So here I am in Africa with Save the Children rather than VSO during the 18th known outbreak of the viral haemorrhagic disease, Ebola. It is very different to my previous experiences as a VSO volunteer in Tanzania but as a pharmacist with development experience I wanted to be part of the international response in Sierra Leone even if not everyone agreed with my decision. It took a lot of persuasion to convince my family that it was the right choice and that I would take every precaution possible to stay out of harm’s way.
I arrived a month ago with a suitcase full of alcohol gel from my Dad, a 6-pack of Handy Andies from Mum and a guitar, a last minute purchase from Amazon. I’m not sure that teaching myself how to play the guitar in the middle of an epidemic is the best idea I’ve had, but it certainly isn’t the worst!
I presumed the plane to Sierra Leone would be empty. Who in their right mind would be heading that way? I was wrong. My flight connected in Casablanca and the airport was full of young, white, European NGO workers congregating in eager huddles talking about how life in the capital Freetown had changed since the outbreak started almost a year ago. Suddenly all international funding and expertise was being redirected into the fight against Ebola rather than education, the wider healthcare system or secure livelihoods.
In truth I see very little of Sierra Leone. For an hour each day on the drive to and from the Kerrytown Ebola Treatment Centre (ETC) where I work, I watch normal daily life through the windows of an air-conditioned minibus. As a pharmacist I am responsible for ensuring there are always supplies of medicines available for the treatment of the patients and the hundreds of staff that work at the centre. Procurement and efficient stock control processes guarantee we never run out of the important items vital for the treatment of the disease, such as antibiotics and IV fluids.
The situation on the ground is in many ways as I expected but the reality of a country in lock down and a population grieving is impossible to imagine until you are in the thick of it. For the past eight months, schools, cinemas, nightclubs and football grounds have been closed. Gatherings of more than five people have been banned (except for church). There’s a curfew on shop opening times and no-one is permitted on the streets after 10pm. Handshakes and hugs are forbidden, temperatures are checked and buckets of chlorine for hand-washing are everywhere. A journey from Freetown to Kailahun, where the first cases of Ebola were reported, has increased from 5 to 7 hours due to the 14 mandatory temperature checkpoints along the way. All of these changes have a profound impact on the people of Sierra Leone.
The restrictions have led to food shortages and occasionally riots in quarantined areas. At the height of the outbreak freedom of movement was limited and food, fuel and basic supplies ran out due to suspension of services by shipping companies and airlines. Last month, 31 houses in Freetown were under quarantine by armed guards with families of confirmed patients no longer allowed out of their homes.
Despite these obvious challenges Ebola is now more widely understood by the population compared with last summer when it was first spiralling out of control. In the early stages of the epidemic, patients and their families were stigmatised by their community and orphans were rejected by their extended family. Fear of the disease and an increasing financial responsibility were immense. Since then, campaigns run by the government with help from volunteers and NGOs have invested in educating communities about hand-washing techniques, recognising symptoms of Ebola and what to do if a case is suspected. Surveillance officers visit neighbourhoods to teach people about Ebola and encourage community engagement whilst Contact Tracers help to locate people who may have been in close contact with an Ebola positive patient.
When a patient gets better and has two negative Ebola blood tests, they are discharged from the ETC. They are issued with new clothes, bedding, toiletries, money, food and a survivor certificate which goes some way to ease re-acceptance into the community. Community Engagement Teams pre-empt discharges and visit the homes and villages of patients to encourage community understanding and acceptance before the patient is driven home to return to their family as a survivor.
But while the Ebola case numbers are now falling, hospitals are yet to reopen. Many were converted to holding centres and ETCs at the height of the outbreak; others closed their doors for fear of spreading the disease or due to lack of healthcare staff. Numerous ETCs around the country have seconded Sierra Leonean health staff from government hospitals and student clinicians from training colleges. While much time is being dedicated to teaching the national doctors and nurses on good clinical practice and disease management, all of them will need to return to their official posts in due course to begin the long and arduous process of regenerating the national health system. Perhaps at this point the long-term impact of Ebola will really be seen and the hard work truly begins.
Facts about Ebola
- To date 3,199 deaths from Ebola have been recorded in Sierra Leone with more than 500 national health staff contracting the disease (WHO 25/01/15)
- The national healthcare system has been decimated by the Ebola outbreak (Ministry Health and Sanitation Sierra Leone, http://health.gov.sl/)
- In January 2015 the Western area including the capital Freetown, has become the latest hotspot for new cases. (Ministry Health and Sanitation Sierra Leone, http://health.gov.sl/)
- There are 1,207 beds in 23 Ebola Treatment Centres around the country to support Sierra Leone’s Healthcare System. (See Uk Government information on Kerrytown)