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 25th, a bank employee of the Sierra
Leone Commercial Bank became the 41st 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
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