Ebola: Sierra Leone's Ose-to-Ose campaign & "lockdown" end...

A few hours ago I received a report from the Ministry of Health and Sanitation, Emergency Operations Centre (EOC) in Sierra Leone - the Ebola House to House Sensitization Campaign is officially over. After 3 days of lockdown, people are no longer confined to their homes. There was a discussion about extending the lockdown since not all of the houses were reached, but it was decided to end the official lockdown and continue the house-to-house social mobilization exercise in the hot spot areas around the country.

It's hard to know how successful a campaign like this was. It sounds like 75% of the households were reached nationwide, which sounds like a reasonable percentage in a 3 day period to me in a country with over 6 million people. Besides one incident in the East of Freetown, the nation was peaceful, which says a lot about people's willingness to cooperate and some trust in the government. From what I have heard, the quality of health talks varied but that's to be expected with over 21,000 volunteers with varying backgrounds and very recent training. I have heard that in some homes a bar of soap was given but little information about Ebola itself was provided and no questions were asked about sick people on the compound. In other homes, talks were more extensive and sick people were identified and taken to holding units. Hopefully overall, awareness increased. Although the main aim was raising awareness, suspected Ebola patients were also identified and dead bodies were also discovered. Of course, not all of the deaths will be due to Ebola.

The campaign is over but the outbreak is not. It is important that the general public realizes this. There are often strange beliefs and already I have heard that some people think that Ebola is now gone. Also, a message was sent around today by a Bishop urging all citizens to call on the name of Jesus at 6 pm this evening to 'kick Ebola out'. From friends in the city, I heard that at 6 pm they did hear loud cries of 'Jesus, Jesus, Jesus'. Some people may well believe that this is all it takes. And while I believe that divine intervention is possible, I also believe that people need to be wise and sensible. Giving people hope is good, but not if it leads to people being careless. We need people to continue taking this disease seriously and move forward with extreme caution. There are still many challenges with sick people being too afraid to go to health facilities, health care workers not feeling protected enough to work, lack of beds in isolation/holding units and treatment centres, lack of staff, etc. It is also good to remember that many more people are now dying of diseases such as malaria, typhoid and pneumonia than they are of Ebola due to lack of general health care. There is still much to be done.

Hopefully this campaign was a step in the right direction...

Ebola: Ose to Ose Ebola Tok...

Today marks the start of the nationwide House-to-House Family Sensitization on Ebola Campaign in Sierra Leone. The campaign is entitled 'Ose to Ose Ebola tok' and is scheduled for the 18th - 21st of September. Three of these days (19th-21st) will be stay at home days for the entire population, except for health care workers and those sensitizing the public.

The main objective is to reverse the trend of new Ebola cases as well as to enhance interpersonal communication and engagement of communities in the fight against Ebola. In total 28,544 (7136 teams of 4 people) will be mobilized across Sierra Leone. 

While the situation continues to worsen in Sierra Leone, it is important that communication is clear and people work together to fight Ebola. Let us hope that these days will be effective and that more people will come to realize  how real Ebola is and what needs to be done to break the chain of transmission.

Let us pray for peace in the country. The fact that people will need to stay at home for 3 days straight can pose many challenges. For some, it will be difficult to ensure that there is enough food and water available in their household. Pray for God's provision for these people and that this will not lead to any rioting. Pray for cooperation and understanding amongst the general public and for wisdom and protection of those leading and participating in the delivery of this campaign.

The impact of the Ebola outbreak on child health in Sierra Leone...

The worst Ebola outbreak in the world is confirmed to have infected 1,305 people in Sierra Leone to date¹ though the actual rates may be higher. Of the Ebola confirmed cases, around 22% are children between the ages of 0 and 17 years². Children are not only getting infected with this disease, but many have either been separated from their parents or been orphaned due to Ebola and many more children can no longer access basic health services for non-Ebola illnesses.

