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Sierra Leone
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Ebola needs holistic approach to repel it

SEPTEMBER 2, 2014 By Joseph Fomolu – josephfomolu@yahoo.com

Ebola is one of the most daunting wars that have confronted Sierra Leone since Independence. There is war on poverty, corruption, and patriotism. Ebola’s war is different. It is real! It is daunting. It is a war wherein the enemy is invisible. It has made everybody apprehensive. It has overwhelmed our health sector. It is getting out of control to an extent the WHO has projected that it will kill 20,000 people before it is contained. The fight against it has brought Sierra Leone to its knees.

Never in my life have I seen or heard from health workers that they are afraid of a patient. Since my association with student nurses at Lightfoot Boston St., Freetown in 1981, I have not seen any of them scared by a patient. HIV/AIDS, a disease pronounced by the WHO as deadly, is yet to scare health workers.

On 4 August 2014, my daughter fell sick apparently from malaria. My daughter rejected water, tea or any food. She told me, “Papa, I will vomit if I drink water or tea.” She cried calling my name and could not sit, stand or lie on the bed. I called my landlord and neighbours. My landlord advised we take her to the nearest hospital. I agreed. We took her to the Bo Police hospital around 1:00am. On arrival, we knocked a ward door and four men greeted us. We asked for the nurse/s or doctor, they replied, “we are patients, the only people here, no nurse.”

We asked for the phone directory which was on the wall. I called the number of one of the doctors. Though the phone rang, nobody answered the call. He may have been sleeping.

I decided to call our own doctor of where I work at Every Nation College. He answered by advising that I take my daughter to the MSF Hospital at Gondama (over five kilometres from Bo). I wondered whether he forgot that there were no okadas at that time, or he did not know that I had no access to any vehicle at that time.

I decided also to call a nurse who is an acquaintance. She told me, “I don’t have any medicine for children in my house.” Suddenly, a policeman on duty at the Eastern Police Station appeared. He suggested we go to a popular pharmacy nearby where there was a well known and experienced nurse who treats patients. We went to the house of the nurse. The policeman called the woman. Somebody answered from inside, but nobody came out of the house. Two or four dogs were barking.

At that point, one of my Samaritan neighbours encouraged me, “Mr. Folomolo (as that is how she calls me since I became her co-tenant in May) let’s go home. Hawa will be okay. Nothing will happen to her. Don’t worry yourself.”

At that point, one of the children of my landlord carried my daughter on his back and we walked home. At 4:30am, my daughter started calling for water to drink. Before 5:00am, she had drunk a sachet of water. I started getting relieved. Today, she has more appetite and sleeps enough in the night as usual.

Before 8:00am, I walked to the house of the nurse whom I had talked to earlier. I was dismayed to find some kids in her house. I asked her why she refused to see my daughter. She told me they (health workers) are now afraid of patients. She also told me about the nurse who stays near the police hospital. I informed her that she did not come out of her house or pharmacy when we called. My acquaintance nurse, however, calls me daily to know about my daughter’s health.

Health workers should not be blamed

In Bo, and other parts of Sierra Leone, I do not think my daughter was the only victim on that fateful Monday when President Ernest Koroma declared everybody should stay at home. However, I am convinced that health workers were not part of those who should have stayed at home. The President’s declaration came after the death of Sierra Leone’s only viral disease medical specialist, Dr. Sheik Umar Khan (RIP). He was followed by his entire team. Therefore, who among the medical personnel was bold enough to confront the most deadly disease in the world?

Many medical officials are not prepared for the gauntlet though they had taken a vow in their nursing schools to save lives. But the irony is that how can a health worker be on the verge of saving the life of a patient and he/she loses his/her life? Few health workers may have survived after getting infected. For instance, the Community Health Officer of Koindu Hospital, Sulaiman Saidu Kanneh, survived. But nurse Mbalu Bonie, who worked at Kenema Government Hospital, including more than 31 of her colleagues around Sierra Leone, have not survived the Ebola virus. The most recent Ebola victim is Dr. Sulaiman Rogers.

The death of these their colleagues have triggered fear in health workers. This may be the reason why they fear patients. Potential patients also fear to go to the hospital when they fall sick. Our health workers and patients fear each other.

