I was appointed at some point to provide strategic support in to one of the epicenters in the country. This involves supporting the affected district through advocacy and removing bottlenecks in accessing funds and logistics for the district. There were growing concerns recently following the increased number of unattended dead bodies in the capital Freetown, leading to scuffles between state security and communities. As a preventive measure, I was recalled to coordinate the national burial teams. I have instituted measures in my first week in this capacity and the result is impressive, as there are no more delays in responding to burial issues in the capital and country as a whole.
On 4-5th September 2014, I attended the consultative meeting in Geneva on potential EVD therapies and vaccines in response to the current outbreak. As a result, I have joined a team of researchers in this country to explore the possibility of establishing a potential site and institution of clinical trials of the EVD vaccine. My fervent wish is that this venture will succeed and give us a breakthrough in the fight. Of course, the primary aim is to get all health workers immunized immediately to give them back the confidence and assurance that has eluded them since this dark period of our history began. With this we hope that we will be emboldened to do more for our nation, for humanity.
Sierra Leone context
The small West-African nation called Sierra Leone is rated as one of the poorest countries in the world. Between 1991 and 2001 the country was engulfed in a civil war that left tens of thousands of people killed and many maimed. The war left the country‟s health infrastructure decimated to near collapse. Since the war period, the country has been considered as one of those with the poorest health indices worldwide, especially on maternal and child health.
Following the end of the civil war, successive governments and multi-lateral agencies and partners have provided huge support to strengthen the health system. Despite these efforts, the situation is still dire due to poor road networks that connect health service delivery points, lack of qualified and competent health personnel, inadequate and mal-distributed health facilities among others.
In May 2014 Ebola Viral Disease (EVD) struck the nation; this is a very new disease to the country and is posing serious challenges in its containment by the fragile health system. The disease at first was concentrated in two districts, Kailahun and Kenema, both in the Eastern region of Sierra Leone. These districts bordered with Guinea and Liberia where EVD first struck. The easy movement of people across the borders in these countries facilitated the transmission of the virus in Sierra Leone. By July 2014, the virus had spread to all but only one district (Koinadugu district) in the country. Since the outbreak in May, there have been a total of 1,503 laboratory confirmed cases, with 468 deaths at the time of writing.
Viral transmission in Sierra Leone
Many factors contributed to the escalation of the spread of EVD in Sierra Leone.
The spread of the virus, especially in rural communities is fueled by cultural and religious practices of handling the dead. Seventy percent of sources of the infection are attributed to burial rites through which communities are affected en masse by the virus. Health workers are also greatly infected and to date, 4 doctors and nearly 50 nurses and other health personnel have succumbed to the disease. The increase spread of the disease among health workers is largely due to lack of protective gear and knowledge in their proper use. The disease being very new and sharing similar features of the traditional diseases such as malaria, contributed to the spread when health workers find it difficult to easily differentiate between EVD and other known infectious diseases.
Also accounting for the rapid spread of the disease are ignorance, myths and misinformation about the disease. In Sierra Leone like the other affected countries in the Mano River Basin, for example, myths and rumours about Ebola abound – such as the claim that it is not a real virus at all or the theory that it can be prevented by traditional medication. Countering misinformation is crucial in efforts to eradicate the disease.
Containment measures of EVD outbreak
A public emergency was declared in the country in August in an effort to contain the spread of the virus. The emergency has led to the two epicenter districts being quarantined, limiting movement of people into and out of those districts. Other measures include the forced quarantine of households with Ebola affected persons for a period of 21 days. Provisions are made to support the affected households with food and water during the quarantine period.
To prevent community-wide exposure to the virus, the operations of mushroom clinics across the country were banned and all burials were to be notified in order to enable health authorities to conduct assessment and rule out Ebola before non-infected bodies are handed over to relatives for burials. These measures among others are being enforced to influence the behaviour of the wider public.
Despite these measures, the country is still grappling with huge challenges to
overcome the spread and these include:
• Insufficient trained staff to manage EVD
• Insufficient logistics such as personal protective equipment, body bags, etc
• Insufficient isolation and treatment centres and laboratory facilities
• Insufficient transportation for surveillance and burials
Economic impact of Ebola on Sierra Leone
Sierra Leone has recently been doing immensely well with double digits economic growth prior to the outbreak. This has now reduced drastically following the cessation of operations of extracting industries, fisheries and international flights, as the country is almost isolated from the rest of the world.
The country is sliding down further into poverty as it is currently closed from the rest of the world with limited or no income generation. This has implications on state security due to the resultant unemployment and lack of government capacity to pay salaries.
The magnitude and spread of the Ebola outbreak in Sierra Leone requires enormous commitment of resources and robust sustained response capacities. It is thus high time that the international community scales-up their support to this war-weary nation to eradicate this scourge within the shortest possible time.
Dr Samuel Kargbo is Director of Reproductive and Child Health in Sierra Leone. He studied medicine in Tashkent and Leeds and has dedicated his career to providing appropriate free medical care to women and children. His work has been recognised by the United Nations and he is regularly consulted by leading medical agencies.