The loss of over 240 healthcare workers due to Ebola infections in the affected countries of Sierra Leone, Guinea, Liberia and Nigeria, with long-standing shortages of healthcare professionals, has understandably instilled fear amongst hospital staff and has led to a demand for more training, sufficient protective equipment and incentives before they feel confident to proceed with their work on the front line. This, in combination with a fear amongst the general public to report at health facilities and the difficulty in identifying suspected cases when reliable histories are not forthcoming, has resulted in many health facilities closing or only running outpatient services. Amongst these health facilities is the Ola During Children’s Hospital (ODCH); the only government run Children’s hospital in the country, which is now temporarily closed.

At ODCH, which Welbodi Partnership has supported for over 5 years now, preparations were made in collaboration with hospital staff and partnering organisations at the start of the outbreak for the possible arrival of suspected Ebola cases. This included setting up a small isolation unit, ensuring the availability of personal protective equipment in the unit, training of staff and screening of patients at the entrance of the hospital. It also involved the reinforcement of using universal precautions on all of the wards.  

The screening questions are based on the case definition for Ebola, which includes specific symptoms, travel to/from an affected district and contact history with an Ebola patient.  Since the transmission of Ebola is through contact with bodily fluids of an Ebola patient, the contact and travel history are important. It is estimated that prior to the outbreak, 80-90% of children presenting to hospital come with symptoms such as fever, diarrhoea, vomiting, and weakness; symptoms that not only categorize Ebola, but many other common diseases such as malaria, typhoid and gastroenteritis. If the case definition were only to focus on symptoms, this would mean that the majority of children presenting to the hospital would need to be isolated, which with approximately 1000 admissions a month at ODCH, would be a daunting task. It would require a rapid turn around of laboratory results and a large medical and logistics team on the ground, as frequent entry into the unit would be required to assure that infants and young children are receiving adequate hydration and care, particularly as it is not guaranteed that these children could be isolated with a dedicated caregiver.

The agreed procedure at ODCH in dealing with suspected Ebola cases was put to the test in early August: a child arrived at the hospital and was screened at the entrance. The history revealed fever, vomiting, weakness and a positive contact and travel history. Since the patient met the case definition, the child was immediately isolated in the hospital’s isolation unit while testing was carried out. Two days later when the test result came back positive, the child was taken to an Ebola treatment centre in the east of the country. All staff that came into contact with this patient were aware that she very likely had Ebola and took the necessary precautions. Although this case brought up a few challenges in the process, it did go according to plan and the hospital continued with the same procedure.

Only a week later, however, another child arrived at the hospital. This child had symptoms of fever, diarrhoea and vomiting, but the father denied any history of contact with an Ebola patient or travel from an affected district, most likely because he was afraid to hear that his child might have Ebola. For many, the diagnosis of Ebola is seen as a death sentence. Since the father withheld essential information, the child did not meet the case definition and was admitted to the Emergency Room. It was not until two days later that one of the doctors found out from another relative that the child had been in contact with an Ebola case. Alarm bells rang and preparations were immediately made to transfer the child to an isolation unit for testing for Ebola. All other patients were moved onto another ward and the Emergency Room was decontaminated.

As one can imagine, hospital staff was nervous, having cared for this patient for two days on a general ward, using gloves and universal precautions, but not using the full protective suits since the patient was not admitted as a suspected case. It was decided that all staff in direct contact with this case, would be quarantined in their homes where they would sit out the 21-day incubation period with the hope that they had not been infected.  Since that day, ODCH has been closed to new admissions, because without reliable histories during screening it is impossible to identify a suspected case and isolating all cases arriving at the hospital was an impossible task due to size limitations of the initial isolation ward. Over the next few days, most children were discharged from the hospital. Two days later, the result for the child was announced: positive.

Thankfully, 21 days has passed and none of the staff that came in contact with this case have shown any signs of Ebola, but to date, ODCH, the country’s only government-run paediatric hospital, remains closed.

