The mobilizer may be notified by the family or community, the DERC, the Social Mobilization Pillar, or their supervisor that a sick person has been reported in a home, and that an ambulance has been dispatched.
How Mobilizers Can Support Case Management Teams
Before the Ambulance Arrives
- Express concern and help the family to stay calm. An ambulance in the community can be a frightening experience.
- Listen to the family’s concerns. Express gratitude for keeping themselves and their community safe by reporting the sick person using the alert system.
- Stress that the sick person has not yet been confirmed to have Ebola. This cannot be confirmed until after testing.
- Discuss what can be done to stay safe and protect the family while waiting for the ambulance, including not touching the sick person, their body fluids, and items they have touched; supporting the sick person to drink liquids and oral rehydration solution (ORS); and keeping a safe distance. (Refer to the Consolidated Messages Guide.)
- Prepare the family and community for what they can expect when the ambulance arrives, and inform them when the ambulance is expected to arrive.
- Explain what will happen in the process, including: 1) why the ambulance team members will be in full PPE and use chlorine, 2) the procedures for transporting the patient to an ETU/holding centre, 3) the process for testing, 4) the conditions at the center and 5) how they can find out about their family member after he/she is taken away.
During Ambulance Visit
- Make introductions and help facilitate the conversation between the ambulance team and the family. Ask for the ambulance siren to be switched off after arrival.
- Remind the family that they may ask any questions about the process. Allay fears about the use of PPE and chlorine.
- Stay with the family to support them, providing compassion and support while the family member is removed from the home.
- Follow up with the family to ensure they understand clearly where their relative is going and what is happening. Ensure that all contact details have been exchanged before the ambulance team leaves. If available in the District, provide information on the Family Liaison Office/Desk at the DERC.
- Do not act as an ambulance team member. Only ambulance team members with proper training are allowed to use PPE and provide ambulance services.
- If negative events or experiences are registered, provide a detailed incident report to your supervisor or the DERC for immediate action.
- If the family/community experience is positive, it is equally important to provide feedback to the DERC.
During the Patient’s Stay in the Holding Centre/CCC/ETU
- Regularly check with family members, to make sure the family has the latest updates on the status and location of the patient. Follow up with ETU/Family Liaison Desk/other pillars/partners if the family is not receiving this information.
- Do not provide test results or other medical information. Do not speculate on the nature of the treatment. The mobilizer’s role is to ensure that the family members have access to case management professionals who can give them the accurate information, and to advocate for the information to be shared with the family in a timely manner.
- In case of a death in the Holding Centre/CCC/ETU, the Social Mobilization Pillar should be notified, and local mobilizer sent as liaison person, to ensure appropriate steps are followed (see How Mobilizers Can Support Burial Teams below).
After the Patient’s Stay in the Holding Centre/CCC/ETU
- Accompany survivors home from the CCC/ETU.
- Follow up with those discharged from the holding centres as Ebola negative, to help them reintegrate in the community, and address stigma and discrimination. Help them to understand that even though they tested negative, they will now be on a contact list and receive follow up visits from the contact tracers. This point can often be confusing. Clarify questions and concerns from the community and those discharged. Refer to the Consolidated Messaging Guide.
- Follow up with the family if the patient has died in the center. Help to link them to other pillars/services, especially psychosocial support. Provide information on how they can take part in the safe and dignified burial (see below).
- Make regular follow-up visits to survivors after they are discharged, and refer them to other pillars/services if needed. Consider their role as mobilizers in future.
- Report back to the DERC any concerning practice in the ETU.
How Mobilizers Can Support Surveillance and Contact Tracing
As local community members, mobilizers can help surveillance officers and contact tracers gain community entry and trust, and learn important information about communities and families. Some of this information can be shared, while respecting the privacy of individual community members.
Before Surveillance Team or Contact Tracing Team Arrives
- Mobilizers must be included within every surveillance team. This may include both 1) a local mobilizer already on site and/or 2) a mobilizer accompanying the surveillance team from outside the community. Because they live in the community, the local mobilizer will often be first to arrive at the family home.
- Express compassion and concern for the family, and help them to stay calm.
- While the family waits, discuss the key Ebola prevention methods and how they can keep themselves safe. Discuss the signs and symptoms of Ebola and what to do if signs or symptoms occur.
- Prepare the family for what they can expect during the surveillance or contact-tracing visit. Explain that everyone who has had contact with a confirmed or suspected Ebola case must observe the 21 days of quarantine for their own and their community’s health and safety. This does not mean they will all contract Ebola.
- Listen to the family’s concerns and answer questions.
- Explain the case investigation process, including 1) who will come and why they need to talk to the family, 2) why it is important to trust the surveillance officer and share their information and 3) what they can do if they are feeling uncomfortable with the questioning.
- Explain the line listing and contact tracing process, including 1) who will come and what questions they will ask, 2) how often they will visit after the initial visit and 3) why it is important to work with the contact tracer because they are there to help.
During the Surveillance Visit or Initial Contact Tracing Visit
- Make introductions and help facilitate the conversation between the surveillance team and the family.
- Remind the family that they may ask any questions about the process.
- Provide the surveillance team with additional relevant information about the community and families, based on the mobilizer’s longer-term presence there. Always respect privacy, and do not disclose confidential information (e.g., a family member’s HIV status).
- Listen and facilitate. Look for signs of discomfort and look for ways to allay fear and anxiety.
- Help to engage others in the household for fuller stories related to the contact, using your experience, trust and knowledge of the community.
- Do not take on the role of the surveillance officer. Do not burden the family or community by asking them to recount the details of the events that took place over and over again. You are not a trained case investigator. Your role is to help facilitate the trained professionals to access the information they need and to advocate for the families to be treated in a respectful and compassionate way.
