State of Emergency – Still?????

Yes, Sierra Leone is Ebola-free (having gone 42 days or two cycles of incubation periods without a case of Ebola). Yes, Liberia and Guinea have each clocked “42 days of being Ebola free”. Of course, Ebola was the big story/occurrence and crisis of 2014-2015 in West Africa. Whew… I’m glad to be finished… Or are we?

Sierra Leone is still technically under a “state of emergency” as declared by the President and Parliament back in 2014. This state of emergency was enacted during the Ebola crisis and remains in place… Hmmmm, one can ask, “why?” but there will be no answer.

From the Sierra Leone Constitution (now under review)

29. (1) Whenever in the opinion of the President a state of public emergency is imminent or has commenced, the President may, at any time, by Proclamation which shall be published in the Gazette, declare that—

a. a state of public emergency exists either in any part, or in the whole of Sierra Leone; or

b. a situation exists which, if it is allowed to continue, may lead to a state of public emergency in any part of or the whole of Sierra Leone.

29. (2) The President may issue a Proclamation of a state of public emergency only when—

a. Sierra Leone is at war;

b. Sierra Leone is in imminent danger of invasion or involvement in a state of war; or

c. there is actual breakdown of public order and public safety in the whole of Sierra Leone or any part thereof to such an extent as to require extraordinary measures to restore peace and security; or

d. there is a clear and present danger of an actual breakdown of public order and public safety in the whole of Sierra Leone or any part thereof requiring extraordinary measures to avert the same; or

e. there is an occurrence of imminent danger, or the occurrence of any disaster or natural calamity affecting the community or a section of the community in Sierra Leone; or

f. there is any other public danger which clearly constitutes a threat to the existence of Sierra Leone.

Ebola was a “calamity affecting the..”. Ebola was a “public danger … constitutes (ing) a threat to the existence of Sierra Leone”.

But, under Section 29 of the Constitution of Sierra Leone the government/President has far-reaching powers including:

i. the taking of possession or control on behalf of the Government of any property or undertaking;

ii. the acquisition on behalf of the Government of any property other than land;

c. authorise the entering and search of any premises;

d. amend any law, suspend the operation of any law, and apply any law with or without modification: Provided that such amendment, suspension or modification shall not apply to this Constitution:

e. provide for charging, in respect of the grant of issue of any license, permit, certificate or other document for the purpose of the regulations, such fees as may be prescribed by or under the regulations;

f. provide for payment of compensation and remuneration to persons affected by the regulations;

g. provide for the apprehension, trial and punishment of persons offending against the regulations;

h. provide for maintaining such supplies and services as are, in the opinion of the President, essential to the life and well-being of the community: Provided that nothing in this subsection shall authorise the making of regulations during a period of public emergency for the trial of persons who are not members of defence forces by military courts.

Ebola was a crisis… an emergency… a threat to the public order of Sierra Leone… therefore it was probably necessary to declare this state of public emergency – Section 29 of the Constitution. Liberia lifted their state of emergency long ago… Guinea, I’m not sure… but Sierra Leone???? Hmmmm, almost unlimited powers to the President… makes me a little worried. The President said Parliament was considering lifting the state of emergency at the official announcement of the end of Ebola on November 7^th. But, till today… we’re still under this “emergency umbrella”. Like so many things in Sierra Leone – it can’t be explained.

Bye-Bye Ebola - November 7, 2015

On Saturday, November 7, 2015, the World Health Organization declared the Ebola Virus Disease crisis OVER in Sierra Leone. We can say, “bye-bye Ebola”… The first confirmed case of Ebola was diagnosed in Sierra Leone on May 26^th 2014. After 18-months of living under the shadow of Ebola… the country is tired, relieved and elated.

The declaration, “Ebola-free”, was celebrated in many ways… One of the most memorable took place on Friday evening as groups of civil society organizations held a candlelit march along the main business street in Freetown. The march culminated under the giant, historic “cotton tree” in the centre of Freetown and, among other activities, a list of 221 names of healthcare workers who’d died was read before the hushed masses. Those same hushed masses later erupted in jubilation when an MC counted down the seconds to mark midnight – and the official “day of declaration” – November 7. (117) I’ll come back to the significance/coincidence of this pattern of numbers.

