I can't say enough good things about MSF in Kailahun...

Images from MSF compound in Kailahun.

 Clean and neat compound.

  Meal time.

 Hand washed scrubs.

Big Guns Visit Sierra Leone... and more

Stephen Douglas

Wednesday, August 27, 2014

In the sweltering, crowded room in Block B of the WHO compound off King Harmon Road in Freetown, Dr. David Nabarro, Ebola Response Coordinator of the United Nations, stated that this is “a war on Ebola… and the UN is mustering it’s considerable forces”. Dr. Nabarro was speaking to a group of journalists in Freetown on Monday. He was accompanied by the new WHO Country Representative, Dr. Daniel Kertesz, Dr. Keiji Fukuda, WHO Assistant Director General and David MacLachan-Karr, UN Resident Coordinator in Sierra Leone.

As the rain pelted the tin awning outside, the new WHO Country Representative introduced himself. Before the local press, Dr. Daniel Kertesz, who’s Canadian and been working in Africa for years, described how he’ll be taking over from Dr. Jacob Mufunda. I’d met Dr. Kertesz the previous day and welcomed him, as a fellow countryman, to Sierra Leone. Of course, we initially debated the great Canadian dilemma, Gretzky vs. Howe, and settled into a quick discussion about the health crisis in Sierra Leone.

On Tuesday, the WHO evacuated a Senegalese epidemiologist who’d been working in Kailahun and become infected with the Ebola virus disease. The WHO has launched an investigation into how the doctor contracted the disease and have moved their staff into the Kenema area. Among the group moved to Kenema are three Canadian scientists. According to Canada’s public health agency, these Canadians will soon be pulled out of Sierra Leone.

The Doctors Without Borders (MSF) Ebola treatment centre in Kailahun was literally carved out of the jungle. It sits atop a small rise about 5 km outside the small town of Kailahun and is surrounded by dense, green, rolling countryside. To get to the centre, you have to travel along a muddy, rutted road that often disappears under the flooding waters of heavy rains. The gleaming white tents and blue tarpaulins of the centre pop out of the green vegetation. It’s a long drive from Freetown and the final stretch of road into Kailahun is a dangerous, muddy trek over bumpy roads and through small streams.

The MSF compound is a complex, intricate network of fenced paths leading to and from a series of designated tents. The gravel courtyard that separates patients from doctors and nurses is as immaculate as one can expect in a jungle. The atmosphere is organized, structured, meticulous and cautious. It’s a far cry from the environment at the Kenema Government Hospital 4 hours to the west.

On Sunday, the day after their arrival, this very high level delegation of United Nations and the World Health Organization officials took a tour of a local hospital. Connaught Hospital, in the central and oldest part of Freetown, is not known for its hygiene or level of healthcare. But, it is popular because of its location and proximity to the morgue and nursing college. On Sunday, only the paediatric ward housed any patients. The broken-down beds in other wards were eerily empty.

As Dr. Kertesz, Dr. Nabarro, David MacLachan-Karr and Dr. Fukuda, crowded into the front entrance, nurses in starched, white uniforms clustered along the moldy, poster-plastered walls. The nurses explained that they don’t have medical equipment, training or personal protective equipment (PPEs), and many of the nurses are afraid to come to work for fear of contracting the Ebola virus. Patients are also afraid.

There’s a frantic feel to the vibe in downtown Freetown. It’s a frenetic, Ebola disease fanaticism that’s taken over especially now that there are over 40 confirmed cases of Ebola disease within city limits. All talk is of Ebola from street corner to office block… from cookery shops to bank queues.

On Monday the 25^th, a bank employee of the Sierra Leone Commercial Bank became the 41^st confirmed case of Ebola in the city. She’d attended her mother’s funeral several days before and probably contracted the disease during the funeral and burial rites. Word quickly spread and ramped-up the paranoia. The Commercial Bank was closed and there was a rush of rumours about banks withholding money, running out of money and closing for good. Unfortunately, the rumours were partly true and partly nonsense.

The relatively regal façade of the Commercial Bank sits opposite the colonial law courts building. Both buildings are grand and majestic in their own way. Steel bar gates now block the entrance to the Commercial Bank and Siaka Stevens Street, normally bustling with beggars, street sellers and bank customers, is strangely clear. Even the disabled guy, Alimamy, who sells pens from his wooden cart, is not at his regular post.

