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The horror of how a weak health system hinders the fight against Ebola in Sierra Leone

OCTOBER 24, 2014 By Sheriff Mahmud Ismail

Health Minister, Dr. Abu Bakarr Fofanah
Health Minister, Dr. Abu Bakarr Fofanah

The World Bank and other partners have provided funding, logistics and technical support to the three most affected countries yet, new infections are doubling, and more people are dying. The problem is that, “we have still not been able to break the chain of transmission”, a senior government official in Sierra Leone said.

Three key challenges remain: inadequate logistics, resistance to behavioral change and inadequate technical expertise. Logistically, health workers still need mobility, among other things to be able to respond effectively. Contact tracers, surveillance and burial teams are key in breaking the chain of transmission. But they could also be infected and spread the disease. If there is a sick or a dead person in a home but the ambulance and burial team cannot get there in time, it creates the risks for the family members to come in contact with their sick or deceased loved ones. The surveillance teams and contact tracers also should be able to quickly identify and put under observation all the people that may have come in contact with Ebola patients or dead bodies.

A Sierra Leonean, Zahiyer Sheriff shared the following poignant account with me:

Augusta Vandy – aged 15 years, died of Ebola at home in Wellington near Freetown on 18th October 2014, two weeks after the death of both of her parents. She had been taking care of her two younger sisters, one aged 9 years and the other just 5 months old. On the 14th October 2014, an ambulance was called to come and pick up Augusta who had become ill; and each day during that week multiple calls were made to the helpline by NGOs, family members and friends, requesting a vehicle to take Augusta and her siblings for testing and treatment. On 16th October, 2014, as her health worsened, Augusta decided to sleep on the veranda as she was worried about infecting her sisters. There were 57 people waiting for an ambulance in the Western Area on Saturday and we learned that the service could not respond. Augusta died on 18 October 2014. The ambulance finally arrived on the afternoon of the 19th; they could only take her remains away. So at Augusta’s house in Wellington on the morning of 20th October, was her 9 year-old sister struggling to take care of her 5-month old sibling who was now showing signs of fever. Distraught family members and friends stood outside the house giving advice and support but unable to enter. Calls continued to be made for a vehicle to take the girls to an isolation/treatment unit.

Zahiyer, who has been in direct contact with the family, told me that the children (the 9 year old and her 5-month old sibling) are still at their house quarantined as of 21 October!. Weeping over the phone Zahiyer said, “Nobody needs an extra brain to know that these two kids could also have been infected, it is only a matter of time before they start showing advanced Ebola symptoms. Must we wait until it is too late for these innocent kids?”

Fortunately, the girls have been finally picked up and are being cared for at the Connaught Hospital, Sierra Leone’s main referral hospital.

The problem is with the weak state of the country’s health sector. There are only about 5 labs testing for Ebola in the whole country and with the number of new infections, these facilities have been inundated. The problem has been compounded by the state’s directive that no burials should be done until the cause of death is determined by the health authorities. The waiting time for lab results sometimes exceeds 48 hours. For instance, a patient reported with his pregnant wife to a clinic on Wednesday, October 15, they were held at the clinic, their samples taken and sent to a lab. The result was not available until Friday, October 17. On Saturday, the husband died. The wife’s pregnancy wasted while she still battles the disease at a treatment center.

For the families of people dying in their homes, the 2-3 days wait, to watch the body of a loved one go bad, is too long. In desperation, in some cases, the families have gone ahead and buried their dead only for the result to come out later and, unfortunately, confirmed Ebola as the cause of death. Lack of feedback in good time and the absence of structures to tend to the dead while the family awaits the results from the lab have contributed to new infections. People quarantined in homes where people had died of Ebola face similar heartbreak. For them, they have to show symptoms of Ebola before any action could be taken.

Acts of love have become potentially fatal

Many people have contracted the virus through acts of love; caring for a loved one – a baby, a father, a mother, a husband or a wife; some because of their traditional/cultural believes of honoring the dead. But Sierra Leone’s Chief Medical Office (CMO), Dr. Brima Kargbo, told me that family contact with the sick and dead must stop because “the predominant mode of transmission is from person to person through burial practices”.

Dr. Kargbo went on to say that, “Standard Operating Procedures have been developed and if followed by community members, the spread of the virus will be slowed down”. The CMO assured the public that the Health Ministry will continue its community engagements but urged the general public to assist in educating the people on the risks associated with burial practices.

However, observers say that pathetic situations like that of Vandy’s need much more than just education; it requires the world community to redouble its efforts in helping the beleaguered countries save their people!

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