Sierra Leone

Sierra Leone tries to scare public into stopping ebola spread

From the Guardian: ‘Western area surge’ will use similar tactics to UK drink-driving campaigns to scare people into changing their behaviour

A Sierra Leonean health worker carries the body of a child for burial

A Sierra Leonean health worker carries the body of a child for burial. Swab tests show that 30% of bodies picked up by burial teams are positive for Ebola. Photograph: Francisco Leong/AFP/Getty Images

The president of Sierra Leone will launch a massive campaign on Wednesday to curb the spread of Ebola in the western areas of the capital Freetown, which will aim to scare people into changing their behaviour.

The “western area surge” will use the sort of tactics that worked in the UK to discourage drink-driving, according to Donal Brown, head of the UK taskforce leading the international response in the country.

“We have got to go into every street, every house everywhere,” said Brown. “The western area surge is about massive social mobilisation and massive surveillance. “Freetown is not a place that feels scared or where people are bothered about Ebola. It is like the car crash or drink-driving campaigns in the UK. We want a campaign that says this is scary, this affects me – along the lines of, ‘Your neighbour stays at home? He kills you.’”

At the moment, swab tests show that 30% of bodies picked up by burial teams after calls from families are positive for Ebola. People are still nursing the sick rather than having them taken to holding centres for testing and then moved into treatment centres where half will probably die. It is in the last stages of the disease that victims are most infectious.

“We know it is out there. We have got to turn it around so that 2% to 3% of these bodies are actually positive,” said Brown.

The reluctance to make the call is rooted not only in family values but also cultural tradition around burials. In normal times, relatives would wash the bodies of those who die and dress them for the funeral. Many are still doing so – and calling the authorities afterwards, which means they have already exposed themselves to great risk.

“The behaviour change is not working,” said Brown. “We need to get to much more active surveillance, rather than passive surveillance.” Many thousands of people will be employed to visit communities and spread a tough new message in the course of the campaign, which will last for two to three weeks over the Christmas period. People now understand what Ebola is and what the risks are, but they are still in denial because they do not think it will happen to them, he said.

The latest data from the World Health Organisation shows a drop in the number of new cases in Sierra Leone, including Freetown, which may herald a flattening of the epidemic in the country as happened in Liberia – though it is also possible that the numbers will shoot up again as they did after dropping in Guinea. Last week there were about 250 fewer new cases in Sierra Leone, including a drop of about 100 in Freetown.

But as long as there are cases, there is the possibility of spread to a new region, triggering another outbreak. That has recently happened in rural Kono and in Kambia, the district north of Port Loko, which are causing real concern. In Kono in the eastern province bordering Guinea, it is thought men from Ebola-hit areas travelling for illegal diamond mining may have been a factor in the sudden outbreak.

Kono was unprepared. Some of the infections happened in a building being used as an isolation centre, where people who will have had other illnesses with similar symptoms such as malaria were being held with those who turned out to have Ebola. “We believe the spike is associated with unsafe burial practices and with poor infection control in a temporary holding centre,” said the UK’s Department for International Development.

The World Health Organisation reported 119 cases in Kono as of 9 December and said 87 bodies had been interred by burial teams stretched beyond their capacity before the alert was sounded and reinforcements drafted in.

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Despite Aid, Ebola Raging in Sierra Leone

NOV. 27, 2014

KISSI TOWN, Sierra Leone — Military choppers thunder over the slums. Nearly a thousand British soldiers are on the scene, ferrying supplies and hammering together new Ebola clinics. Crates of food and medicine are flowing into the port, and planeloads of experts seem to arrive every day — Ugandan doctors, Chinese epidemiologists, Australian logisticians, even an ambulance specialist from London.

But none of it was reaching Isatu Sesay, a sick teenager. She flipped on her left side, then her right, writhing on a foam mattress, moaning, grimacing, mumbling and squinching her eyes in agony as if she were being stabbed. Her family and neighbors called an Ebola hotline more than 35 times, desperate for an ambulance.

For three days straight, Isatu’s mother did not leave her post on the porch, face gaunt, arms slack, eyes fixed up the road toward the capital, Freetown, where the Ebola command center was less than 45 minutes away.

“This is nonsense,” said M.C. Kabia, coordinator of the volunteer Ebola task force in Isatu’s area. Help rarely came, he said, and people were quietly dying all over the place.

While health officials say they are making headway against the Ebola epidemic in neighboring Liberia, the disease is still raging in Sierra Leone, despite the big international push. In November alone, the World Health Organization has reported more than 1,800 new cases in this country, about three times as many as in Liberia, which until recently had been the center of the outbreak.

More than six weeks ago, international health officials conceded that they were overwhelmed in Sierra Leone and reluctantlyannounced a Plan B. Until enough hospital beds could be built here, they pledged to at least help families tend to their sick loved ones at home.

The health officials admitted Plan B was a major defeat, but said the approach would only be temporary and promised to supply basics like protective gloves, painkillers and rehydration salts.

Even that did not happen in Isatu’s case. Nobody brought her food. Nobody brought her any rehydration salts or Tylenol. No health workers ever talked to her about who she might have touched, which means anyone directly connected to her could now be walking through Freetown’s teeming streets, where — despite the government’s A.B.C. campaign, Avoid Body Contact — people continue to give high fives, hug and kiss in public.

Community volunteers said Isatu’s case was the norm, not the exception.

“We have a huge number of death cases,” said Mr. Kabia, the volunteer Ebola coordinator in Isatu’s area, Kissi Town, adding that residents rarely survived because of the slow response.

Photo

On Freetown’s outskirts, burly youth are setting up roadblocks. The police are nowhere to be found. The young men barricade the road brandishing digital thermometers. CreditDaniel Berehulak for The New York Times

Discouraged, scared and furious, Sierra Leoneans are taking matters into their own hands. Laid-off teachers (all schools in this country are closed) race around on motorbikes, monitoring the sick. In some villages, informal isolation centers are popping up, with citizens quarantining one another, an incredibly dangerous ad hoc solution being performed without appropriate protection. (United Nations officials say this country is still short hundreds of thousands of protective suits.)

