World Health Organisation

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.


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.