Sunday, July 6, 2014

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.

What do the numbers tell us?

More on the Ebola Virus Disease… from 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

Now, we all know that numbers tell only a portion of the story… the full story, at least here in Sierra Leone, will probably never be told. Secrecy, embarrassment, cover-ups, a lack of information, corruption, mistakes, are all part of the story. And, that side of the story is as scary and sad as the tale the numbers tell.

But, let’s start with the success stories, which will probably also never be fully told. Thirty-two people have been treated and released. That’s interesting because according to my research and basic knowledge of the disease, it’s fatal up to 95% of the time. According to some sources here, this virus strain of Ebola is slightly different this time around. I’ll have to look into this notion of a “different” strain of the EVD.

Apparently now, if a patient is confirmed with the disease and they’re given immediate care, ie. isolation, rehydration and heavy doses of antibiotics, the disease will dissipate and a patient can be released. Again, I’ll have to look into this…

Back to the numbers...
73 people have died
-       32 have been treated and released
-       92 are being treated BUT…
-       254 people have been confirmed with the disease…

Now, my mathematics isn’t great… but from what I can tell… 73 + 32 + 92 = 197. That’s 197 people, according to these numbers, that have been confirmed with the disease (dead, being treated and those that have been treated and released). But, if you take the total number of cases confirmed (254) minus the total number of people dead, being treated and those treated and released (197)… that still leaves 57 confirmed cases who are neither dead, being treated or released/”healed”.

I have no idea why there’s this discrepancy. I have heard tell of patients who have been confirmed with the disease… and then run away or hidden from health authorities. There are lots of reasons for this… fear being the primary motive for not seeking treatment. I’ve heard some people are afraid to go to the medical facilities because if they are confirmed with the disease, they think/know they’re going to die.

The rumours around this crisis have multiplied as the disease numbers grow. At one time, many people didn’t believe the disease was real. In fact, I sat in Parliament here when the Minister of Health, Miatta Kargbo, presented information to elected MPs. One of the questions from a Member of Parliament was, “is the disease really real?” To which the Minister replied, “we have teams of international experts on the ground in the affected area and they have confirmed that this disease is Ebola and is very real.”

Then there was the rumour that nurses and healthcare workers were injecting the disease into people who sought treatment for their aches, flu symptoms, etc. This resulted in several violent incidences in Kailahun (the centre of the outbreak) between nurses and civilians. The police had to be called in several times to quell the upset. Along the same lines, a rumour spread that nurses were injecting children with Ebola via a vaccine injection campaign. And of course, there’s ever-present rumour that this is “African magic” or “juju” and is an invention of a witch to kill off the people in the East of the country. Sigh. No comment…

Does this account for the “missing” numbers – 57? Possibly.

Again, this discrepancy is worth looking into… and, as you can see, there are still many sides to the story that are yet untold.


Saturday, July 5, 2014

On Ebola...

Ebola… Sounds innocuous enough… but deadly and scary at the same time… especially in West Africa and specifically Sierra Leone.

And, since I’m currently living and working in Sierra Leone, I had to look into the issue. The World Health Organization was my first Internet stop… then the Center for Disease Control… then African Ministries of Health. I also surfed through the Red Cross, Doctors without Borders, Mayo Clinic, WebMD and other websites. Yes, this kind of Internet research takes considerable time… given the current state of web-access in Sierra Leone.

Ebola Virus Disease (EVD) is a severe acute viral illness characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. People are infectious as long as their blood and secretions contain the virus. And, there’s a 2-21 day incubation period.

There is no vaccine for Ebola. There is no specific treatment available.

Ebola first appeared in 1976 in two simultaneous outbreaks, in Sudan, and in Yambuku, Democratic Republic of Congo. The disease got its name from the Ebola River in the DRC near the site of the first outbreak. Documented information concludes the infection originated through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, and antelope found ill or dead in the rainforest.

Ebola then spreads through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

Because there’s no treatment… raising awareness and taking protective measures are the only way to reduce infection and the spread of the disease.

So says the W.H.O… Educational public health messages for risk reduction should focus on several factors:
  • Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat.
  • Reducing the risk of human-to-human transmission arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients. Regular hand washing is required especially after caring for patients.
  • Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.

The public messages are running over radio stations here in Sierra Leone. UNICEF and the Ministry of Health have printed informational posters. NGO vehicles display A4 posters on their windows. Signs are up in hospitals and clinics. Sensitization campaigns are underway in communities around the country. But it seems this is not enough. People are still dying in Sierra Leone.


I’ll update this blog with info and numbers as they become available…

Wednesday, May 22, 2013

About keeping "public order"


Interestingly, Chapter 2 of the Constitution of Sierra Leone, 1991, states, “5.(1) The Republic of Sierra Leone shall be a State based on the principles of Freedom, Democracy and Justice”. Really?

It started on Thursday evening (the 25th of April) as an argument in a compound in my neighborhood of Aberdeen. The compound in question has several houses around a common courtyard where people cook, launder clothes, dry laundry, wash, play, meet, talk, eat, etc. An argument erupted between two women/neighbors and eventually spilled over to include the families of these neighbors, including children. The argument had something to do with politics and ethnicity/tribe.

I am writing about this for several reasons… 1) it happens all the time in compounds all across Sierra Leone, 2) it involves a Junior Secondary School student (14 yr old) that I tutor and support in school, 3) involves a family that’s “adopted” me and that I help on occasion and 4) it represents a horrendous problem for all of Sierra Leone.

