Tuesday, July 22, 2014

Sierra Leone Should Recalibrate Ebola Response

Correct Ebola Protective Gear
The sheer incompetence with which the Ebola outbreak has been handled in Sierra Leone is mind boggling. When government first made the fateful decision to move Ebola patients from the relatively isolated areas of Kailahun district to the populated Eastern capital of Kenema,  I did in one of my earlier postings question the wisdom of such a move. For a deadly virus like Ebola,  isolation simply does not simply mean building isolated wards in populated areas. It actually means confining such outbreaks in remote locations, away from population centers.

Unfortunately,  the response to the Ebola epidemic in Sierra Leone at the official level been mired in mudslinging and political infighting.

Sierra Leone Ebola Worker
Poor Protective Gear
Instead of having a Presidential task force comprised of district leaders,  the President's circle of trusted advisers and leading infectious disease specialists working together to stem the outbreak, the response has been characterized by political grandstanding,  accusations of disrespect and incompetence, and the pursuit of personal vendettas.
Freetown Based Miatta Kargbo

The open war of words between the Health Minister Miatta Kargbo and the Special Executive Assistant to the President Sylvia Blyden,  fueled by alarmist stories from her Awareness Times paper and social media has painted a picture of a government that was unprepared to deal with the Ebola incidence,  in spite of the fact that the virus had been waging it's deadly rampage in the neighboring countries of Guinea and Liberia for some time,  and it was only a matter of when before it surfaced in Sierra Leone,  given the geographical proximity to the areas of infestation.

This mixed message from those close to the President has been one of the main problems in the country's response,  as all efforts to educate the mostly illiterate people of the affected areas has been drowned out by the belief of the people that the government does not care for them and that the health officials do not know what they are doing,  a view buttressed by the daily accusations of ministerial incompetence by none other than the Special Executive Assistant herself,  who has seen this tragedy as a source of political capital and intends to milk it for all that it's worth.

The Kailahun district, where the virus initially surfaced is in the Eastern part of Sierra Leone, far removed from the country's capital. Chronically bad roads mean that it is also relatively geographically isolated.  Years of civil war also cut off most of the district from the rest of the country for extended periods. During the war Health care infrastructure and systems in the area were mostly destroyed and even the then premier teaching and Lassa Research Hospital at Segbwema was abandoned and became a compound full of dilapidated structures. The rebuild has been slow.

Ex SLPP Chairman Benjamin
with Kailuhun District Chairman Bhonapha
at Kenema EbolaCenter
Some of us initially thought that government would use the relative isolation of the jungle areas of Kailahun to work with international health partners and set up Ebola treatment centers in relatively remote locations away from population centers. We were however alarmed when patients were being brought to Kenema from remote areas make use of the Lassa Fever experience of the health workers there, a tragic mistake.

Unfortunately the transportation of Ebola victims to Kenema has turned out to be a disaster in the making,  as the health care workers who have worked for years with Lassa Fever are now tragically finding out that Ebola is a different kind of virus; a potent virus that cannot be handled with conventional isolation precautions,  due to its potency, longevity and the fact that no known cure exists and about 90% of those affected usually do not make it.
Benjamin with Dr. Shek
Umar Khan (Has Tested
Positive too!)

Reports from Freetown today puts the official Ebola figures at 422 confirmed cases with 143 fatalities. What is now very alarming is that many of the fatalities include front line Ebola health workers, who have been handling patients and highly infectious corpses of the deceased. Somehow, breaks in the chain of infection, has exposed some of the front line workers to the virus and they are now dying at disturbing rates.
Over the past months, many health care workers in Kailahun district have died from the outbreak. Now in Kenema, over the past few weeks, health care workers have also been falling prey to the virus. Just yesterday three workers at the Kenema hospital died from the Ebola fever

One of those who died yesterday,  Mrs. Mbalu Fornie, was a veteran Lassa Fever worker from Segbwema with over 15 years of experience working with Lassa patients. Just a week ago, the former Chairman of the Sierra Leone Peoples Party (SLPP) Mr. John Benjamin, who has made the fight against Ebola his latest mission, made one of his regular visits to the Ebola treatment center in Kenema and was given a tour of the facilities by Mrs. Mbalu Fornie who he had known for years in Segbwema, as that was where he was also born and bred.

According to Chairman Benjamin,  the experienced nurse tested positive for the Ebola virus just two days after he left the center and he was particularly devastated to hear about her untimely death.
Just this morning another young Segbwema nurse working at the Ebola center, Momoh Fudie, died from Ebola infection,  in what is now becoming a daily occurrence.
These deaths have created panic in the Kenema government hospital and the workers have threatened to down their tools, unless the Ebola wards located inside the Hospital premises are relocated elsewhere. They have also requested that the Ebola wards be under the control of the French NGO Doctors Without Borders (MSF), as they no longer have faith in the capacity of government health officials to effectively handle the outbreak.
Late Mrs. Fornie in Red

The rapid Ebola spread in Sierra Leone has been propelled by just the right mix of factors.  The areas of infection have a high level of illiteracy,  the people are very suspicious,  their faith in the government is traditionally low,  the messages from health officials have been mixed and chaotic, and  many high level government officials have stayed away from the area preferring to  only make radio announcements from from the relative safety of Freetown, and the message being disseminated is that the disease is incurable.
This cornucopia of factors has created a situation where people are now so afraid that they are hiding their sick relatives, believing that the government is killing them and the government has now called on the police to round up suspected cases and bring them to treatment centers.  I just hope the police are provided with adequate Ebola personal protective equipment.

Dr. Sama Banya (Puawui), a veteran politician and medical doctor and a sage,  who is renowned for his thorough knowledge of Sierra Leone political and sociocultural history wrote what I think is an excellent summation of the situation in the afflicted areas. He wrote the following:

"Dear All,
I trust you and your families are doing fine. I am sending you the latest update on Ebola released by the Ministry of health and sanitation as of last Friday July 18. The figures are cause for concern because they show that the number of new cases and the cumulative death have risen instead of diminishing.
Why would this be happening in spite of the fact that we have been combating the infection since April? I can give two main reasons among others. That there is still a lack of full understanding about the disease among our people. That may in itself be due to the kind of interpretation of the nature of the disease. If you start with “There is NO CURE for this sickness” it no longer matters whether you add that early treatment gives an almost 100 percent cure, it is the initial “HAS NO CURE” which would stick in the minds of our illiterate brothers and sisters who have asked, “Then why bother?”
My opening line would have been that “We have a new and dangerous disease with us, but those who get early treatment have a chance of a 100 percent cure.” There is also the important matter of the reported attitude of some field staff to patients, contacts and their families. From what I have heard some unfortunately appear to be callous in their behaviour.
A sad picture but true nonetheless.

I really can't add much to the old man's words, he paints a picture that is easy to see. Unfortunately Sierra Leone is so politicized that as an opposition politician, he may as well as be making a speech in a cemetery in the middle of the night.

And news filtering from Fretown is that Dr. Shek Umar Khan, the doctor leading the Ebola team has also tested positive for the virus and his life currently hangs in the balance. May God save his life.We will just continue to hope for the best and encourage every Sierra Leonean to constructively engage in this fight against such a dreaded killer.

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