On Freetown’s outskirts, burly youth are setting up roadblocks. The police are nowhere to be found. The young men barricade the road, but instead of wielding weapons, they brandish infrared thermometers.

“Show me your forehead,” commanded a ringleader, wearing a white tank top and baseball cap askew.

A passenger leaned out of the car while the ringleader scanned his head. 98.5. The posse then lifted the barricade, keeping anyone sick out of their neighborhood.

Fever is the scarlet letter of Ebola. Just about every important building in Freetown — hotels, banks, government offices — is now manned by a guard with an infrared thermometer and a bucket of diluted bleach for a mandatory hand wash.

But in the slums, it is a different story. In Kissi Town, an underserved area of dirt roads and dirty wells, the local Ebola task force said that more than 150 people had recently died of the virus, and that many had received no food, medicine or any other help.

Photo

Ebola patients waited in the recovery area after testing negative for the virus at a treatment center in Freetown, Sierra Leone. CreditDaniel Berehulak for The New York Times

Stuck in her house, waiting for an ambulance, Isatu kept burning up. She was intensely nauseated, she said, but still able to walk a few steps, an important factor.

“If they walk in, their chances are good,” said Komba Songu M’Briwa, a doctor at an Ebola clinic. “If they have to be carried in, well …”

By last Friday morning, Isatu was not walking anywhere. She had become too weak to stand. Her chances were plummeting.

She curled up on the floor, her jeans splotched with dried black vomit. She was delirious, eyes bolted open, huge and blank. A shadow would cross the threshold and they would not even flicker.

The virus was moving faster than all the aid workers put together.

“I’ve called 10 times myself, ” said Abu Bakar Kamara, a community volunteer, as he paced the scratched dirt yard in front of Isatu’s house. “No response.”

Photo

Health workers outside the high-risk area at the Hastings Ebola treatment unit in Freetown, the capital of Sierra Leone. CreditDaniel Berehulak for The New York Times

Sierra Leone has an elaborate Ebola response system — on paper. It starts with a call to 117, the toll-free number for central dispatch. A surveillance team is sent out, then an ambulance takes a patient to a holding center, then blood tests and a proper treatment center where the patient might receive intravenous fluids or other special care.

But the Ebola clinics do not have nearly enough beds, especially in Freetown, and an ambulance will not show up at a sick person’s house unless there is a bed somewhere for that patient. The government says it needs 3,000 beds nationwide but has fewer than half of that now.

Ambulances are hurtling across the country for hours to remote clinics in the east, where there are a few vacancies. The roads are horrendously bumpy; the jungle heat without reprieve. Many patients are dead on arrival.

Western officials are quick to add that even if all the resources were in the right place, that would not stop the virus.

“You can have as many helicopters, ships and kit here as you’d like,” said Lt. Colonel Matt Petersen, a British adviser. “But unless you change behavior, it’s not going to stop transmission.”

Public health professionals are beginning to look harder at Sierra Leone’s culture, which is dominated by secret men’s and women’s societies that have certain rituals, especially around burials. Many people here — just like in other cultures — believe that the afterlife is more important than this one. A proper burial, in which the body is touched and carefully washed, is the best way to ensure a soul reaches its destination.

Protest: Ebola victims’ bodies left in hospital entrace by burial teams

Health workers in Kenema, Sierra Leone, say they have not been paid their hazard allowance for seven weeks.

An Ebola treatment centre run by the Red Cross in Sierra Leone.
An Ebola treatment centre run by the Red Cross in Sierra Leone. Photograph: Francisco Leong/AFP/Getty Images 

Bodies of Ebola victims have been dumped outside a hospital in Sierra Leone by burial workers, who are protesting at the failure of authorities to pay them bonuses for their hazardous work, residents have said.

Tensions in the eastern town of Kenema reached new heights with the action by members of the burial teams. Local residents said three bodies were abandoned in the hospital doorway, preventing people from entering. There were reports that 15 bodies in total had been left in the street.

Healthcare workers have repeatedly gone on strike in Liberia and Sierra Leone over lack of pay, unfulfilled promises to pay them more and their dangerous working conditions. Two weeks ago, health workers walked out of the Ebolatreatment centre in Bo, the only one in southern Sierra Leone, over the same issues.

A spokesman for the striking workers in Kenema, who asked not to be identified, said they had not been paid their weekly hazard allowance for seven weeks. Authorities accepted that the money had not been paid but said all the striking members of the Ebola burial team would be dismissed.

“Displaying corpses in a very, very inhumane manner is completely unacceptable,” said the spokesman for the National Ebola Response Centre, Sidi Yahya Tunis.

The head of the district Ebola response team, Abdul Wahab Wan, said the bodies had included those of two babies, and some had been displayed around the hospital.

The pressures on burial teams and health workers in Sierra Leone are severe as the case numbers continue to climb, in spite of a slow-down in neighbouring Liberia. Official figures from the World Health Organisation on 21 November showed there have been 6,190 cases in Sierra Leone, including 136 healthcare workers, and 1,267 deaths. There have been 15,351 cases and 5,459 deaths reported in the Ebola outbreak in total so far. The true figures are expected to be far higher.

Public Services International (PSI), a global trade union federation, has launched a video to name and honour 325 health workers, including doctors, nurses, ambulance drivers and cleaners, who have died of the disease in the three worst-hit countries. According to the WHO, 588 healthcare workers have been infected and 337 have died. Some will have lacked the personal protective equipment needed to do their job safely.

The federation said the “grievously high loss of lives” revealed a failure to invest in public health systems in the three worst-affected countries.

