-Epidemic
Maximum 6 weeks
Position within the Organigram:

Under the hierarchal responsibility of the General Emergency Coordinator otherwise the mental health
component coordinator
Technically and functionally under the responsibility of the psychological and psychosocial coordinator
and the Psychosocial Health Advisor in BCN.
Responsibilities and description of main activities:
Receive new cases in the treatment ward : initially for psychological intervention with the patient and
once admitted, to provide support to the family.
Daily psychological follow up of the patient and family in the designated place for this activity.
If security conditions allow and the psychologist is willing to assume the risk, to enter the isolation area
when the medical or psychology team believe it necessary. Entry to the isolation unit can be for the
psychological care of patients or to accompany families.
Implementation of an Individual file for each patient/family to guarantee the intervention is recorded and
its confidentiality
Activate the circuit prior to the alarm for new cases whether it be for hospital admissions, or burials.
This activity should be coordinated with the organization responsible for the search for new cases.
Work continuously in collaboration with the assigned cultural mediator, and should also conduct basic
technical training. It is possible that the mediator be responsible for the transfer of activities carried out
during the mission. In addition it would be this person who accompanies our replacement.
Accompaniment of families in the event of the patient dying in hospital. Likewise, to collaborate with the
family in preparation for the funeral. If time and workload allow, accompaniment at the funeral together
with watsan. This activity can be carried out by alternating between the hospital and community
psychologists.
In cases where the patient survives, accompaniment home once medically discharged. This activity can
be carried out by alternating between the hospital and community psychologists.
Accompaniment and follow up at home of patients under the Home Based Risk Reduction Strategy
(HBRRS) : in coordination with the watsan health worker in charge of this activity. Psychological follow
up of patients and families. Likewise, recommend or carry out community sensitization should the
psychologist see it necessary. As with the previous activity, this can be carried out by alternating
between the hospital and community psychologists.
Attend medical coordination meetings and propose follow up of cases in which all health professionals
intervene with the patient.
Facilitate brief daily meetings with the medical team to study the evolution of each patient. To agree or
to define who gives information about each subject. Accompany the health team if they elect to be
responsible for informing the family of a death. In the event that this activity is designated to the
psychologist, it will be this person who notifies the family.
Inform the HR psychologist regarding any employee whether national or expatriate in the event of
psychological difficulties.
Provide technical support to the rest of the mental health team if required.
Provide technical support to the rest of the team according to the most pressing needs.
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Participate in mental health component meetings contributing knowledge and ideas from the rest of the
team.
Profile required: Psychologist

-
Experience in evaluation, diagnosis and intervention as clinical psychologist.

Experience in family intervention and accompaniment in the grieving process.
Previous MSF experience (desirable) or otherwise work experience in situations which require the handling of
high levels of stress.
Capacity to manage own level of stress such as by being flexible, creative and having social skills
Languages: of the country experiencing the emergency or, failing that, that which is customary for the
translators.
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02.2. COMMUNITY ACTIVITIES PSYCHOLOGIST: Job description

Emergency Intervention: VHF Epidemic
Name of Position:
Project /Mission:
Duration:
Substitute for:
Community Activities Psychologist

Emergency- VHF Epidemic
Maximum of 6 weeks
and the Psychosocial Health Advisor in BCN .
o
o
o
o
o
o
o
Psychological support in all activities carried out by the Water-Hygiene and Sanitation logistic team
(watsan). Intervention with the families of victims, the victim and provision of information to the
community. Included are the following activities:
Inform the family regarding the process necessary according to the activity
Accompaniment, emotional containment and support whilst the activity is being carried out.
Inform the community about the activity being performed with the objective of reducing fear amongst
the population and stigmatization of victims.
Watsan activities in the community are: collection and burial of victims of VHF, disinfection of houses
and transfer of infected persons to hospital.
Programmed community sensitization, in agreement with community leaders and health agents in those
districts with the greatest number of VHF cases, with the aim of supplying the necessary information to
reduce security problems for MSF teams (collection of cadavers and burials, disinfection of houses.).
Psychosocial intervention: home visits to the families of VHF patients as part of the following activities:
Delivery of Solidarity Kit (compensation)
Psychological support facilitating emotional expression and the grieving process
Follow up in the event of detecting possible psychological sequel
Follow up of contacts and possible cases of infection related to household members (activity of the
coordinator with the expatriate nurse responsible)
Accompaniment of families in the event of the patient dying in hospital. Likewise, to collaborate with the
family in preparation for the funeral. If time and workload allow, accompaniment at the funeral together
with watsan. This activity can be carried out by alternating between the hospital and community
psychologists .
In the event that the patient survives, accompaniment home once medically discharged. This activity
can be carried out by alternating between the hospital and community psychologists
Accompaniment and follow up at home of patients under the Home Based Risk Reduction Strategy
(HBRRS): in coordination with the watsan health worker in charge of this activity. Psychological follow
up with patients and families. Likewise, recommend or carry out community sensitization should the
psychologist see it necessary. As with the previous activity, this can be carried out by alternating
between the hospital and community psychologists.
Implementation of an Individual File for each patient/family to guarantee the intervention is recorded
and its confidentiality.
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psychological difficulties, especially the mobile team responsible for burials and disinfections in the
community.
team.