Amidst the crowd, there were nurses, survivors, NGO workers, military personnel, International aid workers, journalists, funders, kids, teens and adults… who all survived the Ebola crisis in one way or another. I should add… the theme colour for the procession was YELLOW, recognizing the Yellow Ribbon campaign to End Ebola that the Sierra Leone Association of Journalists initiated (and I was an integral part of) way back in February 2015. It was a sea of yellow ribbons/shirts, candles, tired tears and jubilant hoopla. And, I’ll admit, I felt tingles of excitement and a welling of tears several times during the march and presentations.

 The following morning, starting at 8:00 a.m., the more formal declaration was to be made. In the stately Bintumani Conference Hall, surrounded by women in yellow dresses, men in yellow shirts or yellow ties, and yellow ribbons/wristbands, the country’s leaders, diplomats, journalists, healthcare workers, survivors, burial teams, and politicians from the ruling party, gathered. The President sat alongside his appointed Vice and his First Lady at the head table. Paulo Conteh, the CEO of the Emergency Response Centre sat beside one of the Ministers of Health. The first Ebola survivor and the last Ebola patient/survivor sat at one end of the table. The head of UNMEER was there… and, of course, the WHO Country Director.

 In a surprisingly short statement, the WHO Country Director, Dr. Anders Nordstrom, congratulated the people of Sierra Leone, International partners, INGOs, funders, religious leaders, traditional leaders, healthcare workers and the GoSL. He said, … after two incubation periods of 21 days, with no new cases of the Ebola Virus Disease, on behalf of the World Health Organization, I officially declare the Ebola crisis OVER in Sierra Leone. And, the gathered dignitaries erupted with sustained, standing applause.

After several speeches, a song from a young survivor and thanks – all round – the morning ended with the playing of the national anthem. It was nowhere near as emotional as the candlelight vigil but I felt the tingles raise the hair on the back of my neck as the declaration was made.

Throughout the ceremony, special attention was given to the healthcare workers and doctors who’d lost their lives to the Ebola virus. Survivors took centre stage as well and were recognized by all presenters, including the President.

The numbers - In Sierra Leone, more than 3,900 people died and there were more than 14,000 cases confirmed. Over the past 18 months, across the most-affected countries in West Africa, according to the World Health Organization, 11,314 people have died. And, 28,607 cases have been confirmed. Most experts agree these numbers are grossly under-estimated.

November 7 – 11/7. Over the course of the disease progression, the phone code 117 was used as an emergency telephone number to report sickness, death, suspected deaths, cases, etc. It was used to summon ambulances, aid and contact tracers. After months of initial failure, this 117 hotline became symbolic of help… and sometimes became the butt of tension-relieving jokes. 

“Got a problem – call 117.”

Canada is involved with the fight against Ebola...

Canada's financial contributions

Canada has committed funding to support health, humanitarian and security interventions in West Africa. Allocations include:

