Sierra Leone in the time of Ebola

I am just back from Sierra Leone and wanted to share some random impressions from my visit. In no particular order…

• With all due respect to Bob Geldof, people in Sierra Leone do know it’s Christmas but they’ve been told to cancel festivities anyway – along with New Year celebrations – for fear that family reunions over the holidays will lead to a spike in transmissions.
• Whether or not Sierra Leoneans go home for the holidays, our surveys of public opinion show that people are scared of what might happen to them at the checkpoints set up to stall the spread of the virus. The greatest fear is that a thermometer-wielding volunteer will pack you off to an Ebola holding center where risks of infection are considered high. Getting temperature readings wrong is common, I was told, because lines are long, the sun is hot, and the ubiquitous handheld thermometers are not always reliable. Better training of checkpoint orderlies may be a solution.
• Some development experts argue that the Ebola crisis is a lost opportunity to rebuild Sierra Leone’s institutions and management capacity. Others parry that the threat to global health is too great to use the epidemic as an exercise in institution building.
• “Ebola does not allow for mistakes. The response needs to be perfect”, says an ECHO official in Freetown.
• A propos, DFID has done a remarkable job of mobilizing and co-financing a robust program to address this exceptionally demanding disease.
• Frontline workers reckon that stigma remains a major obstacle to the reporting of new cases, which is central to success, but some 67% of the general public says they are ready to support the families of people who contract the virus. Are they equally willing to accept Ebola survivors back into their communities? That’s a crucial question and we plan to ask it next week.
• Staff in the district-level Ebola response centers report that burial teams are now responding quickly but front line workers, who we survey fortnightly, say things are a lot less rosy.
• People in uniform working in humanitarian programs can be a turn-off but the British military in Sierra Leone bring impressive levels of skill and energy to the international effort.
• Despite a wide-reaching communication strategy, our front line worker survey finds that people don’t trust official information about how to stop the spread of the virus. Message or messenger? The comms people need to get to the bottom of this fast.
• The U.N.’s Office for the Coordination of Humanitarian Affairs is absent, except for a few specialists wearing other organizations’ hats. Where are those experienced disaster coordinators and crisis managers when you need them? Another example of the UN tripping over its mandate thing.
• Sierra Leone has endemic corruption, rotten governance, appalling social indicators, and now Ebola – yet the people are coping with courage, discipline, and fortitude. Is that what we mean by resilience?
• To that last point, our most recent survey of the general public finds that 45% of people say they can earn a living against 39% who say they can’t. This is so despite major disruptions to trade and an economic knock-on effect from Ebola that is devastating many vulnerable communities.
• Front line workers are non-committal about progress in dealing with the spread of the virus but the general public is more bullish. Our weekly survey of citizens’ views finds that 74% see things moving in the right direction. Let’s hope they’re right, but ‘getting to zero’ is a huge challenge that requires meticulous tracing of everyone who has had contact with an infected person. Hard to do, but not impossible.
• Meanwhile, heaven help you if you need medical attention for something other than Ebola. Our surveys confirm this gaping hole in the struggling health system. I heard a heart-wrenching story of a pregnant women hemorrhaging to death in front of the closed doors of a hospital as her family pleaded for her admission.
• While everyone is bent on turning the epidemiological corner, Ground Truth is tracking perceptions of the response in real time and promoting use of this intelligence to improve effectiveness – a first in a humanitarian emergency.
• Thank God for Brussels Airlines, the only carrier that still flies direct from Europe to Sierra Leone – and back.
• US citizens and those in other far-away lands should chill. As Hans Rosling, a Swedish epidemiologist now working in Liberia, told me: the Ebola virus travels on foot and in crowded minibuses but only rarely by plane – and if it does make it on board, our sophisticated medical systems are well prepared to cope.