UNICEF

Life under Ebola in Lagos, Freetown, Monrovia

As we headed toward the gate, a young boy passing by glanced at us and said: “That’s the Ebola house.”The doctor pushed the rusty gate open with the sole of her shoe, warning me not to touch anyone or anything. “Not the walls, not the doors, nothing.”An eerie silence filled the empty courtyard that leads to the Lagos house where a nurse died of Ebola. The five families – 26 people in all – who shared the house with her were being monitored for possible signs of the dreaded disease.

I wasn’t sure what to expect and I must admit that my apprehension was high as I accompanied the doctor who had been visiting the house on a daily basis to monitor the health of the 26 people listed as contacts – meaning they had contact with a person who had Ebola.

Each family has its own separate room, but the bathroom is shared by all the compound’s residents. The doctor called out someone’s name and people began to emerge from the doorway. Within a few minutes about a dozen people, young and old, had gathered. Greetings were made, but we remained a couple of yards (meters) away from the contact persons.

All of them had brought along their digital thermometers so their temperature could be recorded. One of the first symptoms that Ebola patients tend to exhibit is a fever. All the contacts were given a thermometer and told to take their temperature daily for 21 days, the incubation period of the Ebola virus.

Entrance to the Lagos Ebola treatment center. (c) UNICEF Nigeria/2014/Terry Howard

The contact monitoring teams meet every contact person daily to make sure temperatures are properly taken and recorded. Anyone who develops a fever or shows any of the other Ebola symptoms, such as vomiting, diarrhea, headache, or a rash, is taken to the treatment facility for testing. There is no known cure for Ebola, but proper clinical care, if started early, can greatly increase chances of survival. In Nigeria, 12 of the 19 cases confirmed by September 16, survived.

But survivors face another battle after fighting off the disease – stigmatization – which also affects their families and anyone they had contact with. In the compound, I asked what life has been like since the nurse had taken ill and passed away. Everyone wanted to talk at once, and all said they had been contending with stigmatization in one form or another.

Three of the men living in the house had lost their jobs – two of them had just been informed that morning. Both of them worked as security guards for a nearby church that they attended. The third was a private driver.

Community members who used to come into the compound to draw water from the well now stayed away, even though the house was decontaminated the day that the nurse was taken to the hospital.

Terry Howard

“If we go out onto the street, people run away from us. They are afraid,” one of the contact persons said.

“We’re hungry-o,” an older man said, pointing to his stomach. “People won’t sell us food, they won’t take our money. It’s three days now since we’ve eaten and we’re hungry.” All of those standing around nodded in agreement. .

The families in the compound were not receiving any assistance. When they told me that they had not eaten anything for three days because nobody would sell them any food…that really tugged at my heartstrings.

As we drove away the man’s words “We’re hungry-o” kept ringing in my head. The children, the adults…they’d done nothing wrong. They were simply being monitored for their own safety and that of their community.

I just had to get them some provisions – bread, rice, and ground cassava. I re-entered the courtyard after pushing the door open with the sole of my shoe. They seemed surprised to see me return so quickly, and their eyes lit up as I put the plastic bags filled with food down on the small bench. Everyone reassembled and thanked me. Such a small gesture…but one that made a big difference to these hungry children, women and men.

The following day, I was told that, somehow, news of me giving them food reached the local government authorities, who then provided some more supplies.

Terry Howard is a Staff Counsellor at UNICEF Nigeria. Since the Ebola outbreak started in Nigeria, he has been providing psycho-social counselling to people affected by the disease in Lagos and Port Harcourt. UNICEF is playing a key role in sensitizing people about Ebola, to help contain the spread of the disease and to combat stigmatization.

Life under the three-day lockdown in Freetown

Source: KSN via Associated Press – Sep 20, 2014

(AP Photo/ Michael Duff)
(AP Photo/ Michael Duff)
A health worker volunteer marks a home with chalk to identify that it has been visited.(AP Photo/Michael Duff)
A health worker volunteer marks a home with chalk to identify that it has been visited.(AP Photo/Michael Duff)

FREETOWN, Sierra Leone (AP) — Some in Sierra Leone ran away from their homes Saturday and others clashed with health workers trying to bury dead Ebola victims as the country struggled through the second day of an unprecedented lockdown to combat the deadly disease.