• Over $20 million to the World Health Organization (WHO):
  • Over $15 million to strengthen the medical response in Ebola-affected countries.
    • This will be used to assist with preparedness activities in neighbouring countries not affected by Ebola.
    • It will also be used to improve coordination efforts.
  • $5 million to support international security-related Ebola response activities in West Africa.
    • Canada's contribution will support essential biosafety and biosecurity measures. These measures will strengthen the field response to the outbreak and reduce associated threats to health and security.
• $10.5 million to the World Food Programme (WFP):
  • This will be used to meet immediate food needs and prevent acute malnutrition among young children and women.
• $10 million to UNICEF for health education efforts in communities. Canada's support will:
  • increase the knowledge of health staff and community volunteers on preventative measures,
  • expand in-community care services for Ebola patients, and
  • improve access to basic services such as food, water and non-Ebola health services.
• $9.5 million to the WFP's United Nations Humanitarian Air Service (UNHAS). This support will help the Logistics Special Operation:
  • meet the critical logistics and transportation needs of responders, and
  • improve the efficiency of the overall humanitarian response.
• $4 million to the UN Ebola Multi-Partner Trust Fund to address critical gaps in response efforts.
• Over $3.8 million to the International Federation of the Red Cross and Red Crescent Societies (IFRC). This will be used to:
  • support medical capacity to trace contact cases and manage clean-up efforts,
  • strengthen capacity in non-affected countries to prepare for and respond to the Ebola crisis, and
  • enhance coordination efforts.
• $5 million to the Canadian Red Cross (CRC) to help fill urgent medical and emergency staffing needs in emergency treatment centres. Canada's support is designed to save lives and stop the spread of Ebola.
• $5 million to the French Red Cross Society (FRCS) to support the operation of its Ebola Treatment Centres in Guinea. This support will ensure that Ebola-infected patients receive the treatment and care they need to survive.
• $4.2 million to Médecins sans Frontières (MSF) will be used to:
  • support treatment efforts, including in community care locations,
  • train medical and support staff in Guinea,
  • provide isolation and protection measures to limit and contain the spread of the Ebola virus, and
  • provide care to people affected by Ebola.
• $2.6 million to Samaritan's Purse to meet the urgent needs of those affected and prevent further spread of Ebola in Liberia. Canada's support will also be used to provide home-based care kits, educational material, and infection prevention and control kits.
• $1.3 million to Action Contre la Faim (ACF) will be used to increase awareness and training in communities in Sierra Leone and Guinea. These activities are designed to help contain the Ebola virus.
• $1 million to Plan Canada to set up Ebola Care Units. These Units will provide complementary care to people in Liberia who are affected by Ebola. This support will also be used to train healthcare and community workers.
• $1 million to CANADEM to support the deployment of Canadian and non-Canadian experts. They will be deployed to help United Nations agencies responding to the Ebola crisis in West Africa.
• $1 million to OXFAM Québec will be used to help contain and reduce the spread of Ebola. This support will also increase access to treatment facilities for affected populations in Liberia and Sierra Leone.
• $1 million to Save the Children will be used to implement an integrated multi-sectoral Ebola response in Guinea. This response effort will provide immediate assistance to vulnerable children and their families.
• $500,000 to CARE Canada will address the broader humanitarian impacts of Ebola. Canada's support will improve access to clean water. It will also enhance awareness of good hygiene practices to help contain the Ebola outbreak in Liberia.
• $23.5 million to support further research and development of Ebola medical countermeasures. Canada's Ebola vaccine and monoclonal antibody treatments will be used to:
  • support clinical trials in Africa, and
  • help produce monoclonal antibody treatments.
• $3 million to support the provinces and territories in the delivery of infection control training and equipment. These funds will be used to help with the deployment of the Public Health Agency of Canada's Rapid Response Teams.
• $1 million to deploy additional trained Quarantine Officers at Canadian airports to support these enhanced border measures.
• Contingency planning to provide appropriate duty of care for Canadian personnel deployed to affected regions.

Canada is engaging in discussions with a number of partners on how best to continue to respond to the Ebola outbreak.

High profile (Canadian) visitors to Sierra Leone.

During the week of April 12th, we had visitors to Sierra Leone... The Canadian High Commissioner (based in Accra, Ghana), Christopher Thornlee, the Chief Public Health Officer of Public Health Canada, Dr. Gregory Taylor, the President and CEO of the Cdn Red Cross, Conrad Sauve, and the Executive Director of MSF/Doctors Without Borders, Stephen Cornish. 

Together, we visited the Cdn run laboratory at the MSF Ebola Treatment Centre in Magburka and the Kerry Town Ebola Treatment Centre where a group of Cdn military personnel are treating patients and supporting the efforts of the British military.

L-R: Conrad Sauve - Cdn Red Cross. Dr. Gregory Taylor - Chief Public Health Officer. Stephen Cornish - Cdn MSF/Doctors Without Borders and Christopher Thornlee, Canadian High Commissioner to Sierra Leone (based in Accra, Ghana). 