Anthony Banbury, head of the UN Mission for Ebola Emergency Response, said on Monday that the target of getting 70% of people with the virus into treatment and 70% of those who die safely buried by 1 December would not be met.

”In some places, we are definitely going to make it: we see some really good impact of the efforts of the national authorities and the United Nations system,” he said.

“It’s clear where there are escalating cases rapidly accelerating the spread of the disease, and where we don’t have the response capability on the ground, and that’s definitely the case in some places, we’re not going make it.”

The areas of greatest concern are in rural parts of Sierra Leone, the city of Makeni in the centre of the country, Port Loko in the north-west and the capital, Freetown.

Millions of dollars in aid have been pledged, troops have been sent by the UK and the US, and volunteer health workers are slowly arriving, but the epidemic in Sierra Leone is yet to show sign of abating.

Behaviour change a major problem with Ebola crisis in Sierra Leone

Via BBC News, 1 December, 2014

For weeks it has been the same here in Sierra Leone’s capital, Freetown. Every day the Ebola burial teams – now well organised and promptly dispatched – collect about 60 bodies from around the city and its crowded suburbs.

Some days it is 50, sometimes as many as 80.

About 20% of those bodies turn out to be Ebola cases. The rest are just the usual range of deaths you might expect in a large city in West Africa. Every death is now treated as suspicious.

There is an air of brisk efficiency at the workers’ base – the British Council offices, on a hill overlooking the Atlantic Ocean, now transformed into an Ebola command centre for the western region of Sierra Leone.

Calls are logged, white boards filled, statistics for the past month collated by close-knit teams.

Down the hill, at the municipal cemetery, bulldozers are busy clearing new ground, scraping away mounds of rubbish to give the gravediggers more space.

“At the moment we’re having some success in holding on to the epidemic and I don’t see the more astronomical predictions coming through at the moment,” said British army Colonel Andy Garrow.

Dying at home

And yet, as the weeks go by and the body collection teams continue to bring in the same number of corpses, Col Garrow finds himself drawn increasingly to one particular conclusion.

“Behaviour change,” he says. Or rather the lack of it.

Health workers at the Kerry Town treatment centre, on the outskirts of Freetown (13 November 2014)Sometimes suspected Ebola cases are not reported to the health authorities

Here is the problem: By now, everyone knows about Ebola; and nobody with symptoms should, logically, be dying at home or on the street anymore.

They should all have been taken to hospital.

But to understand why that is not happening, all you have to do is drive to any of the impoverished suburbs of Freetown.

Mariatu Kamara had been hiding her illness for several days.

When we found her outside her home in Rogbangba village only a few people knew she was sick – a headache, sore bones and boils on her head and legs.

Perhaps it was not Ebola. But if it was, her three young children – one tied to her back – were at grave risk.

This Freetown graveyard shows “the almost industrial scale” of the Ebola crisis, reports Andrew Harding

Ebola burials

  • Bodies still contain high levels of the Ebola virus
  • At least 20% of new infections occur during burials, WHO says
  • Relatives perform religious rites including touching or washing the body
  • Safe burial process involves observing rituals differently, such as “dry ablution”
  • Volunteers with full protective clothing are trained to handle and disinfect bodies
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“I don’t have a phone,” Ms Kamara explained at first, when I asked her why she had not contacted the Ebola telephone hotline.

But she became visibly alarmed when I suggested we could help.

“I can’t leave my children here on their own,” she said. Her nine-year-old daughter, Aisatu, began to cry.

The village headman, Abdul Karama, arrived and promptly called 117 to report a possible Ebola case.

He was worried that it would not make a difference. “We call, but sometimes nobody comes,” he said, citing other instances.

Ignoring quarantine

A few doors away, Rogbangba village revealed another problem – quarantine.

Fifteen-year-old Aminata Bangura died last week of suspected Ebola.

The rest of her family – 11 people – were promptly told to stay indoors. Food parcels were delivered to help them out.

But it was quickly obvious that the family were ignoring the quarantine order.

We saw Ms Bangura’s brothers emerging from a crowded mosque across the dirt road.

“It’s lonely at home. I go to the mosque because I don’t know how to pray on my own,” said 22-year-old Ibrahim Bangura.

He continues to run a hairdressing business from a nearby wooden shack.

Ebola deaths in West Africa

Up to 24/25 November

6,928

Deaths – probable, confirmed and suspected

(Includes one death in US and six in Mali)

  • 4,181 Liberia
  • 1,463 Sierra Leone
  • 1,284 Guinea
  • 8 Nigeria
Getty

The local headmaster – now out of work because the schools are closed – has become a fervent anti-Ebola campaigner and social mobiliser.

But Godfrey Kamara is finding it almost impossible to change the community’s behaviour.

“It’s not working. When they’re quarantined people should stay around and have security. And they still wash the dead,” said Mr Kamara, accusing Ms Bangura’s family of doing just that.

“They washed her body before calling 117. I know it. They shouldn’t do that. I tell everyone they shouldn’t wash the body but they still don’t believe Ebola kills.

“I’ve been house to house telling them not to touch bodies, but they still do it,” he said in a quiet fury as he stood on the road outside the quarantined house.

Later, I called Mr Kamara to find out what happened to Mariatu Kamara (no relation).

She had been taken the next day to a hospital in Freetown. Her children were being looked after by neighbours.

But while he was on the phone, Mr Kamara said those neighbours were now attacking him – blaming him for breaking up the family.

“They’re angry with me,” he said, before hanging up.

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Read Andrew Harding’s other reports from Sierra Leone:

Kigbal village orphans

Focus on girls in Sierra Leone amid Ebola

Chernor Bah, a global youth advocate and education activist from Sierra Leone, recently returned from a visit to his home country. He discussed his findings with Judith Bruce.

Judith Bruce is a policy analyst at the Population Council, whose work helps build the health, social and cognitive assets of girls in the poorest communities in the developing world. Bah was one of the founders of the Sierra Leone Adolescent Girls Network, designed to reach vulnerable girls throughout the country.

