Plastic gloves on the streets of Freetown

On the streets of Freetown... plastic gloves are selling for Le2,000 a pair... Quite steep when you consider a "cookery" plate of rice and plassas (cassava leaf, potato leaf or ground nut stew) costs Le5,000. I took these photos on July 31st, the day after President Koroma announced a national state of emergency over the Ebola crisis.

 One shop was also encouraging passers-by to dip their hands in the chlorinated water...

My friends at RIM Investment where I buy my phone top-up. They're worried about transmission of Ebola from the paper money.

 Selling chlorine tablets and plastic gloves on Siaka Stevens Street in downtown Freetown.

 Gloves for sale... And, I should add that this woman, Fatmata, was doing a booming business.

 Martha sells cold water in plastic bags... and was worried about greeting people and handling money.

These two guys stepped out of a government office and immediately donned their gloves... telling me "it's better to be safe than sorry".

You can’t keep an okada down…

For those who haven’t read several of my previous blog posts… an “okada” is a public, motorcycle “taxi” driven by a young, male (I’ve only seen one woman) driver… who picks up passengers to hurry them to work, to market, to home, to court, to visit girlfriends/boyfriends, to hospitals, to funerals, to family and sometimes to the police station. Okadas can weave between traffic… between lanes (down the centre of roads between traffic, usually) across walkways, up trails and down pathways. They go where no car, truck or bus would ever dream to venture.

The 125cc motorbikes are made by an Indian company, TVS or Baja, and have an extended seat for passengers, goats, bags of rice, car tires, wardrobes, baskets of fish, bags of charcoal, pregnant women, children… Yes, almost anything and everything goes atop an okada. They are strong, sturdy, reliable, rugged and reasonably priced. The average motorbike costs about Le 6,000,000 or roughly $1,300. Second-hand parts are plentiful and almost every street corner sports a mechanic or two who can install gaskets, fix brakes, repair flat tires, change lightbulbs, etc.

In my opinion, okadas are an essential and integral part of the transport system here in Sierra Leone. Okadas are everywhere… the capital city, Freetown, provincial towns, border towns, villages, up the hills and across the nation.

The guys who ride, most anyway, are decent sorts… trying to earn a little money to pay school fees for their children, put themselves through college, pay medical bills for ailing family members or just put food in the pot. And most of these riders can’t find decent jobs that would take them off their bikes. Some are illiterate. Some only speak native languages. Some are former combatants. Some are college graduates. Some are orphans. Some are former convicts.

Some riders carry driver’s licenses. Some of the bikes are insured. Some of the okadas are properly registered… but many are not. Part of the problem with illegal okadas is the cost to license and register a commercial motorbike with the SL Road Transport Authority. According to a rider-friend, it cost him almost Le 800,000 ($175 or so) to register his commercial bike. He told me, “I’d rather just pay the police to let me off because that’s only Le 10,000/day.”

To ride an okada in Freetown is not easy, as they say here. I’ve asked around and learned a little about the economy of being an okada rider. First, they have to rent the bike from a “master”. Most okada guys don’t own their own bike. It costs anywhere from Le 40–50,000 (around $10) per day to rent a bike. Then there’s fuel… about 10 litres (enough for a day) costs Le 45,000. Police bribes cost between Le 10–20,000 per day… to avoid being arrested. If stopped/arrested by the police (if the officer is having a bad day) it’ll cost the rider up to Le 50,000 to get his bike back. If they are “charged to court” a rider faces a Le 150,000 ticket… and probably a year in jail (a hell I’m thankful to avoid). An average rider can make (depending on the weather) around Le 60–80,000 a day. Now, take away expenses… and these guys are barely scraping together Le 20,000 a day (under $5/day).

Now… getting to the point of this diatribe.

About a year ago, the government of Sierra Leone (GOSL) tried to stop the okadas from using some of the streets in the centre of Freetown. They said the okadas were “lawless and indecent”… dangerous and useless. The GOSL quoted non-existent accident reports… non-existent medical evidence, non-existent police files, etc. in their public relations campaign.

The GOSL definitely get an “A” for effort… And, as they say around here, “they tried”. To give the government of Sierra Leone credit, they tried almost everything… extra police, newly recruited “azonto” police, beatings, random arrests, sporadic checks of paperwork, Operation W.I.D. (I can’t recall what that even stood for), Presidential task forces, road monitors, bike rider union task forces, “spike rods” (long pieces of wood with nails driven through to flatten tires) … and even SL Road Transport Wardens. But, nothing worked… and okadas are still plying the streets.