The SLAJ Yellow Ribbon campaign to End Ebola

The campaign - launched on the 14th of February - has kick-started and enlivened the fight against Ebola in Sierra Leone. Time to buckle down and get to work... to rid the country and region of Ebola.

Some pics... I'm collecting to eventually do a big project...

Fluctuating numbers… and “living with Ebola”

As Liberia succeeds in the battle against Ebola… and Sierra Leone continues to struggle… I’m starting to wonder about something. Can a country “live with” Ebola?

Getting to zero new cases… and then going through two rounds of 21-day incubation periods without any new cases seems like a long, long way off. Is it even possible in Sierra Leone???? Some districts have succeeded… But, fluctuating numbers… ineffective quarantines, corruption, disbelief, resistance to behaviour change, cultural practices, mismanagement of administration, nonsensical policy flip-flops, etc. has lead me to this momentary pessimism… and got me thinking.

Perhaps Ebola has been in Sierra Leone for a long time… and was just “recognized” internationally last May. Perhaps people have been dying of Ebola for years… and we (in Sierra Leone) just failed to recognize what it was. Perhaps the isolation of small villages and poor road networks masked and prevented a large-scale outbreak like the one we’re experiencing right now.

Remember… the healthcare system here was abysmal. There were no laboratories to detect Ebola. The number of doctors, especially in the countryside, was appallingly low. Hospitals were understaffed and under-resourced. People often died for unexplained reasons. People died… Some said “witchcraft.” Some said “the cold” or “the breeze”. Some said “malaria-typhoid”. Some said “low pressure”. Etcetera.

Granted, this outbreak has killed a shocking number of people – families, farmers, healthcare workers, market women, traditional healers, etc. And, it truly is an international threat, as headlined by the WHO. But… is this something to think about???

I’ve heard, time-and-time again, “one case is too many…” One case is how this whole thing started. That’s why we MUST battle our way to get rid of Ebola in this region – for good. I agree!!!! According to official tracking documents, one case in the Kailahun District has accounted for over 3,100 deaths in Sierra Leone and well over 8,000 cases.

But, can a country “live with” Ebola? I’ve asked this of a number of doctors, disease experts and epidemiologists. They all say, resoundingly, “NO”. I agree… but let me speculate.

Let’s say Sierra Leone and other countries had a very quick, efficient way of testing for Ebola… a test that was easy to use and could be distributed to small health clinics across the country. Let’s say there was a vaccine to prevent Ebola. (Vaccines are being tested).

Now… because early Ebola symptoms are similar to malaria symptoms, each patient exhibiting sudden fever, body aches, vomiting and diarrhea could be immediately isolated and tested for malaria, typhoid and Ebola. No one would touch that patient till adequately tested. If it were confirmed to be Ebola – that patient would be safely transported to one of four existing Ebola treatment centres… one centre in each region of Sierra Leone… that have been built during this crisis.

Then, a team of vaccinators and permanent Ebola communicators/healthcare workers would go to the village or area and administer a vaccine to everyone in the area. The trick or aim would be to stop the chain of transmission of Ebola to prevent the disease from becoming an epidemic – like it’s become now.

Let’s also say that the “new” infection prevention and control behaviours that we’ve seen during this crisis were to continue… indefinitely. We’d all be healthier, I’m sure… all that hand washing is bound to help. And, cultural practices like genital cutting, washing and anointing dead bodies, gathering to sympathize with the sick… would have to change. But, as we’ve seen during this scourge, those practices can be curtailed.

After all this international attention and intervention, let’s hope some of these behaviours and resources will be utilized into the future. Let’s hope there’s a positive remnant of what Sierra Leoneans (and Liberians and Guineans) have gone through. Of course, successive governments will ultimately be responsible… (another jolt of pessimism strikes me).

Sierra Leone now has ambulances, a 117 call centre for emergencies, trained healthcare workers, survivors, laboratories, treatment centres, personal protective equipment, gloves for nurses, adequate pay for healthcare workers, dead body management teams, trained burial staff, contract tracers, etcetera. And, we have a different mindset… an awareness of disease and infection that Sierra Leoneans probably never had before. Let’s hope… some of this continues but my pessimism somewhat overwhelms me at this point.