The health workers do not want to fall victim of Ebola infection. Potential patients think health workers are spreading the disease. In fact, some Sierra Leoneans have started stigmatizing them with the name, ‘Ebola nurses’. But are health workers to blame? No! Their colleagues have died. Moreover, those who have survived complain of lack of appropriate materials to contain the virus. Hence, they do not want to die to save lives.

Rebranding the Ebola message

When the disease entered Sierra Leone in March, I was in a village in Kailahun District called Yendema (a mile from Daru). Little was known about it. HIV/AIDS is a household name in Sierra Leone, but not Ebola. Some people started asking, “how can a disease come and is deadlier than HIV/AIDS?” When it started ravaging Daru, denials were common among Sierra Leoneans that it was a political gimmick. However, that denial started to wane, especially after the death of the Ebola Specialist, Dr. Khan.

There was poor communication about Ebola. No clarity in message. For instance, one of the reasons that may have instilled fear in potential patients is the radio jingle that it has no cure. If the jingle tells the listener there is no cure, then why should an Ebola infected person go to the hospital when he/she knows that there is no cure? Yet, information has started coming to the public that some people have survived. How did they survive?  The public needs to know.

Ebola yet to spread like wildfire

The blame game is no longer the solution. I know our governments have the history of making any problem a national issue when a government official is a casualty. For instance, the 10 years war started on 23 March 1991 when combined forces of the Revolutionary United Front (RUF) and the National Patriotic Front of Liberia (NPFL) attacked Bomaru, Kailahun District. Government only decided to send troops to Kenema, Bo and Sierra Rutile in July that same year, instead of the battle area, when President Joseph Momoh was told that rebels had killed a chief in Pujehun.

The late declaration of Ebola as an emergency has made close to 400 Sierra Leoneans to lose their lives. More than thirty-two health workers! It is alarming. If we are to think of their respective experiences in the medical field, loved ones that they have left behind, is a big loss to Sierra Leone. Ebola has depleted the human resource base of the health sector. It has now become daily news at both national and international levels that somebody has died of Ebola. Guinea, where the epidemic started, is gradually scaling down the infection. According to a Guinean doctor, Kohorgho Sanno, who was interviewed on the BBC on Friday 15 August, there are a total of 12 Ebola patients in hospitals across the entire country.

The population of Guinea is over 10 million. The epidemic emanated from there. Yet, they have tried to contain the disease, even when MSF boss, Joanne Liu, has said, “it will take about six months to bring under control the Ebola epidemic in West Africa, which feels like ‘wartime’ and requires greater leadership from WHO.” The population of Sierra Leone is less than 10 million. But Dr. Sanno informed that tracing has been very effective. That is one of the reasons for them to be on top of the Ebola outbreak. Here in Sierra Leone, the number continues to increase. Kenema and Kailahun have been quarantined for weeks now. In Bo city and its environs, some residences have been quarantined too.

In Freetown, a prominent doctor, Modupeh Cole and others have died of Ebola. Only God knows how many patients whom Dr. Cole had treated before may have been infected with the virus. However, it is prudent to follow Dr. Sanno’s advice. Tracing of all those whom Dr. Cole had contact with at his residence, surgery and hospital is expedient. How to do it? Trace his family and check the ledger of all his patients and his visitors before he died; including his personal nurses or assistants. Taking such a measure ‘will break the chain of transmission to separate the infected from the uninfected’.

Ebola has spread in Kailahun and particularly Kenema because Mr. Fullah, who was an assistant to Dr. Khan, had a clinic at Combema. He may have infected so many of his patients, who in turn may have been infecting other people. An infected nurse (RIP) from Kailahun carried the virus to Daru where many people died at first. Therefore, tracing is a prerequisite in the fight against Ebola.

Holistic approach

It is commendable that it has now become a national issue since President Koroma declared Ebola an emergency. MSF and the Ministry of Health, as well as other ministries, MPs, religious leaders, security forces, civil society and journalists have all joined to fight this deadly disease. Timely, appropriate and clear messages are required to make the public aware of the disease in all corners of Sierra Leone.

Government and the international community must provide the appropriate materials to health workers to work with in order to create confidence in them to treat suspected Ebola patients. It will prevent ‘rejection among people of the existence of Ebola and hostility towards health workers’.

Overcrowding in our public transports must stop, as well as government disallowing transport owners to increase their fares. In addition, let it be a criminal offence for all traders who increase the prices of foodstuffs and all materials to combat the Ebola epidemic.