Despite these setbacks, officials said most of Sierra Leone’s 6 million people were complying with orders to stay at home as nearly 30,000 volunteers and health care workers fanned out across the country to distribute soap and information on how to prevent Ebola.

The virus, spread by contact with bodily fluids, has killed than 560 people in Sierra Leone and more than 2,600 in West Africa since the outbreak began last December, according to the World Health Organization. It is killing about half of the people it infects.

The streets of the capital, Freetown, were empty Saturday except for the four-person teams going door to door with kits bearing soap, cards listing Ebola symptoms, stickers to mark houses visited and a tally to record suspected cases.

Among the volunteers was Idrissa Kargbo, a well-known marathoner who has qualified for races on three continents but whose training and career have been stymied by the outbreak.

(AP Photo/Michael Duff)
(AP Photo/Michael Duff)

Although early responses to the disease have been marred by suspicion of health workers, Freetown residents on Saturday seemed grateful for any information they could get, Kargbo told The Associated Press.

“Some people are still denying, but now when you go to almost any house they say, ‘Come inside, come and teach us what we need to do to prevent,’” Kargbo said. “Nobody is annoyed by us.”

Sierra Leone’s government is clearly hoping the lockdown will help turn the tide against the disease which the U.N. health agency estimates will take many months to eradicate in the country. In a speech before the lockdown, President Ernest Bai Koroma said “the survival and dignity of each and every Sierra Leonean” was at stake.

The strategy has drawn criticism, however. The charity group Doctors Without Borders warned it would be “extremely difficult for health workers to accurately identify cases through door-to-door screening.”

Even if suspected cases are identified during the lockdown, the group said Sierra Leone doesn’t have enough beds to treat them.

In a district 20 kilometers (12 miles) east of Freetown, police were called in Saturday to help a burial team that came under attack by residents as they were trying to bury the bodies of five Ebola victims, Sgt. Edward Momoh Brima Lahai said.

A witness told state television the burial team initially had to abandon the five bodies in the street and flee. Lahai said later the burials were successfully completed after police reinforcements arrived. The bodies of Ebola victims are very contagious and must be buried by special teams.

In northern Sierra Leone, health worker Lamin Unisa Camara said Saturday he had received reports that some residents had run away from their homes to avoid being trapped inside during the lockdown.

Police guard a roadblock as Sierra Leone government enforces a three day lock down. (AP Photo/Michael Duff)
Police guard a roadblock as Sierra Leone government enforces a three day lock down. (AP Photo/Michael Duff)

“People were running from their houses to the bush. Without wasting time, I informed the chief in charge of the area,” said Camara, who was working in the town of Kambia.

Several health care workers and volunteers complained that supply kits were delivered late, preventing their teams from starting on time.

But Kargbo, the marathoner, said his team was on track to meet its goal of visiting 60 households by the end of the lockdown Sunday. He said the effort would be worth it if the outbreak is shortened even a little.

Other Freetown residents, however, were having trouble making it through the three days.

“The fact is that we were not happy with the three days, but the president declared that we must sit home,” said Abdul Koroma, the father of nine children in Freetown.

“I want to go and find (something) for my children eat, but I do not have the chance,” he said.

Coco’s journey, losing 10 of her family in Monrovia

Source: Pastor Garrett

Can you imagine the feeling of defeat and despair that one who has lost 10 family members to the Ebola virus could sense? We recently sat down with Coco Dahn and her husband, Peter, as she talked about the pain of having ten close family members pass away due to the Ebola virus over in Monrovia, Liberia. And if that pain isn’t enough, she still has three teen-aged children there who are trapped in isolation inside Liberia and whom she hasn’t seen in months (although she has spoken with them on the phone.) Their names are Bernice, Luther, and Nelson. Luther and Nelson are 15-year-old twins.Coco3

As you have probably already heard, the CDC is currently urging everyone to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of the unprecedented outbreak of Ebola in those countries. The CDC further recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola.