After the Surveillance Visit or Initial Contact Tracing Visit
- Work with the family and community to coordinate any additional visits in such a way that communities are not over-burdened by outsiders and visitors.
- Follow up with the households and ask people if they have any questions they did not feel comfortable asking at the time of the visit, but which they might want to ask privately.
- Do not take on the role of a contact tracer. Do not offer to take temperatures, fill forms, or do other work of contact tracers that you have not been trained to do.
- Where negative events or experiences are registered, provide a detailed incident report to your supervisor or the DERC for immediate action.
- Where the family/community experience is positive, equally, provide feedback to the DERC.
How Mobilizers Can Support Quarantine Officers
Mobilizers are not directly responsible for maintaining quarantine. However, they can assist families and service providers throughout the quarantine process. Mobilizers play a role in preparing the community and providing two-way information flow. They can also keep up a dialogue with quarantined families so that they understand why they are quarantined, and the risks posed to themselves and their communities if they leave the quarantine. Mobilizers answer questions, provide advice, relay information to the DERC about gaps in services and maintain a trusted point of contact for families if they experience problems.
Before the Quarantine
- After being alerted and briefed by the surveillance team, arrive at the family home/community as quickly as possible.
- Listen to community members, answer questions, and help them to stay calm. Express concern and sympathy.
- Prepare the family for what they can expect during the quarantine. Explain that everyone must observe the 21 days of quarantine for their own and their community’s health and safety.
- Discuss the signs and symptoms of Ebola and what to do if signs or symptoms occur.
- Explain the quarantine process, including 1) what a quarantine is and why it is important, 2) the use of chlorine and the disinfection process, 3) how long the quarantine will last, 4) how to stay safe and minimize contact during quarantine, 5) how the family/community nutritional needs will be met during quarantine and 6) how the family will be able to communicate with family members in the ETU.
- Do not raise expectations about the food/non-food items that a family will receive.
- Do not take on the role of a quarantine officer. Mobilizers can assure family members that their needs will be met, and let them know that the quarantine officer will be able to provide more details.
During the Quarantine
- Attend daily integrated partner meetings at the ward/community level to receive the latest information on quarantine services and plans for the day.
- Continue an ongoing dialogue with families and provide consistent advice and encouragement.
- Pay special attention and provide additional support to pregnant women and others with special needs in quarantined homes.
- Work with the family and community to coordinate visits of the different service providers in such a way that communities are not over-burdened by outsiders and visitors.
- Provide up-to-date information to families on the quarantine and distribution process, locations of distribution points and timing of distributions.
- Be a key point of contact with families, keep returning to troubleshoot problems and provide two-way information flow, and effectively use the contacts agreed with the DERC.
- Check with family members who have sick relatives in the ETU to make sure the family has the latest updates on the status and location of the patient and can communicate with them. Follow up with other pillars/partners if the family is not receiving this information.
- Based on the needs of the community members, link to other pillars/services, especially psychosocial support and religious community.
- Report any incidents or concerns to the DERC immediately.
After the Quarantine
- Work with the family and community on re-integration into the community and help reduce stigma.
- Where negative events or experiences are registered, provide a detailed incident report to your supervisor or the DERC for immediate action.
How Mobilizers Can Support Burial Teams
The mobilizer may be notified that a death has occurred in the community by the family, community, the DERC, the Social Mobilization Pillar or their supervisor. If notified directly by the community, the mobilizer must immediately ensure that the family calls in the burial alert to a local hotline, for example, in Sierra Leone, the call would be made to the DERC (117/district hotline).
Before the Burial Team Arrives
- Meet the family in the home as quickly as possible.
- Express compassion and condolences for the family’s loss. Express gratitude for keeping themselves and their community safe by reporting the death using the alert system.
- Advise the family that if they can access a coffin or shroud quickly, the burial team can use it in the burial. The burial team cannot wait for these items, so the family should act quickly.
- Maintain regular contact with the DERC and/or burial team to update on the progress and expected arrival time. For female deaths, request the need for a female burial team member to be present.
- While the family waits, clearly explain how and why they must keep a safe distance from the body and minimize contact with the room/items that were used by the deceased.
- Listen to the family’s concerns. Offer to help the family to contact a religious leader or community leader join the conversation.
- Prepare the family for what they can expect when the burial and swab teams arrive. Explain that all bodies will be prepared for a safe burial, whether or not the case of death was Ebola.
- Explain the swab and burial team process, including 1) what is a swab and when the results are usually available, 2) what is a safe and dignified burial and why it is important, 3) how and why the burial teams spray the body and prepare for burial whether at home or at another facility (e.g., ETU), 4) how the body is moved and laid to rest and 5) how they can learn about the burial location/time. Refer to the Consolidated Messages Guide.
- Discuss with the family that while tradition is important, as long as Ebola is present, everyone must find a way to respect the dead and observe burial rites without putting themselves or anyone else in danger of catching Ebola.
During the Burial Team Visit
After the Safe and Dignified Burial
- Ensure feedback to the community, such as where the body will be taken and liaise with the burial team about viewing times.
- Liaise with other partners and pillars to ensure that the families receive the death certificate and laboratory test results, and explain if it was an Ebola or non-Ebola death. Explain that if the death was Ebola-positive, they will now be listed as contacts (see Surveillance above).
- Within two days of the burial (see Burial Pillar SOP), visit the family to 1) ensure that they are aware of the grave location, 2) inquire about their satisfaction with the burial process and get feedback on their experience and 3) address additional support needs as necessary.
- Where negative events or experiences are registered, provide a detailed incident report to your supervisor or the DERC for immediate action.
- Where the family/community experience is positive, equally, provide feedback to the DERC.