Sunday, October 26, 2014

Ebola: The reality as Freetown and outskirts hit 1001 cases...

It seems as if an hour doesn't go by without Ebola being a part of it. Whether it is during a conversation, work at the hospital, a radio programme, an advertisement, a bucket of chlorinated bleach outside a restaurant, an ambulance with driver in a protective suit that drives by, the constant thought of not touching one's face, no personal contact, a billboard etc. Ebola has become entwined with daily life. Strangely though, when driving through Freetown things still feel fairly normal. It's a bizarre situation. 

Sadly, the situation in Freetown is getting worse with today's report revealing 1001 confirmed cases in the Western Area district (Freetown and outskirts). It is concerning that this might be the tip of the iceberg since it only includes cases reporting to a health facility. Since isolation beds are full, sick people are often turned away at the gate and forced to go back home meaning they aren't tested for the disease yet and they can further spread Ebola at home if that is what they have. As beds open up, sick people are transferred to a facility or someone waiting outside the gate may be lucky to get in. In an overcrowded urban setting, numbers are going to increase exponentially. I fear that Ebola will not only be a continuous part of daily life as people take precautions, but it will become a real life event for many people who will lose family members and colleagues to this dreadful disease, not to mention to other diseases due to the lack of healthcare in the country at the moment. In contrast to the USA, where the chance of someone knowing a person infected with Ebola (much less die of Ebola) is very small, for people in Freetown, the likelihood is far greater.

At the Children's hospital on Friday we received results back from the Ebola lab and had to transfer three confirmed Ebola patients to the treatment centre in Hastings. Two were mothers whose children died in the isolation unit in the hospital earlier in the week. And the third was a little boy who was admitted to the isolation unit 9 days ago. The ambulance arrived and while hospital staff put on full protective suits to escort the mothers to the vehicle, a father walked with his son in his arms from the isolation unit to the ambulance. It was heartbreaking to watch the father lift his 6 year old son into the back of an ambulance not knowing if/when he would see him again. I cannot imagine what he was feeling. I felt sorry for one of the ladies who looked terrified as they were lifting her in. She has already lost her toddler and now she was being taken to a place she does not know or understand by people in full protective suits. 

On Friday I witnessed the impact of Ebola on three families, but many more families out there will experience similar tragedies. Unfortunately the case numbers seem to be increasing at a faster pace than we can contain it. Efforts are being made to improve contact tracing, case identification, case management (isolation, testing, treatment) and dead body management (safe burials) but it is complex.    Basically we need to achieve 70% safe burials and 70% isolation nationwide to see transmission reduce. I hope that somehow the situation will start to improve with more relief efforts on the ground and we will begin to see a decline in numbers. I just feel like we don't have much time to wait! Thankfully in the East of Sierra Leone cases have decreased from a high of 50 per week to 4 per week. 

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