This Ebola outbreak is over but not quite; the time is now to assist Sierra Leone’s recovery programme


November 10, 2015 By Sheriff Mahmud Ismail

1.            Sierra Leone has been declared Ebola free by WHO but threats of the virus making a comeback remain.

2.            The Ebola outbreak badly affected the economy and created many social problems- there are many orphans, widows and survivors requiring urgent assistance.

3.            The government is poised, with support from it development partners to implement its Ebola recovery plan

Freetown-November 7, 2015 – At the Bintumani Conference Center in Freetown, the WHO Resident Representative in Sierra Leone, Andres Nosdtrom dramatically delivered that long awaited ‘verdict’- “Today 7 November, 2015, WHO declares the end of Ebola in Sierra Leone”!

The statement by the WHO representative may have been terse yet deeply profound for a population badly terrorised by this monster of a viral disease. For over seventeen months, the people of Sierra Leone whimpered under the brutal siege of Ebola, a viral disease completely unknown to the country and the West African sub region.

Sierra Leone had gone forty two days without any new case of Ebola – the benchmark set by the world health body before an affected country could be declared free of the virus. Medical experts used that number of days as the yardstick even though the Ebola incubation period is twenty one days. This, they say, is to ensure that the epidemic is truly over before it is so declared.

For the people of Sierra Leone and the direct victims of Ebola, those 42 days were too long in coming and the accompanying suffering was too much!
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The Sierra Leone’s Minister of Health and Sanitation, Abu Bakarr Fofanah captures the mood:

“The fight against Ebola has been long, winding, thorny and painful.”

Several survivor accounts indicate that early symptoms of Ebola include headache, muscle and body pain. As it worsens, vomiting, fatigue and loss of appetite set in, causing dehydration and further loss of energy. Weakened by pain, thirst and hunger, the patient becomes helpless and bleeding in all openings herald the ghastly terminal manifestation of a battered immunity.

Back in September 2014, I spoke with some of the survivors at the Hastings Treatment Centre, the hundred percent Sierra Leonean managed facility. Emmanuel Koroma, a devout Christian described himself a ‘prayer warrior’ but when Ebola struck him, he said his faith in God was seriously tested. Emmanuel recounted that he vomited until his throat started aching and then he asked; “God why are you doing this to me?”

Like Emmanuel, many more innocent Sierra Leoneans broke down under the ferocity of the virus. 26 years old Alaymatu Mansaray told me that when Ebola hit her, she lost control.

“I was losing fluids practically from every opening on my body!”

The brutality of Ebola and its health complications on survivors have been well documented. While some suffer partial blindness, others grapple with mental challenges and still others endure excruciating body pains. Few days ago, the BBC reporter in Freetown, Umaru Fofana who has reported widely on the survivors posted the following somber accounts on social media:

“A middle aged woman survivor just walked in (at the MSF Ebola Survivor Clinic), struggling to walk, struggling to see…”

At another location on the same day Umaru met a “23 years old who lost both his parents and 15 other members of his family to Ebola. He has had to drop out of school and has no job”.

Survivors face another challenge, stigmatization. Experts say the virus stays in the seamen of male survivors for up to 90 days and for a similar period in breast milk of the females. This reality makes survivors’ situation precarious and the possible source for the reemergence of the virus. All the new cases that held the country back on the march to the resilient zero originated from contacts with survivors. On the eve of the 42 days milestone, news of a new case in the eastern district of Kono caused quite a stir and Sierra Leone waited in bated breath for clarifications. That clarification came first from the National Ebola Response Center (NERC) and later with the stamp of the WHO authority.

“There is no new Ebola case in Sierra Leone…an investigation determined that earlier reports of an Ebola case in Kono are unfounded and related to routine health care support to survivors,” WHO assured.

Those few lines provided the assurance needed but the chilling reality remains that the battle is not over yet. The virus is still around in the body fluids of thousands of survivors. So while President Koroma, the international partners and indeed the Sierra Leonean public applaud their heroism and recognize that survivors deserve special attention, the fact is they also have a very important role to keep Ebola at bay.

The survivors know this and apparently some of them have been doing their bit. Yusuf Koroma, a survivor turned health responder explained when he felt ill he called the 117 emergency line several times to no avail. He then surrendered himself at the government’s Connaught Hospital at a time many people were hiding away from health facilities. He was admitted at the Isolation Unit where he said 5 patients died in less than one week. Yusuf broke down in tears as he explained that sixteen members of family contracted the virus but only he and two others survived. Following his recovery, Yusuf volunteered as a health responder to help defeat the outbreak. Yusuf wants the public to understand that survivors like him have also played their role in defeating this outbreak and that they should be fully integrated into society.  Another survivor, 12 year old Mohamed Koroma puts his thoughts in a moving song,

“I am a survivor”!

“I was contacted, I was infected, but I am a survivor!

If you saw me on the street, don’t laugh at me, don’t reject me, just appreciate me.

It is not my fault, I am a survivor!”

The Chief Executive Officer of NERC, Rtd Major Paolo Conteh acknowledges the role of survivors in the fight to end the outbreak and recognizes the need for them to be accepted but he also wants them to exercise more caution. Rather emotionally, the Rtd Major sobbed as he recounted that:

“Survivors have worked closely with NERC in achieving this victory and communities must welcome them, they are heroes.”

Then he added, “but they also have a responsibility to help prevent flare ups; survivors must practice safe sex”.

The NERC CEO’s concern which is shared by many is the possibility of a new outbreak resulting from complacency especially among survivors. The health minister knows this all too well. Re-echoing assurances by United Nations Mission for the Ebola Emergency Response (UNMEER) and WHO about their capacity to respond and snuff out any flare ups, Abu Bakarr Fofana says, working with the US Centre for Disease Control (CDC) and other partners, his ministry is committed to building a resilient health system capable of detecting and responding robustly in the event of any new outbreak.