There are reports of civil unrest and violence against aid workers all over West Africa as a result of this outbreak. In fact, the public health infrastructure of Liberia is being severely strained as the outbreak grows.

Coco1

Of course, the Liberian government has responded by recently implementing enhanced measures to combat the spread of Ebola. These measures will affect travel in, out, and within Liberia. This creates another aspect of Coco’s Challenge. movement of her children within and without the country. Here are the five-point measures that the Liberian government is taking.

  • All Liberian borders are closed except for major entry points.
  • There are new and stringent measures of screening for the virus to be implemented at those major entry points. Again, this affects ALL incoming and outgoing travelers.
  • There are new restrictions concerning public gatherings.
  • Quarantine measures have been established for communities heavily affected by Ebola; travel in and out of those communities will be restricted.
  • Authorized military personnel have been placed to help enforce these and other prevention and control measures.[1]

Coco2All of these situation make Coco’s story even more difficult. She wants to get her teen-aged children out of Liberia to a place where they can be reasonably safe. But they are trapped within their own city. Because of the quarantine measures there in the city of Monrovia, they are essentially confined to their house … even though they are not sick nor show any signs of the sickness.

So ISOH/IMPACT is trying to help Coco by getting her children out of Liberia. Phone calls are being made to immigration attorneys, emails are being sent to embassies, questions are being researched concerning medical and health screenings, and finances are being raised to support this massive project.

We are aware that there are many who are in a similar situation to the one that Coco is in. And we know we can’t help them all BUT … together, we can help one or two.

Would you consider making a gift of love to help us with this project? We are not sure what the final price tag will be because we are only in the initial stages. But we promise to be good stewards of the gifts that God gives us through you.

If you want to donate, please go to the following website and click on the “Donate” button under “Where Needed Most”: http://isohimpact.org/make-an-impact-with-hope/ Be sure to let us know that this gift is for “Coco’s Challenge.

News mashup: Life goes on amidst ebola

MONROVIA, Liberia — The girl in the pink shirt lay motionless on a sidewalk, flat on her stomach, an orange drink next to her, unfinished. People gathered on the other side of the street, careful to keep their distance.

Dr. Mosoka Fallah waded in. Details about the girl spilled out of the crowd in a dizzying torrent, gaining urgency with the siren of an approaching ambulance. The girl’s mother had died, almost certainly of Ebola. So had three other relatives. The girl herself was sick. The girl’s aunt, unable to get help, had left her on the sidewalk in despair. Other family members may have been infected. Still others had fled across this city.

Dr. Fallah, 44, calmly instructed leaders of the neighborhood — known as Capitol Hill, previously untouched by Ebola — how to deal with the family and protect their community. He promised to return later that day, and send more help in the morning. His words quelled the crowd, for the moment.

Dying of Ebola at the Hospital Door

Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts.

But the scale of the task is daunting. He is trying to beat Ebola in a city of 1.5 million people where the disease is expanding exponentially, where entire families search in vain for medical care, and where the main hospital is dangerously overwhelmed, plagued by electrical fires, floods and the deaths of health workers infected with the disease.

Dr. Fallah has slowly begun winning over the city’s toughest neighborhood, West Point, the seaside slum where he spent two years of his childhood. Deadly clashes between angry residents and soldiers erupted recently after Liberia’s government placed the entire neighborhood under quarantine. The 10-day cordon, enforced by the army and the police, merely deepened the mistrust of the government in the city’s slums, the very neighborhoods most affected by Ebola.

They divided West Point into zones, much as was done during the war to ensure that everybody received food and other vital supplies. Surveillance teams of volunteers overseen by Dr. Fallah now scour West Point, searching for information about a dead or sick person, hoping to identify victims and remove the bodies before the disease can be passed on.