-
Experience in family psychological intervention especially in grief situations and where emotions such
as fear and anger prevail.
Experience in community intervention and the capacity to manage large groups of persons. The
community activities require experience as situations of great stress are dealt with owing to fear by the
population, for which the possibility of violent demonstrations should be anticipated.
Previous MSF experience (desirable) or otherwise work experience in situations which require the
handling of high levels of stress.
Capacity to manage own level of stress.
Flexibility, creativity and social skills.
Languages: of the country experiencing the emergency or, failing that, that which is customary for the
translators.
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02.3 ACTIVITIES OF COMMUNITY SENSITIZATION AND COMMUNICATION

Job Description
Emergency Intervention- VHF Epidemic
Name of Position:
Project/ Mission:
Duration:
Substitute for:
Social Communicator or Social Psychologist

Emergency-HVF Epidemic
Maximum 6 weeks
Position within the Organigam:

and the Psychosocial Health Advisor in BCN .
Identify the means of communication available in the area and the people who have access to them.
Verify the general type of information the population and health institutions have particularly concerning
VHF.
Formal sensitization proposals providing information regarding VHF which could assist our work.
If necessary, accompaniment of the community psychologist to carry out informal sensitization (groups of
persons who are not summoned) parallel to watsan activities and psychological intervention with the
families of victims.
Advise and orientate the rest of the team as to the most appropriate management of information and
communication regarding VHF.
team.
-
Experience in formal and informal communication of complex contents.

Experience in community activities with potentially large numbers of persons and with complex emotions
amongst the group (fear, anger.).
Work experience in stressful situations (communities in grieving process and in some occasions
complicated).
Previous MSF experience (desirable) or else work experience in situations requiring the handling of high
stress levels.
Capacity to manage own stress levels.
Languages: of the country experiencing the emergency
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02.4 COORDINATION ACTIVITIES

MENTAL HEATLH COMPONENT
Job Description
Emergency Intervention-VHF Epidemic
Name of Position :
Project/ Mission:
Duration:
Coordinator of psychological and psychosocial component

Emergency- VHF Epidemic
Maximum 6 weeks
Under the hierarchal responsibility of the General Emergency Coordinator

Technically and functionally under the responsibility of the Psychosocial Health Advisor in BCN .
Analyze and plan activities of the rest of the mental health team.
Participate in interinstitutional meetings of mobilization and/ or social sensitization with the intention of
guaranteeing the link with the Subcommission of Psycho-Social Support.
Up-date the Guide to Resources which is available and implemented by the remaining organizations
and/ or institutional commissions.
Guarantee that MSF patients benefit from assistance available according to the resources guide.
Provide support to the rest of the mental health team at technical level when necessary.
Identify possible cultural mediators needed by the mental health team, carry out a work interview jointly
with the person in charge of HR to contract the candidate.
technical training.
Attend coordination meetings providing information regarding the mental health component. Inform the
area team of the contents of these meetings.
Organize periodic mental health component meetings with the purpose of fluid communication which
will facilitate greater impact of activities performed as well as the functioning of the team.
Provide support to the rest of the team according to the most pressing needs .

-
Experience in coordination activities.