Also, spiritual panacea is necessary. Ebola infected a small boy in Guinea before infecting his parents. How did he come in contact with the virus? For some of us who know a little bit of life in Guinea and Liberia, bush meat, especially monkey meat, is a delicacy in the infected areas. In Sierra Leone, these animals become delicacies to prevent them from destroying cocoa pods. Yet, it has never been known that they carry a deadly virus until this year. The disease may be a plague from God because of sins of witchcraft, idolatry, adultery, lying, fornication, stealing and killings of fellow Sierra Leoneans for property, promotion, chieftaincy, money, girl and boyfriends, etc.

With HIV/AIDS, it is a crime to discriminate or stigmatise its victim, nor were any flights suspended. There is free and easy flow of people from country to country. Those who die of HIV/AIDS are buried in dignity with love ones and relatives giving their last respects to them.

I had interviewed a HIV/AIDS victim at Pastoral Centre, Kenema but never got infected since 2003. I put the recorder on my knee, while I sat very close to the victim. On the contrary, Ebola does not allow this.

Seychelles was the first country to make Sierra Leone a pariah state. She did not allow the national team, Leone Stars to go for the African Nations Cup qualifying series match for fear of infecting their tourist-dominated economy. Hong Kong and other countries have opened quarantined centres for suspected Ebola victims visiting their countries from West Africa. Flights such as Arik, Asky, British Airways and others have suspended their flights to Sierra Leone because of Ebola. Kenyans are urging Kenyan Airways to follow the measures these three airlines have taken. Ghanaians are on the alert. South Africa, UK, France etc, have almost made Ebola affected countries pariah states. Nigeria has declared an emergency, a week after Liberia declared it. Ebola has killed one person in Senegal who came from Guinea, Conakry.

In Sierra Leone, all Trade Fairs have been suspended. Public transport owners in the South-East of the country are starving because Kenema and Kailahun districts have been quarantined. Consumers of second-hand clothes are reluctant to buy to avoid buying a cloth which an Ebola infected person had tested before he bought it. Food products from farms are perishing because there is no vehicle to transport them to markets. Tourists are not prepared to come to Sierra Leone because of Ebola. Some international experts have left the country, while others are planning to leave soon.

Some Sierra Leoneans have close hospitality to loved ones. For instance, the sister of one of my good Samaritan neighbours came from Pujehun to spend over two days with her. She gave the room and bed to the stranger alone, and told her she will allow her to spend only a night and should return the next day. Early in the morning when the stranger woke up and was preparing to return to Pujehun, her sister told the children to prepare hot water to launder the bedspread which the visitor had slept on. The woman said, “my sister (name withheld) is it because I slept on the bedspread that you are telling your children to launder it? You are also driving me because of Ebola?” She replied, “yes”.

Therefore which kind of sickness is this? Is it man made? Some people have already bathed with a drum of hot salt water, but suspected cases and death toll continue to increase.

It is probable that Ebola is a divine disease that also needs divine treatment. God sent ten plagues to Egypt; has sent just one to Sierra Leone. For the disease to go back to wherever it came from, Sierra Leoneans need to repent their sins. “In righteousness shalt thou be established: Thou shalt be far from oppression (Ebola); for thou shalt not fear: and from terror; for it shall not come near thee.” (Isaiah 54:14).

Proper medical treatment and proper care, correct communication, effective tracing and divine intervention are essential holistic approaches to drive away this scourge from Sierra Leone. Effective coordination with partners within and outside Sierra Leone is also essential.

Government must construct temporary or permanent treatment centres, buy ambulances and necessary equipment for the fight against Ebola with the so far billions of leones donated, instead of waiting for scrapped ambulances and second-hand medical equipment from benevolent partners. Government must also give special incentive to health workers in Sierra Leone. (Health workers are still running away from patients who visit referral hospitals).

According to the BBC, Ebola has killed more than 1,200 people in Guinea, Liberia, Nigeria and Sierra Leone since it broke out in March this year in Guinea, Conakry. More deaths must be prevented, even though WHO speculates that 20,000 people in West Africa are expected to die of Ebola.

Government must provide timely, adequate tools to health workers. Funds already donated must be used for this, rather than waiting on stationary ambulances from friendly countries. Ebola is an enemy you cannot see.

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