Bruce: You have recently returned from Sierra Leone. In the course of your visit you focused on the impact on girls, and you also met with political leaders and those who control important policy decisions related to the national response to Ebola. How did you explain to them that we should also be focusing on girls at this time?

Bah: Here’s why we should be focusing on girls at this time: Dorcas is 17 years old. Her mom contracted Ebola when treating a patient in the clinic where she was a nurse. Dorcas took care of her mom when she was sick at home. Her dad, her elder sister and her mom were all infected and admitted. At the hospital, after her mom and elder sister died, Dorcas was helping to take care of her dad – even in the ward where they were both sick. Her father eventually died. Dorcas survived. She is left with her two younger siblings, who have become her primary responsibility. She is now the breadwinner and without support might be forced to engage in risky behaviors to fend for herself and her family. She is also unsure of returning to school, as there is no one to take care of her or pay her [tuition] fees.

Unfortunately, her story is not unique. Many of the 30-plus girl survivors of Ebola told me varying versions of a similar story. Girls in Sierra Leone are typically the primary caregivers in the home and in the community, especially for sick relatives.

Despite being primary caregivers, girls typically have less education and even lesser access to scientifically based information. And, despite carrying provisioning responsibility, they have less access to public services.

When emergency distributions are done in communities … girls, who bear the biggest burden, are the last to get anything.

If we don’t begin with the girls, we won’t get to them.

Bruce: We hear that there is a 70 percent mortality rate, but that also means 30 percent survive. How are female survivors being treated?

Bah: Girls who have survived Ebola are super girls. They are celebrated publicly for defeating the virus, but in their communities they have less social capital. They are stigmatized and have fewer friends; they might have lost parents, loved ones or benefactors, and have very little – if any – help from the government.

Fortunately, we mostly know who they are. If they have survived Ebola, it means they have been in a health clinic, where their data was recorded. Figuring out a way of first creating a support system for these girls will be crucial. Connecting them with each other in potential Ebola survivors’ clubs could be one way. It would provide social assets and capital, provide platforms to share their stories and support. They could also be powerful role models for girls, in a society where those are few and far between.

Bruce: Before Ebola, there was already a long-standing culture of sexual exploitation; that is, some girls depended on sexual exchange for basic necessities for themselves and their families. What is the situation now?

Bah: Every girl I spoke to expressed concerns about the increase in transactional sexual exploitation. In fact, girls in Port Loko, north of the country, which has been badly hit by the virus and is now under quarantine, told me that they have friends who are now pregnant and will never return to school. We have received reports of police officers – assigned to enforce the quarantine of households – sexually molesting young females. Bear in mind that typically during school holidays, when girls are at home, there is normally a spike in sexual abuse and exploitation and early marriage. Now you have communities that are shut down or economically depressed, men and young girls are home all day and no one knows when it’s all going to end. As one girl put it to me, it’s not a very safe time to be a girl.

Bruce: We’ve heard that many of the groups originally working on programs for girls have left the country or shut down their operations. Is that true?

Bah: Amid the shock of the epidemic, the government and the donors basically instructed that all programs that were not directly dealing with Ebola be shut down, and that funds all be redirected to fighting the epidemic. So these groups have, for the most part, been on the sidelines, watching helplessly as they see girls falling further behind. I worked with UNFPA (the United Nations Population Fund) to pull together a major meeting with the members of the network, and the first thing I should say was the sense of relief and excitement that they could come together to discuss how the virus was affecting girls and their programs. They were disappointed that their programs have generally been shut down, and many have been told they can’t proceed with their normal activities, including community outreach and other alternative social safety-net programs that they say are critical for the poorest girls they serve.

Some fear a spike in sexual violence and the exploitation of young girls, an increase in teenage pregnancy and forced marriages, an increase in fistula, an increase in maternal mortality and, of course, more girls will drop out of school permanently during this long, unprecedented break in education.

Bruce: How has the emergency affected policies and programs designed to reach girls and young women?

Bah: One of the critical challenges we often face in Sierra Leone is the invisibility of girls in national policies and programs. Youth programs, government policy and interventions – under normal circumstances – typically exclude girls. It gets worse in an emergency. As the president of the country told me in a private conversation, the government was shocked and overwhelmed by this epidemic, and has been playing catch-up ever since.

While in Sierra Leone I was able to review the Reproductive Health Strategy that was being proposed by the government and its partners to respond to the sharp decline in the availability of reproductive services during the outbreak. In some cases, there had been up to a 100 percent drop in the provision of basic contraceptive services for women and girls. The core concept of the strategy was to be the creation of 17 dedicated Reproductive Health Service Centers in each of the districts across the country, but it barely referenced the unique needs of girls or had mechanisms to foster their use of these services. Thankfully, working with the partners, especially UNFPA, we were able to review the proposal to include a stand-alone adolescent girls pillar. This will increase girls’ access to these services.

The stories still hard to find: The local responses to Ebola

Reposted from How-Matters.com

This morning when I googled “local response” + “ebola”, here’s some of the headlines I found:

Nurse’s visit spurs Ohio Ebola fears 

Florida: County and hospitals prepare for Ebola

As KU Hospital tests patient with Ebola-like symptoms, Lawrence agencies coordinate response

Denton City Council to be briefed on virus response

Ohio residents fear Ebola precautions could prompt panic (What’s up Ohio?)

Patrick Poopel holds his certificate that informs the world he is Ebola free in Monrovia in September. Photo: Morgana Wingard / MSF

Not exactly what I was looking for. With all this drummed-up fear and stereotypes and prejudice flying around, I guess it’s easy for Americans to miss that Nigeria has been declared ebola-free, as was Senegal on Friday. And it’s easy to miss stories of people fighting the disease, like survivor Alhassan Kemokai in Sierra Leone who caught it while caring for his ailing mother, independentambulance workers in Monrovia, or 6-year-old Patrick Poopel (pictured) whose smile who the only thing left that is infectious. Nursing student Fatu Kekula saved her father, mother and sister by inventing her own protective gear from trash bags. Apparently international aid workers heard are now teaching her ”trash bag method” and to others who can’t get into hospitals.