This story is not unique. Many health facilities across the country and in the sub-region are in similar situations. The impact of this outbreak on the already fragile health systems throughout West Africa will be immense. On average, ODCH admits 1000 patients in the month of August. The fact that ODCH was shut for the second half of the month means that 500 children who would normally have access to health care services, did not. What is the fate of these children? Children with diseases such as malaria, pneumonia, gastroenteritis and other common diseases may well die. The implications will also be severe for services such as outpatient paediatric HIV/AIDS and tuberculosis treatment, as these patients are either afraid to come to the hospital to receive their medications, or health staff are placed at high risk without proper protective equipment to allow them to safely conduct consultations. The immunization programmes will be hindered and many children may not be immunized adequately during this outbreak. It is fair to say that we will see an increase in both morbidity and mortality over the next months. Extrapolating data from a Lancet article in 2013^3,4 it is estimated that 2,500 women and children die in Sierra Leone every month. With the current strains on the health care services this number is inevitably going to increase, and this will never be accounted for in national Ebola mortality statistics. The closure of the hospital has also had an impact on the few remaining health facilities in the area, already overburdened by the demands of the Ebola outbreak, and with limited experience in paediatric care.

Efforts are underway to re-open the hospital, but this must be done in such a way to ensure the safety of both staff and patients. An effective screening method needs to be put in place so that the hospital is not, once again, forced to close. With a high level of fear amongst the general public, it could be that other caregivers will not be forthcoming with the actual history, for fear of their child being isolated. Finding a safe way to re-open the hospital potentially means that a large proportion of children presenting to the hospital will need to be isolated and tested prior to being admitted, since the symptoms of Ebola mimic that of other diseases. NGOs currently on the ground at ODCH are working with hospital staff, the Ministry of Health and Sanitation and other agencies to discuss plans to set up a larger isolation unit adjacent to the hospital for this purpose. In the meantime, training of hospital staff is ongoing with a big focus on infection control measures, including the use of personal protective equipment. Welbodi Partnership is currently providing advice from afar but hopes to return soon to support the efforts at ODCH.

In itself, Ebola is a terrible disease, causing suffering and death, but the impact on the fragile public health systems in the country means that the morbidity and mortality from more common illnesses will be on the increase. Measures to stop the transmission of Ebola need to be scaled up to control this outbreak.  At the same time, and continuing into the future, the current health systems need to be strengthened to ensure the availability of high quality health care in Sierra Leone, as well as to prevent and control such outbreaks in the future.

¹ MOHS Sierra Leone Situational Report - 9 September 2014 http://health.gov.sl/?p=537
² UNICEF Sierra Leone - Ebola Virus Disease - Weekly update (1-7 September 2014)

³ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60497-9/fulltext

⁴ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60696-6/fulltext

Written by: Sandra Lako, Welbodi Partnership

Ebola: The current situation...

As of the 9th of September 2014, the number of people that have been confirmed to have the Ebola Viral Disease in Sierra Leone is now 1,305. Of those, 893 of the cases are in the two districts of Kenema and Kailahun in the east of the country and 118 of the cases are in the Western Area district, which includes the capital city of Freetown. The rest of the cases are scattered all across the country in all but one district, Koinadugu, the only district with no known Ebola cases.

The situation is getting worse. These numbers are bad enough, but I am certain they are just the tip of the iceberg. The cases mentioned are those who have had laboratory testing, in other words, those who have presented at a health facility. The issue is that many people are not presenting to health facilities. They are either too scared to go for fear of being isolated or contracting the disease, likewise, health care workers are afraid to work for fear of becoming infected. 

All this to say that the numbers reported are likely to be a gross underestimation of the actual situation. There are probably hundreds if not thousands more Ebola cases throughout the country. Many people are sick and dying in their homes, and while suffering they are at the same time spreading the disease to other family members. It is a sad situation.

And now, even if patients want to access healthcare, many health facilities are shut and even the Ebola treatment centres in the country are currently full. This provides a signifiant challenge. The few holding units (isolation centres) in the country that are isolating and testing patients now have nowhere to send their positive patients too. This means that their beds are full and new patients cannot be admitted for isolation and testing. This means that patients are forced to go back into their communities, which leads to further spread of the disease.

The only solution to this problem is to set up more treatment and isolation units across the country, which asks for a strong human resource and logistical commitment from both the government of Sierra Leone, partner organisations and the international community at large. 