The rest of the required profile will depend on which of the aforementioned profiles can be combined
with coordination tasks and the job profile of mental health team members .
Previous MSF experience (desirable) or else work experience in situations requiring the management
of high stress levels .
Languages: of the country of emergency
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02.5 LOCAL CULTURE MEDIATOR :

Job Description
Emergency Intervention-VHF Epidemic
Name of Position:
Project /Mission:
Duration:
Local culture mediator

Emergency-VHF Epidemic
Duration of the emergency
Under the hierarchal responsibility of the psychologist with whom he/she will work directly.
Accompaniment of the psychologist responsible in all activities : the nature of these activities depends
upon the psychologist who is to be accompanied. For example, if in the hospital, the activities
concerned are those described in the job profile of the hospital psychologist, etc.
Show initiative in conflict situations where several people should be attended at the same time
Be vigilante regarding all cultural aspects that the expatriate does not know how to manage and inform
the expatriate facilitating understanding of these aspects. The expatriate should be supportive in this
task.
Analyze the development of interventions.

-
Experience in education and/ or community work.

Ability to listen, communication skills and to give clear messages
Communication skills
Experience in managing significant numbers of people
Patience in highly stressful situations.
Languages: that of the country and speakers of the local language should speak the language of the expatriate
(English, French or Portuguese) .
Adapt the profile for persons who have more credibility in the area (man or woman, youth or adult)
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ANNEX 03
INFORMATION REGARDING THE TREATMENT WARD
PSYCHOLOGICAL RECEPTION CIRCUIT OF PATIENTS IN A 2ND PHASE
Following the withdrawal of MSF personnel, solely activities in the treatment ward and reception
circuit for patients have been reduced and remain as follows:
Doctors responsible for the isolation area.
Dr A
Dr B
Dr C
Dr D. remains in charge of triage and decides whether or not patients are of suspicion.
The remaining aforementioned doctors are responsible for the isolation area and manage and
treat patients with Marburg.
Patients are directed to an emergency room where they are triaged and assessed by the doctor
(Dr.D). Following this step the decision is taken as to whether or not the test is to be performed.
In the event that a case is suspected, they would pass through a security room where the test
would be performed with protective clothing
It would be at this moment, when the test is about to be performed, when the doctors would
require the presence of a psychologist and psychological team to explain to the patient and their
families, the process which follows as well as treatment with tranquilizers and provision of
emotional support in coordination with the medical team and doctor responsible. The aim of this
support -both psychological and through the information given, is to reduce anxiety and fear
which will facilitate collaboration with families and patients throughout the therapeutic process.
Doctors a much as the families involved know that a member of the team is always available to
tend any needs that may arise in the tent.
Should the test result be positive, the psychologist would be responsible for mobilizing and
coordinating the teams required to intervene, firstly in the admission to the treatment ward
intervention and subsequently in the treatment and care: medical team in the isolation area,
watsan and mobile teams.
In the event that the case were positive, the mechanism would be put into place for disinfection,
sensitization, the delivery of kits and follow up of patients and affected families.
From this moment onwards, intervention in the community and its peripheries would remain
under the responsibility of the WHO, as much in the assessment of contacts as in cases of
persons with problems; such as persons who neither want treatment nor to be transferred to an
isolation area. These teams should be coordinated with both the medical and the psychosocial
teams.
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ANNEX 04
PSYCHOSOCIAL PROPOSAL- DISTRIBUTION OF HUMANITARIAN AID
KIT
PROPOSAL FOR PSYCHOSOCIAL SUPPORT FOR MARBURG VICTIMS
Josefa Rodrguez, Supervisor Zohra Abaakouk
MDICOS SIN FRONTERAS (MSF) is carrying out various humanitarian and health actions in
the municipality of Uige with the purpose of controlling the Marburg epidemic and bringing it to
an end.
Amongst those activities already being performed (medical care in hospitals for VHF patients,
collection and burial of the deceased, disinfection of houses, ambulance transfers of suspected
persons....), a means of psychosocial support is proposed which includes giving a humanitarian
aid kit to victims of the disease.
Objectives of psychosocial actions:
a) Psychological care: provide essential care to victims of the epidemic.
b) Community sensitization: take advantage of the space which opens following psychological
care to sensitize the rest of the family and/ or the community.
c) Prevention and protection: have direct access to recent contacts of the victims with the
purpose of early detection of potential marburg cases.
d) Strategy for community protection with the hand over of the kit: gain the confidence of the
community with MSF to accelerate community sensitization which is necessary in the control of
the epidemic. This strategy responds to the concerns of the MSF team due to the reaction the
Uige population had prior to rejecting our actions. The epidemic has required and continues to
require a rapid response in order to avoid infections and deaths. However, this rapid action has
provoked misunderstandings which we hope to resolve to be able to continue with our goal: to
bring the epidemic to an end and to count upon approval by the Angolan people and their
collaboration with MSF.
Psychosocial support activities:
- Delivery of the humanitarian aid kit to affected families.
- Accompaniment of affected families in the grieving process.
- Health assessment of the remaining family for possible warning signs.
Beneficiary population
The objective is to cover the entire population at high risk of contracting Marburg. However,
bearing in mind the large number of persons that this action implies, priority is given to those
receiving assistance according to the following order:
- Admitted or deceased patients currently in the Marburg area of the hospital.
- Medical staff of the hospital, owing to the loss of workmates who have died due to the
epidemic.
- Deceased or admitted patients detected by MSF retrospectively, that is to say, to initiate
actions for patients of the last week and finish with those of the first.
Methodology
Once the list of persons to be assisted has been decided upon, over the period of a week the
following process would be as follows:
Follow up of contacts (Contact Tracing) immediately following medical discharge or death of the
victim.
Once a period of 5 to 7 days of contact follow up has passed, an initial meeting is held with the
psychology team in the victims house with the following steps:
- delivery of the humanitarian kit
- evaluation of the family grieving process
- psychological support in the said grieving process
Sanitary assessment for possible warning signs of Marburg amongst the different family
members. The assessment can be carried out in the accompaniment of a health worker, in the
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event that human resources are available. If this is not feasible, the psychologist can perform
the health assessment questionnaire for basic warning signs and in the event of confirming a
possible suspect, direct them straight to hospital or otherwise transfer as proposed previously.
Psychological follow up over a maximum period of three weeks in the event that the family
accept the aforementioned follow up, with the intention of evaluating possible psychological
sequels owing to the events that have occurred in the family.
Measures of impact
- Acceptance by the family of the MSF team in the house
- Information from the family about possible warning signs in other family members.
- Atmosphere of confidence regarding feelings related to Marburg .
- Facilitate transfer of other possible cases to the isolation unit
CONTENTS OF THE HUMANITARIAN AID KIT

