This blog is a platform I normally reserve for the important issue of fashion in Sierra Leone, but this week, I’m struggling to find a fashion angle. Unless you’ve been living on mars, you will know that West Africa is suffering the worst ever outbreak of the world’s most deadly disease – Ebola. I traveled to Kenema district last week for an assignment to write about the outbreak. I live in Freetown and before leaving, the epidemic hadn’t really kicked off here. ‘EBOLA!’ (said with a loud voice and chuckle) was something that was happening in villages, places that didn’t affect the urban folk of Sierra Leone’s capital. I knew Kenema was a district suffering huge case numbers, but nothing prepared me for what I saw and heard in one of Sierra Leone’s most brutally affected areas.
When you arrive in Kenema, there’s a feeling that Ebola has settled in. Chlorine buckets sit outside most restaurants for people to wash their hands, Ebola information posters are plastered on buildings, crackly radios are broadcasting conversations about Ebola, people are talking about “dis Ebola bisnis’ relentlessly on the street and handshakes have been replaced by a brush of the elbows. I spent three days speaking to anyone who was willing to share their experience of Ebola – hospital staff, Ebola survivors, relatives of those infected and the brave front line nurses who are putting other people’s lives before their own. Everybody was keen to chat about Ebola, their stories were heartbreaking and fascinating and I got a real sense that Kenema is a town under siege by an ‘enemy’ that no one properly understands. Communities are scared, many are confused and most feel let down by the leaders who are supposed to be in charge.
Sister Nancy Yoko – Nancy is a front line Ebola nurse at the Ebola Treatment Centre inside the grounds of Kenema Hospital. She has just taken on the responsibility of sister-in-charge following the death of her colleague Sister Mbalu Fonnie who tragically passed away last week after becoming infected. Nancy works 14-hour shifts and has barely had a day off since the outbreak started seriously affecting Kenema three months ago. Five of her other colleagues have died and her dwindling staff are getting smaller each week due to Ebola infection and the drop-out of nurses who fear becoming sick. “I don’t feel afraid, I’m a nurse, I’m doing my job. We are trained to sacrifice”. Her brow is permanently furrowed and she is exhausted. She is a hero.
Nancy’s job is tough, an Ebola ward is hot and messy and pungent and in Kenema hospital, packed to capacity. You can only enter the ward while wearing the ominous looking personal protection (PP) suit, which in Sierra Leone’s tropical temperatures, is like walking around in a furnace. Nurses like Nancy earn Le150,000/week (about US$40) which include a recent Le50,000 (US$11) weekly pay rise to compensate for risking their lives. The ward is overflowing with 45 patients and as recommended by health officials is in need of a staff of 65 nurses, there are currently about six.
Vandy – While the mortality rate of Ebola is up to 90 percent, in this outbreak there is a growing group of extremely fortunate people who are overcoming the virus. Getting to a treatment centre early can help people to survive but it also seems that it’s possible to contract, as one health worker put it “just a mild case of Ebola”. Basically it comes down to luck. I hung around the exit of the treatment centre for a few days at around 3pm when patients are released. A small boy who looked about three years (But had ‘Age: 7’ recorded on his medical sheet) bounced out of the ward with a massive grin on his face. His name was Vandy and he was adorable. One health worker commented that “Little Vandy was amazing. He would be on the ward singing with patients, laughing, bringing unlikely joy to an otherwise miserable place, “.
Ibrahim – Ibrahim is a lab technician at the treatment centre. Kenema Hospital has the only testing centre in the country for haemorrhagic fever. Ibrahim and his colleagues receive all blood samples from all over Sierra Leone, and each day there are dozens. He has been working long hours and is concerned for his safety “We only get paid Le150,000 per week ($40). It is not enough, we are risking our lives, a slight mistake and we are gone “.
Will – The most alarming conversation I had was with a British volunteer nurse (another Hero) who relayed countless stories of the grim reality of working on the Ebola ward. It was nine pm when I met Will at the grubby guest house where we were both staying and he had just left the Ebola ward with Sister Nancy. That day there had been a riot outside the hospital. A group of confused and angry young men started hurling stones at the hospital gates, a crowd had gathered and soon enough the police arrived with tear gas. Rumours emerged that the ‘riot’ was sparked by a woman claiming to be a nurse who spoke on radio saying that Ebola didn’t exist, it was just a way for health staff to steal blood, harvest organs and make money. The young guys arrived to take on the health workers.
When Will and Nancy left the ward that evening there was no other staff to replace them for the night shift as most of the local staff had fled due to the riot. They were both exhausted after having worked 14 hours and were forced to make the painful decision to leave patients unattended while they took a break before doing it all again the next day. Will was rattled by this dilemma, “We gave the patients water and paracetamol and then we had to walk out. Patients are dying the most horrible deaths, I’m expecting to find several corpses tomorrow morning,”. Will told countless more stories of the indignity suffered by Ebola patients because there are simply not enough trained staff on the wards to adequately care for patients. Mothers watching their children dying, patients laying for hours next to corpses because “a corpse weighs a lot and can be hard to move on your own,” and the excruciating pain people were suffering in their final days of life because they are only offered panadol. And amidst all the sadness and tragedy, he also talked about moments of unexpected joy on the ward with patients singing songs and laughing while they lay sick in their beds. I wondered what what was motivating someone like Will, a young British guy, arriving in Sierra Leone and risking his life doing something that so many others have turned their back on. “It’s the easiest situation in the world to make a difference. I’m not particularly experienced or skilled, but I can do the job and I am actually helping, ”
Lansana Fufuna – Outside the entry of the treatment centre is a constant gathering of people, mostly waiting for news of relatives and loved ones inside. Lansana (42) was standing anxiously alone when I met him, he had been returning to the treatment centre every day for the past three weeks to check on his relatives. His family had been hit hard, and inside were his aunt, two brothers, one sister and two uncles. “In my village Daru, people are dying everyday, more than 36 have died. Thank god my two children are OK, I’m hoping to see my other relatives again, in Allah’s name”.
I left Lansana standing at the gate and wondered what would happen to his family inside. It’s often hard for people to get information about their sick family and friends from outside the hospital. They are not allowed in the compound and talking directly to nurses can be challenging. Patients who are admitted are sometimes unidentified, some dying quickly with no-one identifying their body because they are too infectious. I was later told that Lansana had lost all seven of those relatives he spoke of.
Sierra Leone provides ‘the perfect storm’ for a catastrophic Ebola outbreak. It is a very poor country with a crumbling health system and a recent history of war and civil unrest. This lays the foundation for mistrust between the community and the state who in this situation are represented by the health workers. People do not believe what the government is telling them, information is being delivered ineffectively and too late and resources available for treatment are so limited that it is no wonder people with symptoms are hiding in villages.
I left Kenema a week ago and since then Ebola has made a new home in Freetown. Following the death of Dr Khan, Sierra Leone’s top Ebola doctor, those in power are finally taking notice. The President has announced a State of Emergency, the Centre for Disease Control has declared a level three health emergency, WHO is jumping in with a $100 million response plan, and the international media is all over the story. While recorded case numbers are still relatively low in Freetown (under 10), they are likely to rise and in an urban environment who knows how this will play out. We can only hope that mistakes made in Kenema are avoided in Freetown.
UPDATE 7/8/2014: I updated previously in the week that a Red Cross Clinical team were arriving in the hospital. A day ago there was still no more staff on the ward and nurse Will again reported that patients were being left alone because there was simply not enough staff. The good news is a wonderful woman called Munje Foh from Maryland USA has launched a crowd source to provide immediate relief to the patients in the hospital Click here for details and donate now!