There are plans to set up new isolation and treatment centres, but unfortunately it has proven to take weeks, if not months, for these centres to be functional. What will happen to those with Ebola in the meantime and how much more will this virus spread before patients can be properly isolated, tested and treated again? 

I know that both the US and UK governments have agreed to help with setting up (and possibly running?) treatment centres in Liberia and Sierra Leone? But will the proposed 25 and 62 beds respectively be enough? I think the answer is obvious. The international community and the government of Sierra Leone need to scale up their efforts considerably. It is already expected that thousands of additional cases will surface in the next few weeks. What happens next?

Ebola: The World's Response...

While sitting in The Netherlands after needing to leave Sierra Leone just over a week ago, I am not only pondering when and how I can go back to support the fight against Ebola but I am also reflecting on what the world's response is and should or could be during this current outbreak. Yes, there has been some response from leaders world wide, but is it adequate and appropriate?  Recent articles from The Guardian and New York times state that not enough is being done. Who should respond and what should that response look like?

In the initial phase of this outbreak, I think the disease could (should) have been contained and dealt with by the governments of the West African nations, with strategic support from experienced agencies such as MSF (Doctors without Borders), CDC (Center for Disease Control), Public Health England/Canada and the WHO (World Health Organisation). There are so many factors that have contributed to the fact that the situation is now out of control. I personally feel that more could have been done. Sierra Leone, for example, could have shut the borders to Guinea and Liberia immediately, districts such as Kailahun (and Kenema) could have been quarantined in a very early stage of the outbreak, training of health care staff and mobilisation of resources throughout the country could have been completed prior to the spread of the disease, enhanced security could have been enforced at isolation and treatment centres and a state of Emergency could have been declared weeks before it was. But this did not happen. Some of these measures have since been put in place, but is it too late?

Now, due to a variety of reasons, we have an outbreak, with 783 confirmed cases in Sierra Leone as of the 19th of August (MOHS statistics), that is seemingly impossible to contain. I do not think that the governments can solely be blamed for this, the behaviour of citizens has definitely played a role as well. 

Based on past experiences, many Sierra Leonean citizens did not trust the government or health care workers at the start of the outbreak leading to both a disbelief in the existence of Ebola and a lack of cooperation with health care professionals and government officials. This meant that high-risk cultural practices (such as washing bodies before a burial) continued to take place, confirmed cases escaped treatment centres or were pulled out by their relatives, patients were hidden in their homes and contacts of cases did not come forward. 

Various conspiracy theories concerning the origin of the outbreak added fuel to the level of distrust. Some people believed that Ebola was a way for the governing party to wipe out those in favor of the opposition party (the districts in the East). Others believed it was just another way for the government to gain foreign aid; a way for the rich to get richer with the thought "more cases = more aid". Some believed that the 'white man' introduced Ebola to wipe out Africans or to come and test their drugs. Some thought that health care workers were injecting people with Ebola. There are so many theories that have made it difficult to deal with this outbreak quickly. Rumors of remedies such as bathing in salt water or drinking special water sent by a Nigerian pastor have also compounded the matter.

Now, I think most people believe that Ebola is real. But are people informed enough? Do they realize the scope of the problem? Do people know what to do or not to do? Is the fear of Ebola going to keep sick people at home? 

People are afraid that if they go to a health facility they may contract Ebola from a doctor or nurse. Even for those that want to access health care, the situation has worsened to the extent that the health care system has basically collapsed. Due to fear of contracting the disease from patients or lack of protective equipment or colleagues succumbing to the disease, many health care workers are too afraid to work. Some hospitals are refusing new admissions and have basically shut down. What does that mean for someone with a fever seeking medical care? They may be turned away at the health facilities and forced to self treat at home for disease such as malaria or pneumonia. They may or may not get better. They may die at home of Ebola, meanwhile infecting their family members. People are afraid that if they have a fever and go to a hospital, they will be isolated immediately and be tested for Ebola. They fear they may be isolated with other people that may be positive for Ebola and they might even catch Ebola while waiting in an isolation unit. They are afraid that if they are positive they will be taken to a treatment centre, which for many, is seen as a death sentence. These are all realistic fears that need to be addressed.