His teams visit every morning, tracing the circle of people around Ebola victims to see who else develops fevers or starts vomiting. This painstaking process, repeated until an outbreak is eventually contained, has extinguished past Ebola outbreaks in rural Africa — and may be the only hope of stopping it now.

“Dr. Fallah has taken the situation in West Point as if he were living here,” said Kenneth Martu, a political organizer in West Point. “We can say openly: Had he not been here, things would have gotten far worse.”

Two days after the government lifted the quarantine in West Point, the Health Ministry asked Dr. Fallah to start using the civil war-era zone system in two other Ebola-stricken neighborhoods, perhaps another signal of the government’s turn away from force in its campaign against Ebola.

“We feel that using the communities to provide the leadership for us to do the Ebola work is more effective,” said Dr. Bernice Dahn, a deputy health minister.

Dr. Fallah’s team of contact tracers pushed deep into West Point one morning, into a labyrinth of hovels and alleys that became ever narrower. A group of young men appeared abruptly, blocking the only exit, their intention clear. They went away, with a $10 bill.

“I usually carry small bills,” Dr. Fallah said. “But I forgot to break this bill this morning.”

Monrovia is the first city to face the full onslaught of Ebola. Tracing the contacts of Ebola victims has never been attempted on this scale, yet Dr. Fallah’s team has only five vehicles to monitor hundreds of thousands of people. One vehicle was in the shop for five days, so Dr. Fallah used his own.

In West Point, a slum of up to 120,000 people, Dr. Fallah deployed 15 volunteers to track 150 people who may have been exposed to the virus. The tracers fan out early in the morning to catch the people at home — they are supposed to stay indoors, but many do not — and to minimize contact with an often hostile community.

“On the field, as we are going, they are cursing us, passing around, talking plenty,” said Marie Harding, a tracing supervisor.

At one house — a large one by West Point standards, with eight rooms and, even more unusual, a restroom — about 20 people came to the entrance, emphatically stating that everything was fine. A man named Junior, who rented a room, had died in late August, apparently of Ebola, and a burial team had come to pick up his body three days later.

David Yeah, 75, the home’s owner, said that he had locked the room. Sprayers had come to decontaminate it; they had thrown the dead man’s clothes into the sea. The house’s other occupants had avoided the man before his death, bringing him neither food nor water, he insisted.

Dr. Fallah had seen this many times before. The government’s failure to provide basic services keeps undermining the trust he is trying to build. Burial teams take days to pick up the dead; ambulances — there are only about a half-dozen in the capital — respond to only a fraction of emergency calls. Those lucky enough to be transported to a treatment center are often turned back, taken home because of a shortage of beds, or left pleading at the gate for admission.

“The government has to keep its part of the bargain,” Dr. Fallah said, adding, “The community can do one thing for us. They can limit the spread. But they must see that their labor is leading to some fruit.”

Photo

Dr. Mosoka Fallah, center, an epidemiologist and immunologist, with residents of New Kru Town, a district in Monrovia, Liberia.CreditDaniel Berehulak for The New York Times

The government’s lifting of the quarantine after 10 days also gave West Point a conflicting message. Many rejoiced at the move but interpreted it as proof that there was no Ebola in their community.

On the Sunday after the quarantine was lifted, churchgoers celebrated what many saw as West Point’s deliverance from Ebola. Inside the Dominion Life Church, next to an Ebola holding center, the faithful danced and — disregarding awareness campaigns to avoid touching and risk exchanging body fluids — shook hands and grasped one another’s arms with fervor.

“No, no, no, no,” the Rev. William Morlu, the church’s senior pastor, said when asked whether Ebola was present in West Point.

At the Church of Pentecost, Emmanuel Oben, 45, the chairman of a local P.T.A., said that the government was “not sincere.” But Dr. Fallah, whom he had met twice, was “a man that everybody wants to work with,” he said.

“People trust him,” he said. “He was once like us.”

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

A project to open a maternal care clinic in Chicken Soup Factory brought Dr. Fallah back to Liberia after Harvard. The clinic opened in June but was shut down a month later because of the Ebola outbreak.