This is more of what I was looking for, but these stories are unfortunately often hard to find. So I thought I’d share a few others on the local response to Ebola that I’ve been collecting since the outbreak hit the international media – please share any others in the comments:

  1. The Hidden Heroes Of Liberia’s Ebola Crisis, by Jina Moore
  2. Ebola must be fought from the grassroots, by David Norman and Saran Kaba Jones
  3. The Rain after the Drought: Ebola, International Assistance and Community Initiatives in Liberia, by Charles Lawrence
  4. The West ignores the stories of Africans in the middle of the Ebola outbreak, by Ishmael Beah
  5. Liberian Ebola Survivors Return to Help the Sick, by Heidi Vogt
  6. Ebola: the story of the Sierra Leone diaspora response that no one is telling, by Katherine Purvis

Is Ebola in West Africa a “crisis of governance” or “the ugly face of a global aid system that is broken“? These questions are an abstraction to those who are facing sickness and suffering this very day.

Malonga Miatudila, MD, who was part of the first team that dealt with Ebola first in 1976, describes how they contained the disease without the knowledge we have today: “Engage with communities. Give them the leadership of the fight…International experts are there to support local communities, and not to substitute.”

If you want to give to local efforts, see GlobalGiving and the Ebola Survival Fund. Unfortunately this Indiegogo campaign by 5 grassroots organizations in Sierra Leone didn’t meet their goal, but you can still be in contact with them directly via email. Diaspora, share how you’re responding to ebola here.

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” ~Fred Rogers

Look for the helpers. Reach out. Invest in those that are there for their communities, whether funding is available or not.

What It’s Like To Be An Ebola Survivor In Sierra Leone (PHOTOS)

Via Huffington Post, 10/10/2014

Mohammed Elshamy is an Anadolu Agency photojournalist covering the Ebola outbreak in West Africa. Through his work in Sierra Leone, he was able to meet a 38-year-old mother of four who survived Ebola, named Rigiatu Kamara. Kamara lives in a very poor area with no services like clean water or electricity. Below, Elshamy shares Kamara’s story of being infected with Ebola — and surviving — with HuffPost.

“One day, I felt I had a serious fever. I was cooking at the evening, with plans to catch up with one of my friends that I promised I would take her to church, but I couldn’t go due to the fever,” she remembered.

“I called my man [husband] and asked him to cook in my place because I was sick. I took water with Panadol, then I went to the toilet as I also found I had diarrhea. And it all turns bad; my head and throat ached, my legs felt weak, and my back hurt so bad,” Kamara recounted.

“My body was very weak; I heard on the radio that if anyone has symptoms like fever and diarrhea, they should go to the hospital and report,” she added.

ebola survival

Kamara poses with her husband Baibai in Kenema on Aug. 26. “I was actually happy to see him put his hands over her shoulder,” Elshamy told HuffPost. “For me, it means a lot that they faced the virus and now [she] survived it with her husband.”

A day later, the couple went to a hospital for testing, where a nurse asked Kamara if she had recently come into contact with any sick people.

“I said ‘maybe,’ so they took a blood sample and said I should come [back the] following day,” she said.

Kamara remembers breathing a sigh of relief when the doctors told her that she had tested negative for Ebola.

“I was happy, but I was still feeling weak,” she said.

Her relief, however, didn’t last long. Two days later, two men from the hospital came to Kamara’s house to break the news.

“They said I shouldn’t touch my kids; no sexual intercourse — that I’m infected by Ebola,” she said. “They said my [blood] sample had to go through three stages, the second and third of which confirmed that I had tested positive for Ebola — so I was asked to follow them to hospital to be put in the Ebola unit there,” she recalled. “Meanwhile,” she added, “my children and husband were quarantined for 21 days.”

ebola survival

Kamara looks at photos from her youth in Kenema, Sierra Leone, on Aug. 26.

Talking about her feelings when she was infected, she said she felt there was no mercy in the hospital. Kamara was admitted to a ward packed with Ebola patients, where only a few people were available to help with treatment.

“People died on a daily basis when I was in the ward. For days, we weren’t served food; there was no mercy. I just thank God I survived,” Kamara said.

“Whatever I ate was later vomited; they don’t serve milk, nothing … My husband brought medicine, food and Maltina [a local beverage],” she added.

After five days of treatment, Kamara tested negative for Ebola and the hospital said she could be discharged, although she was still suffering diarrhea.

A doctor at the hospital asked her to stay for a few more days. Five days later, the diarrhea was gone and she was discharged with an official certificate giving her a clean bill of health.

ebola survival

Kamara shows the recovery document approved by the Sierra Leone Ministry of Health. The certificate reads: “The above named patient is been seen and managed at the Ebola isolation unit. Kenema Governmental Hospital. He/She is now clinically, physically and mentally fit to go home to rejoin his/her community. He/She poses no risk of infection to the community.”

However, she returned home only to get the cold shoulder from her neighbors, who feared they might catch the disease from the former patient.

“One of my friends stopped talking to me because I was an Ebola patient,” Kamara said.

She is now helpless and jobless as many in the community continue to avoid her — despite her certificate.

ebola survival

Kamara picks up a towel from a washing line in Kenema, Sierra Leone, on Aug. 26.

“I used to be a seller, but now it’s all gone. School will start, but I don’t have the money to pay the school fees for my kids. I’m bankrupt,” she said.

“When I was discharged [from the hospital], they just gave me 30,000 Leone [around $7]. They didn’t even give me medicine,” she added. “All we have now is dry bulgur — that’s what we have for food,” she said. “This morning, I found nothing to eat.”