Two weeks ago, the Association of Bankers decided they’d reduce banking hours from 7 hours to 4 hours a day. This, they said, was “to reduce the congestion in banking halls and prevent the transmission of the disease”. According to the public notice put out by the Sierra Leonean bankers, all customers will be required to wash their hands in chlorine and water, have their temperature taken and wait outside before entering the banks. After my experience today, I’m more convinced that the banks didn’t think this one through.

Outside the Ecobank on Tuesday, where overhead awnings have been temporarily installed to ward off the seasonal rains, waiting bank customers were furious. The street hawker’s din was overwhelmed by angry shouting. More than 75 people were crowded together, held momentarily in place by an armed, fatigue-wearing guard of the Criminal Investigation Division of the Sierra Leone Police. And in Freetown, where there’s shouting and jostling, a crowd of onlookers quickly forms.

The arrival of a large, blue police vehicle bristling with machine guns soon quieted the surging crowd. The diminutive bank official, in her plastic gloves, looked relieved. There was an occasional outburst of protest as one of Sierra Leone’s “big men” strolled to the bank’s doors and entered… without washing his hands but for the next three hours the crowd remained relatively calm and we sweated together under the mid-day heat. My temperature as I entered the bank was 36.4 degrees and after failing to retrieve my US currency, (“dollars don don”, which means the bank had no US currency in their tills) my temperature was 33.5 degrees. I’m not sure where or how I managed to lose body heat but the official temperature taker/forehead laser-reading woman, looked nonplussed.

Knowing your body temperature is now the Freetown fashion fad. I’ve had my temperature taken more times over these past three weeks than at any other time in my life. At almost every roadblock checkpoint, drivers and passengers are required to wash their hands and get their temperature taken before proceeding. At the Tondola checkpoint, outside of Kenema on my way back to Freetown, my temperature was 35.6. At the Bandema checkpoint, about 100 kms from Tondola, my temperature was 36.9. Yesterday, at the UNICEF compound on Jumo Kenyatta Road, my temperature was 33.4 degrees. When I queried the guard about the accuracy of the “point and click” temperature taker, he said, “don’t worry, we only tell you to go to the hospital if the ‘gun’ makes a beeping noise.”

Mary Alberta Camara, (25) like many Sierra Leoneans, would normally go to a hospital or medical clinic if she had malaria. The usual treatment is an IV drip of saline and vitamins, a dose of Lokmol or Malfan, anti-malarial medications, antibiotics, vitamin/blood tonic and an anti-worm medication. That is, if one can afford it. Government hospitals charge 60,000 Leones (it’s supposed to be free but doctors often require a “consultation fee”) for a malaria visit/check-up and pharmacists charge around 80,000-100,000 Leones for medication. Mary Alberta usually recovers quickly after spending approximately $40.00. Mary Alberta recently had malaria and she was afraid to go to the hospital. “What if they mistake malaria for Ebola and send me to Kenema,” (about a seven hour drive from Freetown). “What if they test me for Ebola and I have it? What if someone else at the hospital has Ebola and I might catch it from them?” All reasonable assumptions given the current healthcare hysteria in the country. So people stay away… pregnant women, ailing elderly, parents with small children, diabetics and even Ebola patients. 

Malaria, which happens more frequently than a good meal for most, is a serious illness. And malaria shares similar symptoms with the Ebola virus disease. Malaria usually starts with a headache with body/joint pain and fever. So does Ebola. Malaria usually progresses to diarrhea and often vomiting. So does Ebola. Ebola is contagious and infectious. Malaria is not. Malaria treatment pills are abundantly available from corner pharmacies. There is no approved medicine for Ebola.

The fear of Ebola has become an international phenomenon. It was the top story for a while on CNN, Fox, Sky, etc. And thanks, in part, to this media frenzy, many countries now sport travel advisories suggesting, “essential travel only” to the countries affected. Airlines, including regional flights and many international flights have been canceled in or out of Freetown, Guinea and Liberia. On Tuesday, the UN and WHO issued a strong statement urging these airlines, including British Airways who have canceled flights till the end of the year, to continue flying into and over this region. “The United Nations… cautioned against flight restrictions into and out of Ebola-affected countries in West Africa, saying such limitations were preventing the transport of critically-needed health workers and supplies, as well as contributing to economic and diplomatic isolation of the region.”