The Ebola outbreak was officially reported on May 25, 2014 in the far eastern part of Sierra Leone. Its mode of transmission (contact with body fluids of infected persons) contradicts the long held customs and traditions of how Sierra Leoneans cared for their sick and buried their dead. This made it increasingly difficult to break the chain of transmission. Within three months; the disease had blasted out to the rest of the country like a cluster bomb inflicting indiscriminate suffering on mostly poor people. As Sierra Leone’s President Ernest Bai Koroma reflects on the extent of the epidemic he also recounts the human loss.

“Every district and most chiefdoms have had firsthand experience of this terrible disease. A total of 8,704 Sierra Leoneans were infected during the outbreak and we lost 3,589 of our brothers and sisters, our mothers and fathers and our sons and daughters. We lost 221 healthcare workers including 11 doctors,” he said.

But that is not all; the Ebola epidemic also devastated Sierra Leone’s economy.

“Before the outbreak, our nation was on the verge of its greatest economic breakthrough. We were in the middle of the biggest infrastructural development in the country and we were constructing roads everywhere. We were being hailed for sustaining our peace, strengthening our reforms, promoting diversity of voices in our media, and bringing more youths and women into decision making positions. The Ebola outbreak halted actions on many of these areas … reversed our economic prospects, dented job creation, and slowed the pace of road construction and other infrastructural development,” President Koroma recalled.

The impact has been as far reaching as it has been devastating- health care, livelihoods, education and the economy have borne the brunt of this calamity. For nearly one year, schools were closed down and in fear of contracting the virus, many citizens stayed away from the health facilities hampering the delivery of health services. Observers say, the Ebola outbreak halted activities in the agriculture sector because the disease mostly affected the 21-59 age brackets that are most active in communities, resulting in loss of farm labour. The fear factor also drove overseas investors away. Mining, which is the mainstay of the economy was disrupted, exports shrunk and air transport sharply contracted which further frustrated tourism. On top of this disaster, the outbreak has left a litany of social problems. This setback clearly affected the country’s indicators including those of the MCC. (But I would discus that in another article).

The Crisis Manager of the United Nations Mission for the Ebola Emergency Recovery (UNMEER), Bintou Kaita, provides some insights:

“There are over 11,000 orphans, thousand more girls became pregnant.”

There are also 4,051 survivors and many widows added to these grim statistics. For Bintou, though this is time to rejoice for the victory over the virus it is also time to reflect and resolve to take hard decisions.

“..People can go back to normal life, businesses can now fully reopen… but we cannot do business as usual…, we have to build on the lessons learned…, some of which were cruel…, we have to anticipate the return of the virus…we cannot become complacent, now is the time to work hard and commit to build a resilient health system.”

The International Community and the UK Government Representative, Marshall Eliot agrees;

“We cannot relax and cannot let our guard down especially when Ebola is still in Guinea.”

Marshall also warns that: “Ebola will return” and reiterates that “we have to remain vigilant and go back to work on Monday with the same vigor”.

For Umaru, “the war is truly underway for these survivors, orphans and widows” and he wants government to do something for them.

Many other Sierra Leoneans, health experts and members of the international community share Umaru’s views and the government is not oblivious to these enormous economic and social challenges. President Koroma was very clear in his address at the ‘End of the Ebola Outbreak Ceremony’.

“We have already started the implementation of the programme priorities for health, education, social protection, energy, water and economic recovery. Over the past four months, we have:

1.            Supported more than 30,000 vulnerable households with cash transfers

2.            Paid school fees for more than 1.1 Million children returning to school

3.            Supported farming households with seed and fertilizer distribution

And in particular reference to survivors, widows and orphans, the president says his government remain committed to on-going work to support survivors. It will provide a comprehensive package of support for Ebola survivors, including free healthcare and psychosocial support. But President Koroma also wants the rest of society to play their part.

“Our 4,051 EVD survivors are our heroes. They have shown great courage in overcoming the disease, and a great many of them have shown heroism in contributing to the Ebola response. There must therefore be no place for stigmatisation or isolation of our survivors. It is the duty of all Sierra Leoneans to ensure that these heroes are reintegrated into our communities.”

On the broader economic issues, President Koroma explains actions taken so far.

“We have taken steps to cushion the economic impact of the outbreak on our people. We have increased salaries by 15%, supported 23,000 vulnerable families with cash transfers, and we provided grants to local councils and gave them the flexibility to utilise the funds in fighting Ebola in their communities. To increase employment prospects for our youths, and stimulate the economy, we resumed suspended infrastructure projects, and restarted the reconstruction of major streets in Freetown. We have also been able to mobilize financial resources to meet some of the shortfalls in government revenues occasioned by decline in economic activities during the outbreak. We are also working with investors to resume iron ore mining and other operations within the next few months.”

Looking ahead, the president says his government is driving forward with plans to:

1.            Double citizens’ access to water,

2.            Double the citizens’ access to electricity,

3.            Drastically reduce maternal and child mortality,

4.            Create sustainable jobs and foster local SME growth, and

5.            Reduce overcrowded classrooms in our schools.

The government will no doubt require a huge injection of funds to execute these plans. Marshall says the UK government has committed over 240 million pounds to the recovery programme. While this is important, it also imperative that all development partners translate their commitments into tangible resources so badly needed to facilitate the recovery programme. For those 11,000 orphans, those over 5000 survivors, those thousands of teenage pregnant girls, those widows, the time is now rather than later!