On an afternoon of heavy rain, Dr. Fallah drove out to two neighborhoods where local residents had begun organizing Ebola awareness campaigns on their own. In the face of the hysteria gripping the capital, they were joining forces and fighting back.

In one area, volunteers like Obediah Daykeay, 22, who had read up on Ebola in an Internet cafe, were instructing neighbors on the use of bleach and water to wash their hands. They had invited Dr. Fallah after hearing him on the radio.

“We are trying our best with the few resources we have,” Mr. Daykeay said. “Nobody else has come here.”

In another neighborhood, a group of youths had raised money to print an eight-page pamphlet on Ebola. Dr. Fallah spoke to them inside a church, urging them to organize monitoring teams.

The youths listened intently, fear visible on many faces, craning forward in their pews toward Dr. Fallah as rain beat noisily on the church’s corrugated roof.

“I’m not saying I know the answer,” Dr. Fallah said later. “I’m struggling like any other person to find the answer — just have a lot of spirit and God. But one thing I’ve realized is that the people in the community, some of them have the answers.”

Five ways UNICEF is fighting Ebola

BY ON 17 SEP 2014 via UNICEF BLOG

UNICEF Ebola Survivors Sierra Leone

1. Delivering supplies

We are delivering supplies that are important for the treatment and care of people who are sick with Ebola, and for continued supply of basic services. We continue to airlift essential supplies to the affected countries on a massive scale. By the first week of October we will have delivered 1300 metric tonnes and mobilized 55 flights. Read about what goes into making these deliveries happen.

2. Helping families protect themselves

In the coming weeks, we will be focusing on packing and shipping 50,000 Household Protection Kits. These kits contain gloves, gowns, masks, soap, chlorine and buckets. The first 9,000 of these will leave this week for Liberia. The Household Protection Kits complement the Family Hygiene kits which are already being packed and distributed in the country.

3. Preparing at-risk countries

UNICEF is also working with Governments in at-risk and neighbouring countries to prepare them for possible Ebola outbreaks. We are already sharing information with communities and developing contingency plans and stockpiles. Learn more about the work being done with communities in affected countries to raise awareness about Ebola.

4. Sending in extra staff

Building on our existing country presence in Liberia, Sierra Leone and Guinea, we are bringing in 67 additional staff members to these three most-affected countries. Another 37 staff members will be deployed in the coming weeks. We’re seeking committed professionals to join our Ebola emergency response team in West Africa.

5. Raising more funds to fight Ebola

We sent more than USD 7 million of our own resources to respond to the Ebola outbreak, including almost USD 4 million to Liberia alone. We have received approximately US 7.5 million from donors, but this is only 4 per cent of the total of USD 200 million we need to respond to this crisis.

UNICEF - Ebola is RealUNICEF - Ebola PreventionUNICEF - Ebola SpreadUNICEF - Ebola Symptoms

Front lines of the ebola bio-war

In July 2014, health workers, wearing head-to-toe protective gear, prepare for work, outside an isolation unit in Foya District, Lofa County.

Flights into disaster zones are usually full of aid workers and journalists. Not this time. The plane was one of the first in after some 10 airlines stopped flying to Liberia because of Ebola, and still it was empty.

When I was last in Liberia in 2006, it was to work on reintegration of child soldiers in a time of peace. Now the country is fighting a “biological war” from an unseen enemy without foot soldiers.

As we enter the airport, an unnerving sight – a team of health workers kitted out with masks and gloves asks us to wash our hands with a chlorine solution and takes our temperatures.

It was to be the start of a new routine – the hours and days since, I have had my temperature taken about 15 times and have had to wash my hands with chlorine at the entrance to every building, every office, every store, and every hotel. Even in small villages. And yet ironically, despite all this, few health facilities are properly functioning.

The next morning, the breakfast room at the hotel is buzzing – a large group of scientists from the US Centers for Disease Control and Prevention (CDC) huddle around computers animatedly talking, checking charts and data.