I’m not suggesting that we stop the fight against Ebola… The battle must continue. But, I’m speculating… and wondering… What will we carry forward? What will life be like a year from now? Will we still be living with Ebola? And, how do we???

Will this be the “final” round in the Ebola battle?

When I was in working in Liberia, a group of us came up with the campaign, “Ebola Must Go”, at the behest of the President of Liberia, Madam Ellen Sirleaf Johnson. The campaign’s goal was simple – get rid of Ebola. So far… Liberia is in the lead amongst the 3 worst affected countries… Liberia, Guinea and Sierra Leone… in the fight against Ebola. Last week, Liberia discharged its final patient and is now counting down to becoming the first country to go 42 days without a case of EVD.

According to the WHO Ebola guidelines, a country must go through two rounds of incubation periods (21-days) to be officially declared “Ebola free”.

On Monday, March 9, 2015, Sierra Leone registered 12 new confirmed EVD cases… so we’re quite a ways behind. More on the numbers from SL in another post…

I’m now back in Sierra Leone… and have been working with the SL Association of Journalists on a campaign to end Ebola in Sierra Leone.

The Yellow Ribbon Campaign to End Ebola

This campaign is a massive crusade initiated through the print, electronic and social media and will draw on the unique strength of SLAJ whose membership is spread across the country. The SLAJ membership controls the media – across the airwaves and along the streets. The media will be used to drive the campaign but it’s anticipated that many, many organizations and institutions will jump on board. 

Individuals and organizations are encouraged to join the campaign and display the yellow ribbon as a demonstration of their commitment to end Ebola.

“The Sierra Leone Association of Journalists is stepping up its intervention in the fight to rid the country of Ebola,” says SLAJ President, Kelvin Lewis. “We are acting together, as a media industry, as families, community members, concerned citizens and as patriots. We, the media, are taking action against Ebola.”

The SLAJ Yellow Ribbon campaign to End Ebola was launched on February 14^th and flashes of yellow can be seen around the historic cotton tree (in central Freetown), outside buildings, around trees, swinging from clock towers in provincial towns, adorning gates and on the lapels of journalists and Ebola responders.

·       The Yellow Ribbon recognizes and appreciates those who are committed to fighting Ebola including healthcare workers, security forces and journalists.

·       The Yellow Ribbon symbolizes the commitment of individuals, groups and institutions taking action to end Ebola in Sierra Leone – and across the region.

·       The Yellow Ribbon represents a commitment to protect yourself, your family and your country by changing dangerous behaviours and adopting key activities.

Yellow ribbons will soon take over the city and the nation symbolizing Sierra Leone’s commitment to ending Ebola. The yellow ribbon brand will be associated with the fight – and victory – over Ebola using the four basic activities and key messages.

All Yellow Ribbons point to the Four Key Messages

The Yellow Ribbon campaign to End Ebola is predicated on FOUR KEY MESSAGES (with specific directions) that everyone must do to end Ebola in Sierra Leone.

Bury all dead bodies safely

·      Call 117 and tell your community leader if you know someone has died

·      Do not touch, bathe or bury a dead person. Do not hide dead people

·      Allow only trained people to handle a dead body

Keep sick people away from others

·      Do not touch sick people or things they have used

·      Keep them in their own area and stay 4 steps away

·      Get the person treatment quickly by calling 117 and telling your community leader

Speak out if you know of a sick person

·      Help find everyone who touched or interacted with a person who has Ebola. If you did, stay home - Call 117 and tell your community leader

·      Do not hide sick people - Do not let others hide sick people

·      Anyone who touched or interacted closely with a person with Ebola is a “Contact” who could have Ebola

“Contacts” must stay in one area with food and water

·      Anyone who touches or interacts with a person who has Ebola must stay in their area for 21 days - Make sure “Contacts” do not run away

·      Help health workers find these “Contacts”

·      Give them food and water and encourage them – talk to your community leader