“This is no time to isolate West Africa from the rest of the world,” said Dr. Keiji Fududa of the WHO. “This region is in need and disease knows no borders.”

SIERRA LEONE - AVOID NON-ESSENTIAL TRAVEL

Foreign Affairs, Trade and Development Canada advises against non-essential travel to Sierra Leone due to the Ebola outbreak and its impacts on mobility and access to quality health care. There is no Government of Canada office in Sierra Leone. As such, our ability to provide consular assistance is extremely limited. If you are in Sierra Leone and your presence is not essential, you should consider leaving by commercial means, as it is becoming increasingly difficult to do so

- 30 -

An excellent article... Toronto Star

Jennifer Yang came to Sierra Leone from Toronto... on assignment for the Toronto Star. She brought smiles and a much-needed care package from my Mom. Whew... what a relief to have new underclothes and Cdn pens, etc.

Jennifer wrote an excellent article... found here.

http://www.thestar.com/news/world/2014/08/13/in_sierra_leone_an_exhausting_struggle_to_contain_ebola.html

She's gone back to Toronto now... Is probably over the Atlantic as I type. I hope she spreads the news... and continues to help the people here through her writing.

Thank you, Jennifer...
S/

From the Globe and Mail - Canada's national newspaper

Courage, death and survival: On the front lines of the Ebola outbreak

STEPHEN DOUGLAS

KENEMA, SIERRA LEONE — Special to The Globe and Mail

Published Friday, Aug. 08 2014, 7:14 PM EDT

Last updated Friday, Aug. 08 2014, 7:15 PM EDT

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The man everyone calls “Shawarma” looks tired and weak sitting in his rickety wheelchair. I’m immediately worried as I enter the Ebola Treatment Center at the Kenema Government Hospital. Shawarma, in his early 30s, is an Egyptian national who was transported to the center from eastern Freetown after being discovered in a private “mushroom” health clinic – one that popped up outside the network of licensed clinics. He tested positive and spent two months in isolation. Shawarma’s hair is uncombed and he hasn’t shaved, for risk of nicking himself, in two months. Beside Shawarma is Mustapha, a very lean looking man in a tight blue T-shirt. He too was in isolation for the past six weeks. Mariama wears a head tie and looks dazed and confused. Fatmata, standing off to the side, is young but her gaunt cheeks and hollowed eyes tell a different story. Today these four are being discharged from the Ebola Treatment Centre. They have survived the virus and can now return to their homes.

People walk by a billboard in Freetown, Sierra Leone. (AP Photo/ Michael Duff)

Two days earlier two nurses passed away in the same clinic, Josephine, the hospital matron, tells me. My friend, Hawa Rebecca, was one. When I tell Josephine that Rebecca was a friend of mine, we exchange condolences and Josephine tells me what a fine nurse and friend Rebecca was to her. More than 20 nurses and healthcare workers including Sierra Leone’s top virologist who was leading the Ebola effort, the Dr. Sheik Umar Khan, have died from contact with the Ebola virus.

Josephine moves from the sadness of death to the joy of discharge very quickly as she introduces me to the survivors. “We have very bad days here and today we’re celebrating a good day,” she says as she gathers the nurses and doctors around her. We’re standing in the entrance way to the clinic, behind the white plastic walls that separate the triage area and the isolation unit, and as we talk more and more people in scrubs and gloves join the group. We all stand apart and no one touches anyone. Josephine makes a compelling speech full of motivation and praise for “the team” and wishes the four survivors well. “You are well now but you still need to heal,” she says, and the staff applaud. But I’m struck by the thought that these survivors have to go home, continue to get well, deal with the negative stigma of being an Ebola patient and also mourn the loss of members of their families who didn’t survive.

There’s a short lull in the proceedings as nurses adjust their goggles and wander back to their stations and doctors turn to each other to discuss specific patients. I’m pulling at my plastic hood and trying to get some air down the front of my slippery overalls. It’s hot standing under the sun and it’s very hot under my plastic coverings. My feet ache in the rubber boots that are two sizes too small. My shirt, under the gown, is soaked in sweat and my goggles have fogged up. I’m thankful for an auto-focus lens on my camera.