The world’s Ebola experts are here – writing the first draft of Ebola history in real time.

The capital, Monrovia, reveals itself as a city branded by Ebola posters shouting out what people know all too well by now – Ebola is deadly, protect yourself, wash your hands. The talk in the car, on the radio is only about Ebola – people calling in want to know what to do when their child gets sick, they either fear health centres and hospitals or they are not treated.

A colleague tells me she has just lost a family member about to give birth. It was a normal pregnancy, but she was turned away by every hospital as staff were too afraid to take her in case she had Ebola. She did not have the virus, but she died because of delivery complications. Her baby at least survived.

News of the US obstetrician in Liberia who contracted the deadly disease while delivering a baby has helped fuel such worries. So far 169 Liberian health care workers have been affected by Ebola and 80 have died – a massive blow to a fragile health system.

 

A UNICEF worker speaks with residents about the symptoms of Ebola virus disease (EVD) and best practices to help prevent its spread, in Zorzor District, Lofa County, (taken in April 2014).

Next I prepare to go up country to Lofa county where more warehouse space was needed – UNICEF has delivered tonnes of equipment, including personal protective suits, chlorine and oral rehydration salts to Liberia – and more monitoring was required of those other now-neglected childhood killers like measles, diarrhoea and cholera.

Ebola has turned survivors into human booby traps, unexploded ordnance – touch and you die. Ebola psychosis is paralysing.

Heavy rains lash down over the weekend – I shudder to think of Medecins Sans Frontieres and health ministry workers and patients battling under plastic sheeting in such rains. Luckily the skies over Monrovia clear for the hour-and-a-half helicopter ride to the hot-zone border between Sierra Leone, Guinea, and Liberia.

In Voinjama, I’m out with a team of social mobilisers who interact and educate communities. They are playing our song – the one UNICEF Liberia set up, Ebola Is Here – on a megaphone through the village.

The jingle has got Liberians jiving and saving lives. We talk to families about protecting themselves from Ebola. They tell us about a survivor in their community. He came back from the treatment centre, but despite testing negative for the virus infected his girlfriend, who died. The semen of male Ebola survivors remains contagious for a minimum of seven weeks after infection.

The villagers ask if survivors can be isolated.

The doctor at the empty hospital we visit says they suspect any patient who comes with fever, diarrhoea or stomach pains as having Ebola. “Guilty until proven otherwise” is the motto – and people are sent away as medical staff do not have the facilities to cope with the virus.

In the grounds of the local district health office, a burial team comes in looking like crop sprayers, carrying visors and chlorine spray. They had just buried three people who died within 10km (6.2 miles) of each other.We keep a safe distance. Death has no dignity here. The dead are taken and quickly burnt with the plastic suits. Funerals, once a ritual, are now rare.

Ebola-is-real1

One of the psycho-social workers tells us she is dealing with 100 children affected by Ebola in Voinjama alone, many of them orphans. She is not sure what can be done. With schools closed at least until next year, perhaps the country’s 26,000 teachers could be used as trained carers?

Back in Monrovia, we hear a bombshell from the World Health Organization – a huge surge in Ebola is expected. The defence minister tells the UN Security Council Ebola threatens his country’s existence.

The hard times are far from over. They are stoic and brave but when I speak to ordinary Liberians they say they feel abandoned; they need help to treat other diseases too.

In the car with colleagues, they talk almost nostalgically about the long civil war here – a time when the enemy was seen, the rockets were heard, the bullets could be dodged. We try to focus on what we can do – more hygiene kits, beefing up the messaging, getting basic mother and child health care going again.

This is the most unusual and surreal field assignment I have ever undertaken. One of the joys of working for UNICEF is children, picking up babies, playing with them. Here we dare not touch babies; there are no handshakes, no hugs. It’s simply too risky.

Sarah Crowe is Chief of Crisis Communications for UNICEF, and she is currently in Liberia reporting on the epidemic.

A version of this story appeared on BBC News on 10 September 2014.