1. REST KIT
- Mattress
- Mosquito net
- Sheets
- Blanket
2. PERSONAL HIGIENE KIT
- 3 Towels
- 3 Soap
- 50 Condoms
- Cloths for menstrual use (training regarding who should wash such cloths and how)
3. CLOTHING KIT ONLY FOR SURVIVORS OF MARBURG
- Radio, according to the budget
3.1 MALE CLOTHING KIT
- 2 Pairs of trousers
- 4 T-shirts
- 4 Pairs underpants
- Thong sandals
3.2 FEMALE CLOTHING KIT
- 4 Sarong dresses.
- 2 T-shirts
- 2 Brassieres
- Thong sandals
4. CHILDRENS CLOTHING KIT
- Radio
It is not advisable to have a large stock available as sizes vary a lot. However, we can think about having
3 estimates of three types of sizes:
4.1. 1-5 YEAR OLD CHILDREN: BABY

- 4 Trousers
- 4 T-shirts
- 2 Pairs of thong sandals
- Gauze and plastic pants
- Ball
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4.2. 6-10 YEAR OLD BOYS

- 4 Pairs of trousers
- 4 T-shirts
- Thong sandals
- Ball
4.3. 6-10 YEAR OLD GIRLS
- 4 Sarong dresses
- 4 T-shirts
- Thong sandals
- Ball
11-15 YEAR OLD BOYS
- 2 Pairs trousers
- 4 T-shirts
- Thong sandals
- Ball
11-15 YEAR OLD GIRLS
- 4 Sarong dresses
- 4 T-shirts
- 2 Brassieres
- Thong sandals
- Ball
5. KITCHEN KIT (prepare sets of 4 and give out according to the number of persons living in
the house)
- 4 Glasses
- 4 Plates
- 4 Sets of cutlery (spoon, fork and knife)
- 4 Kitchen cloths
- Scouring cloths
6. CLEANING KIT
- 4 Bottles of bleach
- 2 Soap for plates
- 5 Soap tablets for clothing
- Plastic gloves (box of 100 gloves which are 50 pairs)
- Syringe to count the drops of bleach required
7. EDUCATIONAL KIT
- Pencils
- Notebooks
- Eraser
8. DOCUMENTATION KIT
Death certificate signed by the doctor in the event of death, or medical discharge certificate in
the event of recuperation from Marburg. It is important that this is an official Angolan document
considering the possibility of future economic compensation by the National government.
Positive Marburg test results are only to be given directly to the victim or guardian in the case of
a minor. Explain that this is a confidential document and that it could be dangerous if the
community retaliates against positive cases. It is not to be given in cases which are negative to
avoid confusion with possible false negatives.
Informative document covering the following aspects:
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If the person has recuperated from Marburg, preventative health recommendations.