The GOSL spent untold hundreds of thousands of dollars… billions of Leones… trying to enforce a law that doesn’t exist (limiting vehicles from certain roads). The GOSL instituted “operations” without any legal basis. The GOSL violated the human rights of hundreds of young men. The GOSL broke their own laws. The GOSL violated the Constitution (only police have the right to enforce the law). The GOSL divided the bike riders union by choosing some members to be “enforcers” over their brother riders. The GOSL sold licenses and registrations to commercial bike riders and then told them NOT to ride on certain streets in town.

It was a big mess for a while there… and the streets became even more dangerous as “illegal” okadas twisted and turned to avoid being caught by authorities. Of course, the minute the police left their post (around 7 p.m.)… or turned their back, okadas were swarming the streets again. Okadas would speed through police checks. Okadas would jump sidewalks to avoid being captured. And, it became a game for the okada riders… signaling to each other where to avoid and where to zip along. I remember watching an okada rider out-maneuver several police officers and I thought to myself… this is a scene from a “keystone kop” comedy.

It would be hilarious if it weren’t so serious… and dangerous.

So, after spending all that money and effort, the okadas are still plying the roads in downtown Freetown… And I, along with my okada brothers, will continue to zip along the roads on my privately licensed, insured and registered, red motorbike… wearing my helmet and my boots, of course. I have a good friend who calls me the "oCadaidian"... Funny stuff. 

This is from a WHO info sheet... on Ebola

The evolution of the Ebola virus disease outbreak in Guinea, Sierra Leone and Liberia remains a serious concern as primary and secondary viral transmissions continue to occur in both urban and rural communities. Analyses of the current trend and the potential risk factors for the continuing spread of this epidemic have been conducted. The major factors responsible for continuous propagation of EVD outbreak in the sub-region include:

1. Some negative cultural practices and traditional beliefs, resulting into mistrust, apprehension and resistance to adopt recommended public health preventive measures. The implication of this include poor health care seeking behaviour such as hiding of EVD patients, home-based management of EVD patients, and customary treatment of dead bodies. These are very high risk practices leading to extensive exposures to Ebola virus in the community. Consequently, community deaths continue to be reported. In addition, the potential contacts to the EVD patients managed at home and exposures during customary burial procedures are not systematically identified and put under observation (very critical measures for containment of community transmission of Ebola virus). This is therefore a major factor amplifying the outbreak.

2. The extensive movement of people within and across borders has facilitated rapid spread of the infection across and within the three countries. The homogeneous community living along the border areas have common socio-cultural activities that enhance viral transmission e.g. visiting sick relatives or attending to burial ceremonies of relatives across the border. In addition, the cross border movement has complicated tracking and follow up of contacts, with several contacts loss to follow up.

3. Currently, the coverage of effective outbreak containment measures is not comprehensive. The unprecedented geographical expanse of the EVD outbreak in the three countries requires enormous and robust response capacity and structures in terms of human capital, financial, operational and logistics requirements. This is the first major EVD outbreak in West Africa and the affected countries had weak capacity and structures for epidemic preparedness and response, particularly for viral haemorrhagic fever. Lastly, the apprehension of some communities limits access to affected population with effective outbreak control measures.

More numbers on Ebola... different again!

More numbers... See how unreliable numbers can be? These numbers are from the WHO website...

As of 2 July 2014, the cumulative number of cases attributed to EVD in the three countries stands at 779, including 481 deaths. The distribution and classification of the cases are as follows: Guinea, 412 cases (292 confirmed, 100 probable, and 20 suspected) and 305 deaths (194 confirmed, 94 probable, and 17 suspected); Liberia, 115 cases (54 confirmed, 24 probable, and 37 suspected) and 75 deaths (38 confirmed, 22 probable, and 15 suspected); and...

Sierra Leone, 252 cases (211 confirmed, 35 probable, and 6 suspected) and 101 deaths (67 confirmed, 29 probable, and 5 suspected).

Contrast these numbers with the Ministry of Health in Sierra Leone... 

On Friday, July 4rth, the Ministry of Health and Sanitation in Sierra Leone released these figures…

-       504 cases/samples have been tested.

-       254 cases/samples have been confirmed as Ebola

-       73 deaths in medical facilities have been confirmed with Ebola

-       92 people are being treated in medical facilities for Ebola

-       32 people have been treated and released from medical facilities

      Nope, I don't understand it either... 