The ripple effects of the outbreak include a collapse of the already fragile health care system leading to more men, women and children dying at home from preventable and treatable diseases. The outbreak has temporarily suspended formal educational systems and will have serious economic impacts as well, with a loss of trade, less investments and reduction in farming.  Fears now are that people may struggle to find food and that the risk of starvation may surface.

It is obviously time for a global response. International support is crucial. Governments from around the world need to work hand-in-hand with the governments of West Africa. Global leaders are needed to help with decision making on solutions to overcome this outbreak. 

However, according to The Guardian, "The international community has made "almost zero" response to the Ebola outbreak in west Africa, with western leaders more interested in protecting their own countries than helping contain the crisis that has now claimed more than 1,200 lives, a senior international aid worker said on Tuesday. "Leaders in the west are talking about their own safety and doing things like closing airlines – and not helping anyone else."

Is that the response the World is ready to offer? Or will they look beyond their borders and realize that their response needs to be directed to what is happening on the ground in West Africa? 

The operations director of MSF (Doctors without Borders) states that "the solution is not that complicated but we need to have political will to do so. Time is running against us. But you need very senior people with high profiles, the kind of people who can co-ordinate a response to a million people affected by an earthquake," he said. He also said containing Ebola was "not rocket science" identifying "contact tracing" and public communications as the key factors.

Can the world deliver this? I hope so because otherwise this fight seems very hopeless. 

Practically speaking, more doctors and nurses are needed to run treatment centres and isolation units across the country. There simply are not enough medical professionals in country to deal with this situation. Mobilisation of resources are needed to make sure that every health facility has the PPE (Personal Protective Equipment) they need - full PPE suits for isolation and treatment centres, and enough protective gear (gloves, aprons, masks, eye protection) on the wards of every hospital and health centre to enhance infection control measures. Training is needed to ensure that people use the protective equipment appropriately and do not infect themselves when taking it off for example.  People are needed on the ground to support contact tracing and surveillance systems. People are needed to go from house to house to follow up on those who have been in contact with Ebola patients. Coordination is needed to support all of these efforts. Communication needs to be effective. Unless this happens, the disease will continue to spread. It's time to work together, it's time for a global response. 

Dr. Liu, President of MSF said that "no matter how many patients her organisation treats, the outbreak will not end until other agencies can halt the progression of new infections."

This is a call for help from West Africa to the rest of the world. This is a please for individuals, organisations and governments to join the fight to end this outbreak. Who will step in?


Quotes taken from: 
http://www.nytimes.com/2014/08/20/world/africa/ebola-is-disaster-of-scale-still-unknown-relief-official-says.html?_r=0
http://www.theguardian.com/society/2014/aug/19/western-leaders-ebola-outbreak-africa-medecins-sans-frontieres

Back to school, but not for children in Sierra Leone...

It's "back to school" for many children. It's all over Facebook. Pictures of children with their backpacks on, ready to go back to school or for some for the first time ever. It's an exciting day for children and their parents and maybe a little sad for some too. However, it's often seen as the start of something new. 

This year, children in Sierra Leone are not so fortunate. They don't know when they will go back to school. Some children were not even able to finish school last year because schools in Kenema and Kailahun closed early. Exams have been postponed indefinitely. Now, although the official summer holiday is almost over, schools in the entire country may not re-open for months. No one knows when. It all depends on the situation and whether or not the Ebola outbreak is under control. For now, it doesn't look like that will happen anytime soon. Schools will remain closed in the hope to help halt the spread of the disease. 

See: http://news.sl/drwebsite/publish/article_200525996.shtml

Since summer schools have also been banned this means that children will be home for months. I am not really sure how that works for most families but I suppose they will have to manage. I suppose if both parents do work (often not the case) there are usually other relatives around that can look after the children, or the older children simply look after the younger ones. Seeing as many people prefer to stay home these days anyway, maybe they will cope. I know some parents are keen on making sure their children continue to learn, but there is only so much you can do at home without any materials. Some families don't allow their children to play outside anymore, just in case another child is sick on the compound. So, it sounds like most children will be staying indoors for a while. 