Following the brief ceremony and posing for pictures, each survivor is called into the office to receive a small allowance of 60,000 Leones (approximately $13 U.S.) and a letter stating they are now healthy. The letter, on A4 paper, is signed by a doctor. It carries an official hospital stamp and has the date in the top right-hand corner. Two of the former patients have to ink their thumbs and provide a thumbprint in a large ledger to acknowledge receipt of the money because they can’t read. I’m not sure what they’ll do with their letters.

Scrub with chlorine, and scrub again

Nurses at Kenema Hospital are sprayed down before being ungowned. (Stephen Douglas for The Globe and Mail)

The security personnel, just inside the metal gates are from a private agency. As I leave, behind the former patients, I greet the older guard with, “Ya Pa. Ow de bodi?” – without shaking hands but with a slight bow. He responds with a smile and ushers me forward. Most of the new “white folk” don’t speak Krio so he was a little flummoxed by my salutation.

On my way out, I pass by the triage area again, a white plastic tarpaulin tent with the logo of Médecins Sans Frontières (Doctors Without Borders) pasted on the side. I’m told to wash my hands, again, in a chlorine mixture by a nurse dressed in full protective gear. She wore her plastic goggles, mask, two pairs of gloves, full body covering and rubber boots proudly. She watched me, from a safe distance, wash my hands and then instructed me to pull each finger from base to tip. She then proceeded to give me a detailed lesson in hand washing making sure I scrubbed my thumbs and fingernails. Upon inspection, she then said my fingernails were a bit long and I should cut them down to help prevent the spread of any disease. “One millimetre, only!” she instructed.

Lockdown ordered, emergency teams move in

The Kenema Government Hospital and Ebola Treatment Center is on a main thoroughfare in Kenema but still well within the town’s limits. There’s a police post opposite one of the two entrance gates where constables in blue coveralls lounge and chat with passersby. There’s a booth selling T-shirts next to the gate and a collection of motorcycle taxis, called okadas, parked to the other side. Behind the okadas is a shop selling plates of rice and sauce for 5,000 Leones. Other street traders have abandoned their stalls, thrown-together affairs of scrap wood and tarps and bits of corrugated metal. Business is slow for those who’ve stayed.

On Thursday, President Ernest Bai Koroma, addressed the nation over radio and television. In Kenema, there are few people with TVs so residents gathered around battery-operated radios. I stood listening with a group of people, all standing at least a meter apart from one another in front of a ramshackle stall selling flashlights and batteries. The President had already declared a state of emergency. Now all bars, cinemas, video parlours and nightclubs were told to stop their activities. All “mushroom” and private health clinics must stop their operations. The Sierra Leone Police will organize regular patrols to prevent illegal activities including unauthorized movement of Ebola-infected persons. Non-essential travel will be restricted between the Ebola epicentres of Kenema and Kailahun and the rest of the country. People seemed bewildered, not sure what all these measures will really mean for them.

Admittedly, Sierra Leone got a slow start on preventing the spread of the disease even though the outbreak was ravaging neighbouring Guinea. But forces are now mobilized here and “all hands are on deck,” according to government spokespersons. The President chairs a task force and the WHO has set up an emergency operations centre. Since the “stay-at-home” day last Monday, there’s been a flurry of activity around the country.

Health workers carry the body of an Ebola victim to the Kenema Hospital morgue. (Tommy Trenchard/The New York Times)

Here in Kenema, Red Cross doctors and nurses have converged from Spain, Australia, Scotland, Norway and Sweden. They are a very impressive group and are now being oriented and trained by WHO and MSF field staff. I meet the Red Cross team every morning for breakfast at the place I’m staying, the National Pastoral, Social and Development Centre, run by the Diocese of Kenema under the Catholic Mission. We break bread and share fresh eggs from the poultry farm nearby with Father Paddy and a Sierra Leonean seminarian named Augustine. Fr. Paddy is an Irish priest in his 60s and has been in Sierra Leone for years. His relaxed attitude and welcoming hospitality are reassuring to the team. Aunty Mariama, who’s worked at the Pastoral Centre for 21 years, is everyone’s mother and beams as she carefully sets out the plates, cutlery and hand sanitizers for the team.