If the person has died due to Marburg, preventative health recommendations for the family of
the victim.
Warning signs for families and what actions to take if these warning signs present in a family
member.
General information about the disease.
9. MEDICATION KIT: for consideration by the health team
Analgesics for minor pain intended to raise the alert for Marburg ,should the tablets fail to ease
minor headaches or fever.
Josefa Rodrguez
Field psychologist
May 2005
Mdicos Sin Fronteras-Spain
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ANNEX 05
RECOMMENDATIONS FOR THE LOGISTIC TEAM IN VHF INTERVENTIONS
Have a room available which has several areas, at least 2, joined to the isolation room
by the door where infected persons enter and families visit. This area should contain everything
necessary to perform psychological consultations in a private and dignified manner: table, chairs,
water, tissues, coffee, biscuits, sweets.....decorated according to local tastes. It is better to have
two areas in the event of having more than one family, so that a small waiting area can be
available.
Have a physical space available (in the house, hospital...) with sufficient space to carry
out emotional debriefings equally for the local team as for expatriates. In addition, set up a time
table of sessions with a fixed date and time. Expatriates often have difficulty attending sessions
due to lack of time and space, but must delegate a fixed period for meetings with the
psychologist.
Three doors in the isolation unit:
1. Entrance for hospital personnel (dressing room)
2. Entrance for infected VHF patients and their families.
3. Exit for persons who die within the isolation unit.
Doors 2 and 3 should not be visible to each other.
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ANNEX 06
PLAN AND SUMMARY OF MARBURG SENSITIZATION
We begin with the information available in the community to emphasize selected aspects
depending on what is already known.
The questions are as follows:
-
Is there a new illness in the area?

What is it called?
What is it?
How did it get to Uige, who or what brought it here, how long will it be in Uige (provokes
a response in the event that the people dont speak about magic or punishment from
god, therefore it is asked directly if it is magic or punishment from god) .
How the illness presents, signs and symptoms which raise alert.
How it spreads, greatest risks for infection.
How to avoid the illness.
Treatment of the illness.
What we can do if we suspect someone is infected .
What we can do in the event of a death.
If the participants answer the questions calmly, the entire questionnaire is completed, but often
we find that they become anxious due to the feedback we give about what they know. That is to
say, we have two ways to undertake sensitization:
-
First they speak and then we explain.

First they answer a question and we clarify any doubts or misinformation.
Once we have given information about all the previous aspects, we present the actual work of
MSF divided into the following areas:
- How MSF works in the hospital and specifically in the Marburg area.
- What the three types of mobile teams do: ambulance, burials and disinfection.
- Capacity to train persons related to health (midwives, traditional doctors, nurses,
equally for public and private health structures..)
- Capacity to sensitize and clarify all doubts held by the community to facilitate work.
Finally, a round of questions is made taking into consideration all of the doubts held by the
community supported by written information which is handed out. Tensions always rise with the
questions as three difficult points must be insisted upon:
-
The origin of the virus: discovered in Germany which is why they consider whites to be
responsible for the disease.
Origin of the virus: possibly through the green macaque and they maintain that in
Angola there are no green macaques
Due to the lack of treatment there is little confidence and people believe they will die
alone and abandoned.
Josefa Rodrguez
Field psychologist
May 2005
Mdicos Sin Fronteras-Spain
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ANNEX 07
SEARCH FOR ANTHROPOLOGICAL ASPECTS TO CONSIDERATION
The characteristics and cultural anthropological contributions of the region should be
considered at the beginning of the intervention. It is useful to bear in mind the following
aspects:
In the event that there had been a previous VHF epidemic in the community, a
brief study would have to be carried out regarding previous management of the
epidemic and the response of the population.
In the event that the population has information about VHF the level of knowledge
within the community must be established regarding VHF (origin, beliefs as to
the cause of the disease, methods of infection, warning signs, preventative behavior,
measures to adopt in the presence of infected patients, etc.)
Knowledge of rituals and customs surrounding funerals. Together with the
cultural mediator, ascertain a way for MSF to actively participate in consoling or
conveying sympathy to the family.
4
(For example: According to local customs, how are condolences conveyed to families? )
Specify views held regarding:

the significance that blood holds for the population ,
religious beliefs surrounding death,
perception and response of the population to work performed by whites
prior to the epidemic
causes and management of violence and aggression in the community.
possible indicators of a degree of stigmatization and local response with the
objective of timely anticipation and avoidance of violent outbreaks amongst the
population.
Gestures which for us show our condolences can have a very different meaning for other cultures . For example, the
crossing of arms whilst bowing slightly towards the family of the deceased is for us a gesture of humility, of sheltering
and solidarity with the grief of the other person (in VHF physical contact is not possible under any circumstances ,
therefore one is unable to offer a hand, to embrace). In Angola, the meaning of this gesture is the same as it is for us.
However in Congo, according to the WHO anthropologist in Angola, it signifies asking for an apology and accepting the
blame for what has happened to the person whom we are bowing towards. This apparently meaningless detail can
provide us with a lot of problems if rumors circulate amongst the population around the idea that whites are infecting
blacks with VHF as has happened in Angola and in other countries.
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ANNEX 08
ACTIVATION OF THE VHF WARNING CIRCUIT
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VHF Guideline-MH Issues - MSF OCBA-2006 - EN

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MENTAL HEALTH & PSYCHOSOCIAL COMPONENT IN VHF INPUT FOR THE MSF GUIDELINE

Medical department MSF OCBA

MENTAL HEALTH & PSYCHOSOCIAL

ROLE AND ADDED VALUE OF MENTAL HEALTH AND

MENTAL HEALTH AND PSYCHOSOCIAL COMPONENT MAIN

To facilitate an understanding of the disease within the community and encourage

To facilitate the psychological process for families throughout various stages :

Medical department MSF OCBA

PRESENTATION OF THE MAIN MENTAL HEALTH

Patient flow and mental health/psychosocial activities

I- WITHIN THE VHF TREATMENT WARD AND THE HOSPITAL

Medical department MSF OCBA

to notify relatives of the death

Information regarding the treatment ward

Recommendations regarding the VHF treatment ward:

II- HOME BASED CARE RISK REDUCTION

To reduce anxiety and fear in order to have better collaboration with

Directors, professionals who work (informal leaders) in the hospital, etc.

Medical department MSF OCBA

to assist in selecting a care-giver

III- TARGET COMMUNITY

To facilitate an understanding of the disease within the community and

Patient transfer to the hospital

To ensure psychological follow-up,

Medical department MSF OCBA

Psychological support of patients

IV- COMMUNITY SENSITIZATION

to train staff (NGOs, public institutions, etc)

For further information, please contact:

Medical department MSF OCBA

Patient flow and mental health/psychosocial activities

Job profile of psychosocial team members

Information regarding the treatment ward

Psychosocial proposal- distribution of humanitarian aid kit.

Recommendations for logistic teams in VHF interventions.

Plan and summary of Marburg sensitization

Search for anthropological aspects to consider

Activation of the VHF warning circuit

Medical department MSF OCBA

Accompany patient home

Accompany patient home

follow-up for patient, relatives and/or

follow-up for patient, relatives

Death in the house

Medical department MSF OCBA

Mental health team component

Psychologist for Inpatient Activities

Position within the Organigram:

Medical department MSF OCBA

Profile required: Psychologist

Experience in evaluation, diagnosis and intervention as clinical psychologist.

Medical department MSF OCBA

02.2. COMMUNITY ACTIVITIES PSYCHOLOGIST: Job description

Community Activities Psychologist

Position within the Organigram:

Responsibilities and description of main activities:

Medical department MSF OCBA

Profile required: Psychologist

Medical department MSF OCBA

02.3 ACTIVITIES OF COMMUNITY SENSITIZATION AND COMMUNICATION

Social Communicator or Social Psychologist

Position within the Organigam: