Ebola - Rwanda conducts a full scale simulation exercise

In the context of the ongoing Ebola outbreak that was declared on 1 August 2018 and has occured in the Congolese provinces of North Kivu and Ituri, Uganda, South Sudan and Rwanda were identified as top priority countries for interventions based on proximity, insecurity and high populations across the border. The Rwandan Ministry of Health, supported by partners, has developed and is implementing an EVD (Ebola virus disease) preparedness and contingency plan. The objective: strengthen preparedness capacities for the prevention, earlier detection, response, and containment of a potential case of EVD in Rwanda.

The plan prioritizes 10 districts bordering DRC and Uganda, as well as districts in the Rwandan city of Kigali. Several drills and functional exercises have been conducted. The Full SIMEX exercise (FSIMEX) was organized by the Rwandan Ministry of Health and the Rwanda Biomedical Center (RBC) in collaboration with the WHO Country Officer, government stakeholders, and technical partners.

The exercise was conducted in two phases and deployed in the Gihundwe and Mibilizi district hospitals and at the Kamembe airport. The Gihundwe and Mibilizi district hospitals are located in Rusizi Distric-Western Province. The Kamembe airport, a civil facility in the same province, is the highest density industrial and transport center in the province's north. The Kamembe Airport serves the city with an estimated number of eleven flights a week to the Rwandan capital of Kigali. The second exercise was conducted at the Rubavu-Rugerero Ebola Treatment Center (ETC), also located in the Western Province. Its capital, Gisenyi, is Rwanda's biggest beach resort and border city.

The FSIMEX focused on testing and validating capabilities for rapid detection, rapid response, and effective coordination at national and district level, including the activation of the PHEOC/emergency coordination mechanism, in order to provide opportunities to identify areas for further improvements. The overall exercise gathered the WHO Country Office's health partners, including the Rwanda Ministry of Health, mainly in charge of policies; the Rwanda Biomedical Center (RBC), which is the implementing arm working with the districts; the Ministry of Disaster Management and Refugee Affairs; the staff of the Public Health Emergency Operation Center (PHEOC); NGOs, international agencies (WHO, AFRO, UNICEF, CDC, UNHCR), DIFID HQ, CDC Rwanda, and the Rwandan Red Cross; and the Rwanda Military Hospital, the Rwanda Health Communication Center, the National Referral Laboratory, and the real on site staff of the tested health facilities.

During the Full SIMEX, participants had a pre-determined number of tasks that had to be performed in order to test the operations or functions of the emergency response, namely:

1. Emergency Operation Center (EOC), response coordination at national and district level
2. Surveillance, laboratory confirmation, and POE (Point of Entry)
3. Rapid response capacity
4. Case management in health facility and at ETC, IPC, disinfections and waste management
5. Risk communications and community engagement
6. Security
7. Logistics management

The scenario also included elements such as public anxieties, community resistance, spread of rumors, and intense media demands. Tested operations included: donning and doffing of personal protective equipment (PPE), preparation of chlorine solution, terminal disinfection and waste management at health care centres, vehicle disinfection, burials, reporting, contact listing, contact investigation, press conference, media release, community negotiation, and collection. Other tested elements were the labeling and triple packaging of blood samples (pre-analytic phase), as well as data management, analysis, and interpretation.

The second exercise at the Rubavu-Rugerero Ebola Treatment Center also allowed participants to identify strengths to be built upon and gaps which may require remedial action. Lessons learnt during the response and feedback from health personnel involved in the simulation have been critical for all partners. The management of the bodies was thoroughly monitored by all partners, particularly donors who have been involved in the national task force of EVD preparedness and response from the beginning. Their participation in the FSIMEX will enable them to tailor and customize their future assistance. They are also expected to provide their recommendations to move forward and better address the needs for EVD preparedness. The drills were also performed by military hospitals, which are also an essential part of the EVD preparedness and response team in Rwanda. The deliverables and the EVD preparedness check list will be completed accordingly.

Rwanda's specificity and challenges are contingent on the fact that the country has never faced an emergency before. The whole exercise highlighted progress and gaps in the national EVD preparedness plan. This FSIMEX exercise allowed the WHO Country Office to reposition itself as the leading health agent and coordinator in Rwanda.