The emergency response unit of the International Federation of Red Cross and Red Crescent Societies has brought a ton of experience and know-how to help the government of Sierra Leone fight the disease outbreak. They’ve also brought much-needed equipment and will be setting up a 60-bed hospital 40 kilometres outside of Kenema in the middle of a deserted area near the small village of Hangha. The logistical requirements are huge and costly but not overwhelming. The ERU team is a well-oiled machine and I’m amazed at what they’re able to accomplish in such a short period of time, especially in this place where it’s “not easy,” as so many people say.

Suspicion of a foreign “miracle cure”

As I approached Binta’s cookery shop located in a newly constructed and basically empty plaza that also hosts a private bus company, I overhear a conversation about a miracle cure from the U.S. The rumour mill is a powerful and pervasive source of community and international news. Word-of-mouth spreads gossip and rumour faster than any disease will ever spread. My lunch of groundnut stew, fish and rice is interrupted by a fierce argument from the adjoining table. Two middle-aged men are thrashing out the ethical dilemma of using experimental drugs on Sierra Leoneans. One man, bald and shining with perspiration, states that if he were sick or his family were sick, he’d choose to be a test subject. The other, a greying man with what they call a “government belly” is fiercely against such experimentation.

Word-of-mouth spreads gossip and rumour faster than any disease will ever spread.

The drug in question is ZMapp, although I’m sure they don’t know its name, is an experimental serum that was recently used on two U.S. Ebola disease patients. The patients, one a missionary, are said to be recovering. And so the debate rages here on the front line of the Ebola crisis. Should the experimental serum be used here? Like so many other things, you’re almost damned if you do and damned if you don’t. As I listened to the debate and finish my plastic bag of water, I thought: If they somehow manage to get the drug here, some people will accuse the U.S. and medical world of experimenting on suffering Africans. And, if they don’t use the drug here some will say, “See? The Western world and those white people don’t care about us poor Africans.”

Strangers, uniforms and even nurses evoke fear

This strange “good and bad/no win” combination hit me again as I talked to Patrick, who’s a young guy working for the Kenema District Medical Office. He was helping at a community volunteer “sensitization training” supported by the International Rescue Committee. As we whispered outside the crowded meeting room, I asked how the new awareness-raising teams were going to work. Apparently, the IRC, supported by WHO through the District Health Office, were going to send teams of “sensitizers” into the community to preach the word of Ebola. The young people would receive a day of training and some posters and then be sent into all chiefdoms and neighbourhoods within the district. I asked how the “sensitizers” would be identified because there have been instances of violence when healthcare workers entered communities. Patrick said maybe they would get T-shirts.

Identifying those “sensitizers” – or being labelled a healthcare worker – is risky. Nurses are associated with the sick, and most people don’t want to be around anyone involved with Ebola. Many people have seen the transport teams as they retrieve sick people or dead bodies, and they seem frighteningly alien. Some communities want nothing to do with anyone in a uniform or matching shirts. But not identifying “sensitizers” or community awareness teams is also risky. And if the young sensitizers don’t wear identifying clothing, they’ll be shunned as newcomers, something else neighbourhoods are wary of. Once again, you’re damned if you do and damned if you don’t.

Preaching Jesus as the Ebola solution

Stephen Douglas for The Globe and Mail

There are other groups who aren’t afraid of being identified along the dirt track roads. These are the evangelists with loud speakers, matching T-shirts and hand-drawn signs. As I wove my way through one of the tightly packed markets, I heard the commotion. I also heard the booming voice of a young man telling people to pray – and that Jesus was the answer to Ebola. All around me the market women, fish sellers and small children would shout, “Amen” in unison whenever the strolling pastor bellowed out: “In Jesus’s name.” The Kenema Council of Pentecostal Churches came rallying through town parading around an SUV that had “No new Ebola infections – in Jesus’s name” printed on the side of the vehicle. Followers were enthusiastic and the market sellers had something to gawk at for a few minutes.

I climbed behind Amadu on his okada motorcycle taxi, careful to avoid any skin contact, and sped away. Amadu is a former child soldier and now rides a motorbike to make ends meet. He turned to me and said, “Crazy Christians” and we shared a good laugh.