This piece has been edited for length and clarity. Additional research by Damon Dahlen.

This story is part of “Inside an Outbreak,” a HuffPost series taking you to the front lines of the world’s worst Ebola outbreak. For more information on how you can help, visit HuffPost Impact.

Voices from the epicentre of the Ebola epidemic

As Ebola spreads across west Africa, we talk to the medical and humanitarian professionals scrambling to contain the spread of the disease

Reposted from  – Guardian Professional, Monday 14 July 2014 12.17 EDT

Ebola clinic Guinea
Medics enter an Ebola isolation tent at Donka Hospital in Conakry, Guinea. Photograph: Sylvain Cherkaoui/Cosmos/Médecins Sans Frontières

The outbreak of Ebola in West Africa is unrelenting: according to the World Health Organisation there have now been 888 cases and 539 deaths across Guinea, Sierra Leone and Liberia since the virus was first reported in March this year. The epidemic is unprecedented and the global health community has been left scrambling to contain the disease, for which there is no vaccine or cure.

In a bid to boost the response to the disease, the World Health Organisation (WHO) convened a special meeting on 2-3 July in Accra, Ghana, with health ministers from 11 West African countries and partners involved in tackling the disease.

Here, professionals involved in fighting the deadly virus share their experiences of what it’s like to be at the epicentre of the epidemic.

Dr Ibrahim Bah, medical supervisor at the isolation centre of Hôpital National de Donka, Conakry, Guinea

I work in the department for infectious and tropical diseases so I am used to working on epidemics but this is the first time I have dealt with Ebola. It is a new disease in Guinea. Before Médecins Sans Frontières arrived, we had no specific training on dealing with the virus. At the beginning, I was scared: I saw people haemorrhaging to death. The experience is traumatising for patients too: they know we don’t have a vaccine or a cure, and they think: “I have Ebola, my life is over.”

The earlier patients seek treatment however, the higher their chances of survival. We have had more recoveries than deaths on the ward. The first recovery was a real celebration – it gave us strength to continue working.

Safety is paramount but working with the protective clothing is exhausting in the heat. On very hot days, you sweat so much that you can’t keep the equipment on in the ward for more than 30 to 45 minutes.

It has been very hard for us: there is a lot of stigma attached to working with the virus and some people have been rejected by their families. But as people become more aware and realise Ebola need not be fatal, things will change.

Dr Jacob Mufunda, World Health Organisation representative, Freetown, Sierra Leone

One of the positive outcomes of the emergency ministerial meeting is that it aligned our actions. Until then, each country had been dealing with the disease individually. Yet the epicentre of the disease is the border area triangle between Sierra Leone, Liberia and Guinea. The people living in this region are the Kissi. They speak the same language in each country and they move across borders along traditional routes.

So WHO is very clear on this issue: closing borders would make no difference. What is crucial is that we keep focusing on surveillance and that we harmonise our approach across countries because if you use different languages and different practices to tackle the disease and approach these people, who should they believe?

We want to encourage countries in West Africa to send their medical staff to affected countries so that they get hands-on experience. That way, if the virus spreads, they’ll be better equipped to tackle the epidemic.

Mohamed Fofana, training manager with ActionAid, Kono District, Sierra Leone

We have just finished training 24 community outreach workers to raise awareness about Ebola. A key consideration in recruiting participants was that they are influential in their community so that when they go back, people listen to them.

The training focused on the origins of the disease, its transmission, the signs and symptoms and what to do if you suspect a case of Ebola. We heavily emphasised the fact that transmission can happen through a dead body because in Sierra Leone, it is customary to pay your respect to the dead, to wash the body, touch it or keep clothes or sheets of the deceased, but these practices do not conform with Ebola prevention.

If they suspect that someone is infected or has died from Ebola, outreach workers know that they should immediately notify the authorities. They must also refer the patient to the nearest health facility or make sure that no one comes into contact with the corpse if the person is dead. A specially-trained burial team will intervene instead.

Dr Bernice Dahn, deputy minister for health services, Monrovia,Liberia

Our biggest challenge is denial. People do not believe that Ebola is happening. There is a lot of fear and panic too and we’re struggling to get people to come into hospital when we suspect they are infected. The key for us is to align our traditional leaders with medical and health ministry officials: our society holds them in high esteem so if they are on board, they can educate their communities.

Dealing with Ebola is labour intensive. Case detection is a door-to-door process; once identified, patients have to be taken to isolation wards; and then we need to trace all the people they have been in contact with. We also need special burial teams to handle dead bodies. Sorting out the logistics for all these interventions has stretched us.

The difficulty is that the situation keeps evolving so we’ve had to modify our response needs: our initial strategy cost was $1.2 million but as the epidemic has progressed, we estimate we’ll now need $6.5 million. We’re still working within the constraints of the initial budget but the international community has been very supportive, so I am hopeful that we’ll be able to tackle this epidemic within the shortest possible timeframe.

Muslim Clerics in West Africa react to ebola

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Imams in Guinea face Ebola with verses from the Holy Quran

Help Point – Awareness campaigns, punctuated by frequent prayers, fasting, reciting prayers to expedite the redemption of the Ebola virus.. Number of activities and rituals recognized recently Liv imams in Guinea, to lead this interface within the various parties that declared war on the epidemic killer, which is more deadly over the past 40 years in West Africa.

Sheikh Mohamed Lamine Diallo, a representative of the imams at the national anti-Ebola virus in Guinea Conakry, is one of the most prominent religious leaders during the row, declared war on the country’s deadly epidemic, where calls are always speaking to adhere to the teachings of the Koran which calls for Muslims to ensure cleanliness, as the best prevention of the disease. In a statement to Anatolia,

He said “Diallo” established religious body of imams and Christian religious leaders, organizing awareness campaigns, and periodically and systematically, covering different parts of the country.

