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

Policies that hinder and help...

New policies via the GoSL... as of January 23. 

I find it strange that in the UNMEER and NERC progress report of January 12-18, it states, "Many businesses are reporting an average of 40% drop in revenue since July/August, according to a new World Bank study." And it goes on to state, "Movements of EVD-suspected people across districts and chiefdoms are impeding effective surveillance." 

It seems the new policies, extending shop openings from 12:00 noon (on Saturdays) to 6:00pm, Monday to Saturday do little to help the economic crisis... But then... they lift a policy that was meant to help eliminate Ebola by limiting travel between districts. This seems to go against the advice in the UNMEER/NERC report.

What should have happened was to extend the shop openings till 9:00pm, Monday-Saturday... and keep the travel restrictions. (in my humble opinion)

Did you hear??? The number of Ebola Virus Disease cases has fallen in Sierra Leone.

That’s good news… welcome news… But, by all indications, there’s a long, long way to go.

Here’s some interesting tidbits of information from an UNMEER report of January 12-18, 2015.

In Sierra Leone World Food Program (WFP) is supporting 102 Ebola Virus Disease (EVD) health facilities including treatment centers, holding centers, and Community Care Centers (CCC).

Between 7th-19th January, 19,673 Ebola Response Workers (ERWs) were paid through mobile money. Of these, 96% have cash-out their pay.

The U.K. is supporting a total of 640 operational treatment beds across the country in Community Care Centers (CCCs) and Ebola Treatment Centers (ETCs).

Many businesses are reporting an average of 40% drop in revenue since July/August, according to a new World Bank study.

The Western Area (which includes the capital, Freetown) represented 40% (10% decrease from last week’s reporting period) of confirmed cases in this reporting period.

Each of these health facilities is to be managed and staffed by Foreign Medical Teams (FMTs, composed of 25-35 clinical and infectious disease experts) as well as national staff (200-250 required per facility).

The number of Ebola Treatment Centres (ETCs) remains the same as the previous reporting period. 23 ETCs are operational with approximately 1,174 current available beds, and total bed capacity of 1,693. There are 3 ETCs in the Eastern province, 2 in the Southern province, 6 in the Northern province and 12 in the western province. They are run by the MoHS, U.K, Médecins Sans Frontières, Save the Children, China, IFRC, Plan International, GOAL, Partners in Health, and other partners.

As of 11th January, there are 52 operational CCCs with approximately 528 current available beds, and total bed capacity of 530.

Since 17 November, UNICEF-supported CCCs have triaged 1,541 patients and admitted 237 patients across 5 districts. The number of patients triaged at UNICEF-supported CCCs has increased by more than 50% since early December. Furthermore, the most recent data demonstrates a 37% increase in the number of patients seeking care less than 48 hours after the onset of symptoms.

Movements of EVD-suspected people across districts and chiefdoms are impeding effective surveillance.

13 laboratories nationwide are operating with a total capacity of approximately 200-700 samples per day. There are 6 laboratories in Western Area, 3 in Northern Province, and 2 each in Eastern and Southern provinces. The US CDC, South Africa, Italy, Nigeria, Canada, UK, Netherland and China run these laboratories.

There are currently 125 burial teams operational in the country, conducting more than 190 EVD-confirmed or suspected burials/day. At a national level, Sierra Leone has sufficient capacity to safely bury all reported deaths. However, under-reporting of deaths during the outbreak impede 100% of safe and dignified burials.

Unsafe burials, including the washing of dead bodies, late reporting and lack of isolation continue to be the major factors in the high rates of transmission across the country, especially in Freetown and in rural areas.

Reporting from districts continues to remain a challenge. Half of the districts continue to fail to report their activities/reach to the pillar, impeding coordination and monitoring.

Observational Interim Care Centres (OICCs) are to be placed in each district (14) for children who have been in contact with an EVD-infected person so they can be closely monitored for 21 days.

There are 13 functioning OICCs covering 12 districts with a total capacity of 262 beds across the country. The OICC provide care for contact children with no caregivers. For the week 8th–12th January, 86 contact children were at the OICCs: Port Loko district with 22 children, Bo district with 21 children, Kono district with 17 children, followed by Moyamba and Bombali each with 7 children, and Kenema and Western Urban with 6 children. Cumulatively 193 children have been admitted in OICCs so far. These OICCs are managed by MSWGCA and supported by the UNICEF

MSWGCA/UNICEF and partners documented 492 additional children during the period 1st–12th January as being affected by the Ebola Virus Disease. Of this number, 421 children (199 boys and 222 girls) are in quarantine in their homes as a result of exposure to an infected person. Eighteen were confirmed to be Ebola positive (9 boys and 9 girls).

The cumulative number of children documented by UNICEF through the Family Tracing and Reunification (FTR) network is 15,258 (7,594 boys and 7,664 girls) of which 7,968 (3,985 boys / 3,983 girls) have lost one or both parents and 552 (253 boys / 299 girls) are unaccompanied.

Strikes and tensions continue to be reported across the country due to lack of clarity and harmonization on payments and incentives. Better communication on cash payments needs to be established with targeted workers so they know what to expect, when to expect it and how to submit questions and/or complaints. Additionally, monitoring mechanisms need to be reinforced to avoid double payments and ghost workers. Hazard pay system needs to be monitored to ensure accessibility and transparency across the country.