A child’s smile, and enduring hope

Amadu dropped me along a rutted and pot-holed dirt road so I could look for the Kamara compound. I was greeted by a swarm of children who’d obviously been told repeatedly not to touch anyone. Normally, I’m peppered by little hands and upturned smiles. On this visit, the children merely gathered around and I kept my hands to myself, which was a bit difficult given my propensity to grab, tickle or rub heads of anyone under a metre tall. I met Pa Kamara, who’s almost 80 but doesn’t know for sure, and his second wife, Mary. We sat under the overhanging branches of a mango tree and were discussing the rising price of food at the market since the quarantine began. A cup of rice, two months ago, was 750 Leones. The rice I bought for the family was 1,200 Leones per cup – and not because I was paying the “white man price.” I’m a shrewd negotiator and quick with “me sabi Salone money,” which means I understand the value of a Leone and can’t be tricked into paying exorbitantly inflated prices.

Mary turned abruptly and shouted in Mende, her tribal tongue, at a small child who’d climbed a small stump and was balanced against a dull yellow house. The little girl climbed down and disappeared behind the lean-to cooking shed. Mary told me that the girl shouldn’t touch the house. Medical personnel had sprayed the house down the day before. Someone in the house had died of Ebola earlier in the week. The house was deserted.

I visited the Kenema Hospital again and demonstrated my hand-washing technique to the triage nurses, who were suitably impressed. The MSF tent was empty, for a change, and nursing staff had lowered their hoods and taken off their goggles. They looked relieved to be bored. I had my shoes sprayed down and donned gloves avoiding the full gowning because I wasn’t going anywhere near the Ebola treatment side of the compound. I visited Josephine, the hospital matron, and handed a bundle of photographs to Joseph, the general secretary. These were the prints of the pictures I took during the discharge ceremony the previous day. After giving the survivors their photos, Joseph thought it would be good to post the remaining pictures on the treatment room notice board for all the nurses and doctors to see. “It will make them feel so good to see the success of their work,” Joseph said to Josephine. “And,,” Josephine added, “it will help give our patients some encouragement and hope.” Perhaps I should learn something from the parading Christians. There may be no cure for the Ebola virus disease but there’s always hope.

First piece for the Globe and Mail - Canada

The shop security guys, clad in plastic gloves, call out, “wash, wash”, outside the electronics shop on Siaka Stevens Street in central Freetown. They’re standing beside a bucket with a mixture of chlorine bleach and water encouraging passers-by to dip their hands in the mixture. Fatmata, who’s standing next to the shop, is selling plastic gloves and chlorine tablets from a small tray – 2,000 Leones per pair (about 50 cents). Business is brisk in front of the bucket and for Fatmata. Business is very slow inside the shop. I dipped my hands but passed on the gloves. Washing one’s hands is an important part of staying healthy, as we all know, and in this environment where Ebola dominates the news and almost every discussion, it’s even more important.

Sierra Leone is a friendly place where hand shaking and holding hands is part of the culture. Wherever I go, meetings, shops or street corners, I’m usually greeted with smiles and handshakes. I’ve had some of the most interesting conversations while walking hand-in-hand with my friend Sullivan. Now, under the umbrella of Ebola, most people are keeping their hands in their pockets or folded across their chests instead of reaching forward to greet friends and family. Nods and salutes have replaced the familiar, friendly, three-step, hand-grasp-thumb-lock-and-grip greeting.

A group of photographers, with whom I sometimes work, shares space along the sidewalk of Siaka Stevens Street with a group of women selling bananas, cold water in plastic bags and cheap costume jewelry. I bought a banana from Kadija, who fumbled with my change in her gloved hands. As we stood along the street, a green SUV topped with a loud speaker and decorated with about a dozen UNICEF-sponsored Ebola posters inches along in traffic. I hear a distorted, discordant, electronic tune… something about “Ebola ea dae” (Ebola is here). Then, there’s a recorded message in Krio, the lingua franca of Sierra Leone, which crackles and reverberates off the concrete Rokel Bank building. My Krio is decent but I had to ask Kadija what the message was saying. She looked nonplussed as she said, “the government says we shouldn’t touch anyone”. I smile as I suggest that it’s still totally fine for her to hug and hold her children, one of which was looped over her back in a lappa. This over-simplified government message is another example of misinformation being circulated about town. But, how do you convey the more accurate message “don’t touch sick or dead people”?