For those children (at least 70) who have been orphaned during this outbreak, the question is whether or not they will have the means to go back to school again. But there are of course more urgent questions at hand for them: Who will take them in? Who will provide for them? Will they receive the basics of shelter, food and water? 

This outbreak will take it's toll on many people, young and old, whether they get 'the disease' or not there will be a negative impact on many of the country's existing systems. This includes the educational system. 

This week and next, while many children all around the world are going back to school, let's remember the children in Sierra Leone, Liberia and Guinea. And let's remember their teachers as well, some of which have already succumbed to the disease. Hoping for a brighter future when this is all over.

Ebola: A Survivor's story...

For weeks we have been waiting for stories from SURVIVORS with the hope that their experiences will encourage citizens who are showing symptoms to go to a hospital immediately. That way patients can be isolated and tested immediately, and if positive they can be transferred to a treatment centre. That's the only way we can stop further transmission as well as give people the best chance of survival. 

I know that in part we are not hearing survivor stories due to stigma and shame attached to having Ebola. Even though they survived it they had 'the disease'. Some of the survivors are being shunned by their villages and many have lost numerous family members and now have little support. However, with over 200 survivors now, we must be able to share more stories. I hope that more encouraging stories will be revealed over the next few weeks. I still think this should be a priority for those working in communications at Ministry level in order to help tackle some of the challenges we are facing such as sick people hiding in the communities or patients escaping from isolation units.

Here is the story of Musa, who survived Ebola but lost 15 close family members. His story is taken from the Awoko newspaper.

"Musa Turay of 35 A-Line, Nyandeyama New Site in Kenema city is one of the over one hundred survivors of the Ebola virus since its outbreak in the eastern region in March this year.  On Monday 4th August 2014, he spoke to Awoko explaining his experience with the virus.

Speaking with joy but with tears in his eyes, Musa said he took 28 days at the Ebola Treatment Center in Kenema and thanked God for saving his life as he lost some 15 close family members including his father. He said he has not set eyes on his mother and elder sister since his discharge from the treatment center. He said he is being told that his mother and sister are still being admitted at the Ebola Treatment Center in Kenema and he cannot visit them.


He explained that he is a footballer and that one morning he went on a jog to clear a fever he was experiencing. He said on his return, he adviced everyone around him not to touch him as he was suspecting haven contracted the Ebola virus. This came after he had lost his father and fourteen other close family members to the Ebola virus.
He said later on went on his own to the Kenema Government hospital even when he had complained of his condition to his two elder brothers. “I refused to even take a motorbike for fear of infecting the rider should I be positive with the virus,” he said. At the hospital, he said his blood sample was taken and asked to go home and return the following morning for the result. But that he insisted that he be given treatment. “I was feeling extremely hot inside me and my throat was dry making it hard for me to even swallow my saliva. I was feeling very uncomfortable and uneasy,” Musa said.
He said as he insisted for treatment to be administered to him, he was met by one Whiteman, he called William who after explaining his condition to him, immediately rushed him up to an empty bed in the Annex Ward and drip was administered. He said Williams provided him with twelve (12) packets of Grafton which he said he drank within the space of thirty minutes. He said he was also given medicines to prevent him from vomiting. He said he ended up taking drips for three days. He said when the result from his test came, he was Ebola positive.
“I was encouraged by the doctors and nurses to eat well and drink enough water and to rest,” he stated.
Musa said he and fellow patients were treated very well and they were given medicines on any other day and that each and every patient was assigned requested to drink more than three coconut jellies which were paid for by the nurses.


Musa appealed to government to increase the allowances of the nurses and ensure their maximum protection.
Musa said even though he lost his mobile phone at the hospital, he was feel happy that he survived as was certificated by the center and was given a certificate and cash amounting to Le 100, 000 (hundred thousand Leone).
He said he may have possibly contracted the virus at a hospital in Kenema where his younger sister had been admitted. He said all of his family members may have contracted the disease in that hospital.