During these campaigns, we offer a very comprehensive explanation about the prevention methods to be followed, to avoid catching the virus, along with reminders of the role each one in the fight against this disease. ”

For “Diallo”, the hasih epidemic in the country is extremely heavy, and the death of 555 case infected with the virus point to bad situation, leaving the limits of control. The death of 509 people in Sierra Leone and 1,224 in Liberia, not counting the rest of recorded deaths here and there. All of which, according to the Guinean forward, to reflect on the ways of salvation from the “unenviable.” And speaking of, inter alia, the measures taken by the imams in their fight against Ebola, “said Diallo, saying” during sermons in mosques and churches, comes to the epidemic.

Moreover, it is expected that the governing body (against Ebola in Guinea Conakry), over the next few days, consecutive training courses for 600 clerics (imams and Christian clergy), spread over 5 districts of the capital Conakry, as we will, simultaneously, in public places. “Diallo, he said, “this initiative launched by the Secretariat of the Ministry of religious affairs in Guinea, as the virus continues to spread المريع″”, expressing his dismay and regret the large number of deaths due to this disease since the beginning of his appearance in February.

In an effort to console himself with his country, “said Diallo was” everything that happened was God’s will, while Ken lay and believers in testing, the imams to come to help the people to resist.

“For us, this is not about trying to find a religious motivation behind the spread of the Ebola virus in Guinea, but we support the fight against this epidemic and eliminate it.”

A Muslim cleric has opined that the deadly outbreak of the Ebola virus in the country is destined by Allah due to persistent violation of mankind’s covenant to be one another’s keepers in the society.

The Chief Imam of the Salafia Mosque, Sheikh Salah Sheriff, said not only is the Ebola outbreak in the country is the result of Liberia’s broken covenant made to God, he sees the disease, according to the Holy Quran, as what he referred to as “Azabolah”, meaning punishment of God.

Making the disclosure at the Salafia Mosque Tuesday August 26, 2014 in Monrovia, the Muslim cleric described the emergence of the killer disease in the country as a signal of God’s warning to all Liberians, regardless of religion, tribal or political connections.

“I am calling on every citizen to turn a new leaf and begin to be right with the Most High,” the cleric said.

Sheikh Sheriff also attributed the outbreak, occasioned by loss of many lives, to the indulgence of some Liberians in acts of lesbianism and homosexuality, armed robbery, wickedness, cheating, fornication, adultery and disrespect to constituted authorities, all of which are forbidden by God.

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Liberia: ‘God’s Punishment’ – Imam Sheriff Describes Ebola Outbreak

“The belief that God is able to heal the land and have the virus kicked out of the country can be made possible if every citizen can repents from his/her sinful ways and begin to fear God rather than the virus,” the Muslim cleric maintained.

He added that since the outbreak of the Ebola pandemic in the country, many people continue to die not only because of fear but also denial.

Regarding full adherence to Ebola preventive messages and awareness activities being brokered by the national Ebola taskforce, the government and international partners, Sheikh Sheriff maintained that sensitizing worshippers on the danger and prevention of the disease as some measures undertaken by his congregation to prevent the spread of Ebola in the country.

He, however, used the occasion to stress the need for total reconciliation amongst Liberians if the nation is to rise again in the comity of nations.

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Daily Chalk Talks in Monriovia

Another voice that competes with Imams is a local initiative called Daily Talk, which presents local and national stories on a chalkboard outside of a small shack on a central street in Liberia’s capitol of Monrovia. The effort presents news to Liberians where literacy is often a problem. This approach is good because it gets the headlines out there for discussion, and sometimes uses infographics instead of words. But a weakness is that it often reflects the author’s bias and framing of headlines, giving the “village scribe” the too much power to influence public opinion.

I originally re-posted the article in full, but the article’s source sent me a nasty take-down notice, so just click to their version instead (on the title above) to read it.

Ebola headlines and local report wrap up, Sep 8 2014

African Union says efforts to stop Ebola are creating sense of siege

MONROVIA, Liberia – The United States and Britain will send medical equipment and military personnel to help contain West Africa’s Ebola outbreak, as the World Health Organization warned Monday that many thousands of new infections are expected in Liberia in the coming weeks.

The current Ebola outbreak is the largest on record. It has spread from Guinea to Sierra Leone, Liberia, Nigeria and Senegal and killed more than 2,000 people. An “exponential increase” in new cases is expected in the hardest-hit countries in coming weeks, the U.N. health agency warned.

“As soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload,” WHO said in a statement about the situation in Liberia. “Many thousands of new cases are expected in Liberia over the coming three weeks.”

Military personnel will set up a 25-bed field hospital in the Liberian capital, Col. Steven Warren, a Pentagon spokesman, said Monday. The clinic will be used to treat health care workers, a high number of whom have become infected in this outbreak.

Once set up, the centre will be turned over to the Liberian government. There is no plan to staff it with U.S. military personnel, Warren said.

Liberia welcomed the news.

“This is not Liberia’s particular fight; it is a fight that the international community must engage very, very seriously and bring all possible resources to bear,” said Information Minister Lewis Brown.

In addition, Britain will open a 62-bed treatment centre in Sierra Leone in the coming weeks. It will be operated by military engineers and medical staff with help from the charity Save the Children, Britain’s Department for International Development said Monday.

The clinic will also include a special section for treating health care workers, offering them high-quality, specialist care, the statement said.

Currently, there are about 570 beds in Ebola treatment centres in Guinea, Sierra Leone and Liberia, the hardest-hit countries, and the World Health Organization says nearly 1,000 more are needed, the vast majority of those in Liberia.

Doctors Without Borders welcomed both the American and British announcements, but warned even the latest surge in efforts may not be enough, saying the disease was moving “catastrophically through the population much faster than new facilities are being created.”

And experts say it’s not just beds, but that more international and local health workers that are needed. Doctors Without Borders also urged Washington to not simply set up clinics but also to staff them.