It’s rainy season here and as I huddle under a blue tarpaulin awning with a small group of “okada” riders (an okada is a small, public motorbike taxi) the conversation immediately turns to the Ebola crisis. I ride my own motorbike around town and so share an affinity with these professional taxi-riders. They tell me stories about witchcraft (juju), Ebola witch guns, crazy nurses injecting neighbours with Ebola, government conspiracies and other nonsensical rumours. Then, in unison, they tell me that we are all in the hands of God and that only God can save Sierra Leone. This is a deeply religious country of Muslims and Christians and many people believe prayer is the only hope against Ebola.

The President of the Republic of Sierra Leone, Ernest Bai Koroma, in his second address to the nation, declared Monday, August 4th as a national “stay-at-home” day for “reflection, education and prayer”. At daybreak, the streets were completely empty as, it seems, the entire country stayed at home. There were no taxis. There were no “poda podas” (converted mini-vans turned into public buses). Stray dogs lounged in the middle of usually busy intersections. Police and security forces strolled empty sidewalks… and all businesses, shops, offices and street markets were closed. The eerie quiet and unusual emptiness was a bit disconcerting. As I strolled through the Aberdeen neighbourhood in the west of Freetown, I noticed women braiding each other’s hair, cooking fires covered with big pots of boiling cassava leaf stew, young folks sweeping porches and older folks listening to radio broadcasts. There was a lot of sitting around… talking, discussing, watching and praying.

I was recently at the water taxi, which shuttles air travellers between the Lungi Airport and the shores of Freetown. I met a group of Latter Day Saints guys who’d come to Sierra Leone to do missionary work. Their white shirts gleamed and they’d gathered their luggage in anticipation of the boat ride across to the airport. I asked about their plans and they informed me that they were being “recalled” because of the Ebola crisis. Most of the young guys were from the U.S. and were leaving Sierra Leone along with the Peace Corps volunteers because of the perceived risks. I told Mark, the only one in a suit jacket, that I didn’t think the risk was overly great. I asked if they worked in hospitals. “No”. I asked if they touched sick or dead people. “No”. In my mind, their organization’s response to the situation here was overly dramatic and not entirely based on evidence.

People are afraid of the Ebola virus and rightfully so. But, I’m hoping factual and clear information can help allay some of this fear. Ebola is here and primarily affecting people who treat sick people, professional healthcare workers and close contacts. Healthy caution, awareness of the facts and a preventative mindset is in order. But, there’s no question it’s affecting many people’s lives. This is a close-knit country, for the most part. People went to school together, were from the same or close-by village, are related by marriage or politics. Everyone seems to know everyone else and undoubtedly will be touched by this disease in one way or another.

And, ebola has touched my life beyond the street conversations and dinner table debates. My friend, Hawa Rebecca, a nurse in Kenema, was recently tested for Ebola. She was positive. Two days ago she was “responding to treatment” in the Kenema Hospital. This morning, she died. She left behind three young children and countless other family members who relied on her small income. Ebola is here and it’s affecting us all.

People are very guarded...

From a Toronto Star article written by Jennifer Yang on July 31st.

In the capital Freetown — which is 400 km west of the outbreak epicentre in eastern Sierra Leone — the fear on the streets is now “palpable,” said Stephen Douglas, a Canadian media development professional who has lived in the country for five years.

“People are selling plastic gloves, rubber gloves, and there are buckets of chlorine set up on street corners,” he said. “It’s not panic yet . . . (but there is) more and more fear and people are very guarded.”

CDC warns travellers

The announcement was made last night... August 1, 2014. Travel warnings... from the CDC in the US. 

Updated: July 31, 2014

CDC urges all US residents to avoid nonessential travel to Sierra Leone, Guinea, and Liberiabecause of an unprecedented outbreak of Ebola.

What is the current situation?

An outbreak of Ebola has been ongoing in Sierra Leone since May 2014. This outbreak also affects Liberia and Guinea; to date more than 1320 cases have occurred in the three countries and more than 725 people have died, making this the largest outbreak of Ebola in history. At least three Americans have been infected; two are health care workers in an Ebola clinic. Affected districts in Sierra Leone include Bo, Bombali, Bonthe, Kailahun, Kambia, Kenema, Kono, Moyamba, Port Loko, Tonkolili, and Western Area, including the capital of Freetown. Instances of civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health infrastructure in Sierra Leone is being severely strained as the outbreak grows.