He called on all and sundry to go to hospital and report whatever condition they feel. He said had he denied the existence of the virus or had feared going to the hospital, “I would have been dead by now, but because I rushed in quick, I was treated and I am well now,” he stated.
Musa Turay therefore call on the government and other humanitarian organization for educational assistant for him to enter college for a course which his late dad started the effort, I have no body to push me he cried.
Meanwhile, a nurse attached to the Kenema treatment center disclosed to this reporter that as at now, they are receiving Le 150, 000 as weekly allowance. She said that if this amount is increased to Le 250, 000 a week, “many nurses that are sitting on the fence will come to work” the nurse stated.
"

By Saffa Moriba
Monday August 11, 2014

http://awoko.org/2014/08/11/sierra-leone-news-survivor-explains-ebola-experience/

Ebola: The impact on daily life...

Ebola. It comes up in every conversation in Freetown and is undoubtedly the number one topic these days. There is obviously more going on in Sierra Leone than Ebola but still it dominates our conversations. It now dominates our lives. That is because Ebola is seen as a threat to the country. Ebola has been confirmed in all but one district in Sierra Leone. There are now 757 confirmed cases, of which 22 are in Western Area (Freetown). It is no surprise that daily life in Freetown now revolves around the Ebola outbreak. 

There are posters in the streets displaying symptoms of Ebola and instructing people when to go to a health facility. There are buckets with chlorinated water outside of every restaurant, supermarket, shop, government building, bank and health facility in Freetown. People no longer shake hands or hug. People greet each other by knocking elbows or with a quick nod. There are vehicles with loud speakers driving around town sharing Ebola messages. Radio stations are talking about Ebola non-stop. SLBC hosts talk shows that revolve around Ebola and shows documentaries about the outbreaks in Zaire. NGOs have re-programmed and their work now revolves around Ebola prevention, contact tracing and management. You can't go anywhere in Freetown without realizing that Ebola is real.

Of course this is good: it increases sensitization, hopefully encourages early presentation to health facilities and keeps people up to date on the current situation. Of course, there are also many aspects of the outbreak that have negatively impacted life in Freetown. These are the hardships that people will need to endure during this fight. Most of the hardships are due to measures enforced by government to try to reduce transmission of the disease. All of these measures, have their consequences...

Schools were stopped early, summer schools have been cancelled and it is unclear if children can start school again in September. The Basic Education Certificate Examinations (BECE) have been postponed indefinitely. CDC travel advice alerts and airlines suspending flights led to a mass exodus of expatriates. This in turn means that hotels and restaurants are struggling to maintain business in Freetown. The President ordered for nightclubs and cinema halls to shut down which has led to a much quieter night life in the city and a loss if income for people running those facilities. Prices are going up for both food and non-food items as people stock up in case the government announces a 'lock down' in the city. Many people spend their time at home. Public transport has been affected as okadas (public motorcycles) are not allowed to ride after 7pm at night and many taxi drivers have stopped running their services due to the fear of catching Ebola. 

For the health care sector it is an understatement to say that the impact is great. Not only have we lost exceptional doctors and nurses in the outbreak, but the system itself has suffered greatly. Some hospitals have been left virtually empty due to a combination of health care staff and patients being too afraid to go to the facility. This inevitably means that patients end up staying at home, attempting to self-treat and hope they get better. Some will, other won't. It is no doubt we will see an increase in deaths in the communities due to other illnesses. Some facilities are still functioning however, and their staff continue to provide the services needed. In some facilities the outbreak has led to increased infection control measures, an important aspect of care that has not received enough attention but in many, this is still lacking.

Honestly, it's hard to remember right now what daily life in Freetown was like before the outbreak. Obviously for many people it has always been a struggle. Most people live from day to day. Now the hardships are even greater. I am praying that someday soon life will get better in Freetown, and Sierra Leone as a whole. And my prayer is that my Sierra Leonean friends and colleagues will be filled with grace, peace, protection and endurance as they continue this fight.