Many health workers, however, have been reluctant to respond to the crisis out of concern that there isn’t enough protective equipment to keep them safe.

A fourth American who contracted Ebola in West Africa was expected to arrive in the U.S. for care Tuesday, Emory University Hospital — where two other aid workers successfully recovered from the disease — said Monday in a news release.

Ebola is spread through the bodily fluids of people who show symptoms, and doctors and nurses are at high risk of infection because they work closely with the sick. The WHO doctor whose infection was announced Monday is the second health care worker with the agency to catch Ebola. The doctor is in stable condition and will shortly be evacuated, the agency said.

In Liberia alone, 152 health care workers have been infected with Ebola and 79 have died, WHO said, noting that country had too few doctors and nurses even before the crisis.

“Every infection or death of a doctor or nurse depletes response capacity significantly,” it said.

U.N. Secretary-General Ban Ki-moon called several world leaders over the weekend, including the British prime minister and French president, to urge them to send more medical teams and money to fight the outbreak.

Officials have said flight bans and border closures — meant to stop the disease’s spread — are slowing the flow of aid and protective gear for doctors and nurses to the region.

At an emergency African Union meeting Monday, members agreed to open borders that have been closed and lift bans on flights to and from affected countries, according to Nkosazana Dlamini Zuma, chair of the AU’s Commission. But it was unclear how quickly those promises would be kept.

Earlier, Senegal, which has shut its borders and blocked flights, said it was planning to open a “humanitarian corridor” to the affected countries.

Liberia: Govt. Suspends Poro, Sande Activities

The Ministry of Internal Affairs through its Bureau of Customs and Culture and in collaboration with the National Council of Chiefs and Elders has announced the immediate suspension of all Poro and Sande activities throughout Liberia.

Sande, also known as zadεgi, bundu, bundo and bondo, is a women’s association found in Liberia, Sierra Leone andGuinea that initiates girls into adulthood, confers fertility, instills notions of morality and proper sexual comportment, and maintains an interest in the well-being of its members throughout their lives. In addition, Sande champions women’s social and political interests and promotes their solidarity vis-a-vis the Poro, a complementary institution for men. The Sande society masquerade is a rare and perhaps unique African example of a wooden face mask controlled exclusively by women – a feature that highlights the extraordinary social position of women in this geographical region.

The ministry says its attention has been drawn to reports of the continued operation of Poro and Sande societies in several parts of the country in violation of the moratorium placed on the operation of Poro and Sande Societies on June 2, 2014.

In a press release issued here, it said the decision then, and now, was intended to ensure that there is no outbreak of the Ebola virus in any Poro or Sande grove in Liberia.“This would be a disaster and it must be prevented in the interest of saving additional lives of our fellow citizens”, the release read. However, the ministry notes that in spite of its demonstration of understanding and accommodation, some individuals have continued to operate Poro and Sande Groves and conduct cultural festivals.

According to the press release signed by Minister Morris Dukuly, such practices in the face of the Ebola epidemic exposes citizens to increased incidents of the virus and untimely death. The ministry therefore directs that all such practices must cease and be seen to have ceased by September 17, 2014.

MIA warns that any grove which operates or reopens its doors to initiate persons will be seen to be in defiance of its General Circular No. 13 and its most recent statement, reaffirming the provisions of the General Circular.

The Ministry says, the two-week extension it is granted under this statement is to allow the smooth closure of all Poro and Sande Societies operating in the country, and should not be viewed as an extension of the term of existing graves.

It said any grove or society found operating beyond the September 17, 2014, date would be ordered immediately closed in keeping with cultural, traditional practices, and its guidelines and regulations, while persons operating such groves will be prosecuted under the laws of Liberia.

Meanwhile, the Minister of Internal Affairs is authorizing all county Superintendents, District Commissioners, County Inspectors, and other appropriate local government officers ensure full compliance with this directive, and to close uncooperative Sande and Poro Societies upon the expiration of the two-week extension period.

The release said the Minister of Internal Affairs has written to inform Chief Zanzan Karwor, Chairman of the National Council of Chiefs and Elders, of the directive, and requested the full cooperation of the council.

Monrovia – The deadly Ebola virus is spreading in Monrovia and beyond, touching the security sector as 18 Police officers have been quarantined in Bloc C at the Police Barracks in Monrovia.

According to sources, one Police officer serving the Police Support Unit (PSU) contracted the virus and is currently undergoing treatment at the ELWA Ebola center.

One senior Police source confirmed to FrontPageAfrica that the officer is in critical condition at the Ebola treatment center. The Police officer is said to have contracted the virus from his wife who is a nurse, who transferred the virus to her husband after also getting infested from work.

The health of the PSU officer prompted the quarantining of Bloc C of the Police barracks where accordingly the 18 Police officers are residing. Located at the intersection of Camp Johnson Road and Capitol By-pass the Police Barracks is home to several Police officers and their dependents.

According to one member of the Ebola Task Force, several items have been supplied the quarantined Police officers including chlorine, biscuits and other materials. Police officers are used in protecting clinics and other medical facilities also accompanying various medical teams, including burial, collection of sick patients and others.

The officers are usually not seen wearing protective gears including gloves and other PPEs while providing protection in medical facilities and carrying out other duties closely related to Ebola. Police officers are also used to implement quarantine in several communities as they were recently deployed to ensure the quarantine of the West Point community and some are now in Dolo’s Town, Margibi County performing similar duty.

United States based Centers for Disease Control has warned that up to 20,000 people will get infested with the virus before it is brought under control, but it seems the Liberian government does not agree with such prediction as President Ellen Johnson Sirleaf has publicly declared disagreement with the CDC’s prediction.

Despite disbursement of funding from the Ebola fund to the security sector including the Police, Police officers are not adequately catered for as some officers have complained that they do not receive daily per diems and other protective materials, thus making vulnerable to contracting the virus.