High level WHO meetings…

In an effort to interrupt further spread of this virus in the shortest possible time, the World Health Organization convened an Emergency Ministerial meeting in Accra, Ghana from 2-3 July 2014 involving eleven (11) countries mostly from West Africa and a number of key international partners involved in the Ebola outbreak response. The aim of the meeting was to discuss how to contain the disease, share experiences and agree on a strategy for an accelerated operational response to bring an end to the outbreak.

Accra, 03 July 2014 – The Emergency Ministerial meeting on Ebola Virus Disease (EVD) has ended today with Health Ministers agreeing on a range of priority actions to end the Ebola outbreak in West Africa. The scale of the ongoing outbreak is unprecedented with reports of over 750 cases and 445 deaths in Guinea, Sierra Leone and Liberia since March 2014.

In a Communiqué issued at the end of the two-day meeting, the Ministers agreed that the current situation poses a serious threat to all countries in the region and beyond and called for immediate action. They expressed concern on the adverse social and economic impact of the outbreak and stressed the need for coordinated actions by all stakeholders, national leadership, enhanced cross-border collaboration and community participation in the response.

In spite of the ongoing efforts to tackle the outbreak, there was consensus that a number of gaps and challenges remain. These relate to coordination of the outbreak, financing, communication, cross border collaboration, logistics, case management, infection control, surveillance, contact tracing, community participation and research.

The Ministers adopted a common inter-country strategy, which highlights the following key priority actions for the affected countries:

·       Convene national inter-sectoral meetings involving key government ministries, national technical committees and other stakeholders to map out a plan for immediate implementation of the strategy.

·       Mobilise community, religious, political leaders to improve awareness, and the understanding of the disease

·       Strengthen surveillance, case finding reporting and contact tracing

·       Deploy additional national human resources with the relevant qualifications to key hot spots.

·       Identify and commit additional domestic financial resources

·       Organise cross-border consultations to facilitate exchange of information

·       Work and share experiences with countries that have previously managed Ebola outbreaks in the spirit of south-south cooperation

The delegates also urged partners to continue providing technical and financial support and work with WHO to effectively coordinate the response. In an effort to promote regional leadership, and highlight the seriousness of the outbreak, the delegates strongly recommended that the forthcoming Economic Community of West African States (ECOWAS) Heads of States summit addresses the issue of EVD outbreak.

The current Ebola outbreak has surpassed all other outbreaks in terms of cases, deaths and geographic spread across Guinea, Liberia and Sierra Leone.

What people are saying... about Ebola

I’ve culled this info from a series of interviews published online…

“Cynicism toward government has a long and justified history in West Africa — Liberia consistently receives poor marks for its record battling corruption, and Guinea recently cancelled an iron mining contract worth billions of dollars after watchdog groups uncovered evidence of massive bribery. Sierra Leone is rife with corruption at all levels. “People's thinking is that the whole situation is being made up by the government to get money from the international community,” says Daniel Krakue, a Liberian community rights advocate.

“When villagers notice a relative or friend becoming sick, the person is hidden away rather than taken to containment facilities, which are viewed as de facto morgues.”

There's often extreme reluctance among those who contract the illness to reach out for help when they become sick. Those tasked with coordinating the medical response to the outbreak say that they are encountering fear and even violent hostility when they try to help. “We are being met with high resistance — sometimes people say that health workers are bringing Ebola into communities,” says Liberia's Assistant Minister of Health Tolbert Nyenswah. He describes a recent situation in which Liberian health officials had to beat a hasty retreat after people they suspected of hiding ill family members threw stones at them.

According to Nyenswah, rural belief in juju — West African magic — is also contributing to the challenges officials face. “Some people believe there is a curse that is causing the problem, and that there is nothing called Ebola.”

Krakue agrees. “People don’t know what the sickness is, and they prefer to go to the traditional healers," he says. "They feel that they have been bewitched.”

As the disease spreads and the death toll increases, officials are becoming more concerned that the outbreak could last for months. Frustrated with people hiding sick relatives, Liberian President Ellen Johnson-Sirleaf this week said that those who know of suspected Ebola cases and who fail to notify authorities could face legal prosecution. Nyenswah believes such measures are necessary to combat Ebola and prevent deaths, but others think they could heighten the stigma and cause sick people to go further into hiding. Regardless, one thing is certain — an outbreak that was once thought to be relatively under control has proven to be nearly impossible to contain.