Sierra Leone’s government has recently instituted enhanced measures to combat the spread of Ebola, many of which will likely make travel to, from, and within the country difficult. The government has taken the following steps:

·       Instituted new protocols for arriving and departing passengers at Lungi International Airport.

·       Instituted restrictions on public and other mass gatherings.

·       Instituted quarantine measures for communities affected by Ebola; travel in and out of those communities will be restricted until a medical team clears them.

·       Authorized house-to-house searches to locate and quarantine Ebola patients and requires all deaths be reported before burial.

·       Authorized police and military personnel to aid in enforcing these and other prevention and control measures.

·       Requires local government officials to establish by-laws to support Ebola prevention efforts.

CDC recommends that US residents avoid nonessential travel to Sierra Leone. If you must travel, such as for humanitarian aid work in response to the outbreak, protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are ill with Ebola. For more information, visit Outbreak of Ebola in Guinea, Liberia, and Sierra Leone on the CDC Ebola website

This recommendation to avoid nonessential travel is intended to facilitate control of the outbreak and prevent continued spread in two ways: to protect US residents who may be planning travel to the affected areas and to enable the government of Sierra Leone to respond most effectively to contain this outbreak. CDC remains committed to the multinational effort to assist Sierra Leone in controlling the outbreak and is scaling up its response activities by, among other things, deploying additional staff to the affected countries. International humanitarian assistance must continue, and CDC encourages airlines to continue flights to and from the region to facilitate transport of teams and supplies essential to control the outbreak.

What is Ebola?

Ebola virus disease (also known as Ebola hemorrhagic fever) is a rare and deadly disease. The disease is native to several African countries and is caused by infection with one of the ebolaviruses (Ebola, Sudan, Bundibugyo, or Taï Forest virus). It is spread by direct contact with a sick person’s blood or body fluids. It is also spread by contact with contaminated objects or infected animals.

Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

Who is at risk?

Travelers could be infected if they come into contact with blood or body fluids from someone who is sick or has died from Ebola, sick wildlife, or meat from an infected animal. Health care providers caring for Ebola patients and family and friends in close contact with an ill person are at highest risk because they may come into contact with blood or body fluids.

What can travelers do to prevent Ebola?

There is no vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.

·       Avoid nonessential travel to Liberia, Guinea, and Sierra Leone.

·       If you must travel, please make sure to do the following:

o   Practice careful hygiene. Avoid contact with blood and body fluids. 

o   Do not handle items that may have come in contact with an infected person’s blood or body fluids.

o   Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.

o   Avoid contact with animals or with raw meat.

o   Avoid hospitals where Ebola patients are being treated. The US Embassy or consulate is often able to provide advice on facilities that are suitable for your needs. The US Embassy in Freetown can be reached at +(232) 76-515-000.

o   Seek medical care immediately if you develop fever, headache, achiness, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.

§  Limit your contact with other people when you travel to the doctor. Do not travel anywhere else.

o   Pay attention to your health after you return.

§  Monitor your health for 10 days if you were in an area with an Ebola outbreak but were not in contact with blood or body fluids, items that have come in contact with blood or body fluids, animals or raw meat, or hospitals where Ebola patients are being treated.

§  Monitor your health for 21 days if you think you might have been exposed to Ebola.

§  Seek medical care immediately if you develop fever, headache, achiness, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.

§  Tell the doctor about your recent travel and your symptoms before you go to the office or emergency room. Advance notice will help the doctor care for you and protect other people who may be in the office.

Special Recommendation for Health Care Workers

Health care workers who may be exposed to people with the disease should follow these steps:

·       Wear protective clothing, including masks, gloves, gowns, and eye protection.

·       Practice proper infection control and sterilization measures. For more information, see “Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting.”

·       Isolate Ebola patients from unprotected people.

·       Avoid direct contact with the bodies of people who have died from Ebola.

·       Notify health officials if you have been exposed to someone with Ebola.

Traveler Information

·       CDC Ebola factsheet

·       CDC Ebola website

·       People Working and Living Abroad

·       US Embassy Security Message: Update on Ebola Hemorrhagic Fever

·       Health Information for Travelers to Sierra Leone

Clinician Information

·       CDC Ebola website

·       Viral Hemorrhagic Fevers in CDC Health Information for International Travelers 2014—"Yellow Book"

·       Health Information for Travelers to Sierra Leone

Information for Airline Personnel

·       Ebola Guidance for Airlines