The argument escalated and insults were exchanged… “abusive language” is how they refer to these sorts of exchanges. The shouting continued… but there was no violence and no physical contact between the groups of women but insults were exchanged. The landlord of one of the houses went to the local police station. He apparently bribed the police to arrest those involved. I have no proof of the bribe but I’ve been told this by several of the people involved and tend to believe this is what happened. The police arrived and arrested two of “my” family’s aunties and one of the other neighbors. Auntie Mary called me at 10:30pm on Thursday, in tears, from the police station.

I should add that Auntie Mary and her sister, Lucinda, are very mature, somewhat older, quiet, law-abiding, responsible women. They have never been involved with the police and live quietly in the home that Mary recently built. I’ve known the family for four years now…

Mary and Lucinda, (my friends and family), were detained overnight – placed in a disgusting, small, smelly, mosquito infested cell at the Aberdeen police station. The charge – “insulting conduct and disorderly behavior”, which is a breach of the Public Order Act of 1965. One of the other neighbors was also arrested and placed in the same cell. Interestingly, one of the main instigators of this argument was not arrested because she is rumored to be having an affair with the landlord and (because he paid the police) he instructed that she not be arrested.

I went to the police station on Thursday night, which is up the road where I now live, and tried to talk to the police officers on duty. Mainly, my role was to watch… to try to monitor the situation and make sure things went according to procedure. Essentially, I wanted to make sure “my family” was treated fairly and that there was no corruption on the part of the police. I didn’t know the landlord had previously bribed the police to initiate the whole thing.

The processing officer, an older woman, was rude and abrupt with me and the arrested “suspects”. She would not discuss the issue and refused to listen to my pleas for reason. The Officer in Charge (OC) initially agreed that this matter was a waste of time but he too had been paid by the landlord (unbeknownst to me) and soon left the station to go home (around 11:00pm). I maintain that this issue was not a police matter and that this was a complete waste of time for all involved. In fact, my opinion was reinforced the next day when other family members arrived and stated that this was a matter that the local Chief should have mediated and negotiated.

Nevertheless, Mary, Lucinda and the other woman removed their undergarments and handed over their possessions and were detained overnight. I felt so badly for these quiet, older, dignified women… they were crying and demeaned… and under arrest for the first time in their lives.

At 7:30am on Friday morning, I went back to the station… again to learn, observe and offer support to Mary and Lucinda. Later on Friday, the police arrested Mary and Lucinda’s sister, Isha and two of Mary’s wards/children who live with Mary and her family. The two children (15 and 14 yrs old) were interrogated without a guardian present and then arrested and placed in the same cell as the others. Also in the holding cell was a man who continuously vomited and lay prone on the floor. (He was later dragged from the cell and propped on the steps of the station, where he probably died) There was also a drunk guy… who was released first thing in the morning on Friday.

I raised a concern about the children in detention… and was told to talk to the Family Support Unit (FSU), located next door to the police station. I went to the FSU and spoke to a manager there who said they’d been notified and were going to request that the children be moved to the holding areas within FSU. The Child Protection Office did visit the police station but did not meet with the children and then told me that the police had already separated the children. The two children were not separated and remained in the cell with the others till they were eventually released six hours later.

I spent the entire day on Friday at the police station… provided water and food to Mary and her family. And learned, first hand, how bad/messed up/corrupt and ridiculous this whole system is. By about 10am, I’d had enough… and started to call in some favours from justice folks and police I know. I called the media representative and the Inspector General of Police. Both men made phone calls to the O.C. The OC told me that the family would be released… but it took hours for them to process the paperwork. Apparently, the woman who was supposed to sign the papers had gone into town to do some shopping and go to the bank. Sigh.

I also called an organization, AdvocAid, who work in the justice sector… and Sabrina, the wonderful Executive Director of that organization, sent a top-notch lawyer to the station. At one point, I offered/threatened to call the editors and station managers I know to send reporters to the station to report on the matter… I think all of this… and knowing that I was a journalist and work with the Canadian government here… scared the police enough to take some action.

I did not pay a bribe… but I did make some phone calls… And, when I explained the situation to the people “above” they all agreed that this case was nonsense and a waste of time. However, I later learned that members of Mary’s family had bribed the police “to get bail” for Mary and the others. The whole system is broken… clearly.

After spending more than 18 hours in police custody – in a horrible, hell-hole of a cell, Mary, Lucinda, Isha, and the two students were eventually released “on bail”. BTW, bail is supposed to be free… but everyone knows you have to bribe the police to get what is a citizen’s right.

Mary’s family was required to “keep the peace” over the weekend and report back to the police station on Tuesday morning. On Tuesday, I accompanied the family to the station… and the matter was “dropped”. All nonsense and a supreme waste of time and energy. And, more importantly, a horrible indignity, infringement of rights and scar on the face of the police in this country.

This sort of travesty of “justice” happens all the time… and this Public Order Act of 1965 is a catch-all for anything and everything. BTW, it’s often used by ruling governments to silence dissent, to muzzle the media (more on that later) and “control” the public. And, it’s a scary law…

For reference:

According to the Public Order Act of 1965, PART II – BREACH OF PUBLIC ORDER.
(Public insult and provocation).
2. Any person who in the view of the public or in any public place, insults any person in his presence, in such a manner as would be likely to provoke that person to commit a breach of the peace, shall, on conviction, be liable to a fine, not exceeding twenty leones or to imprisonment not exceeding three months or both.
(Insulting conduct)
3. Any person who—
i.          makes use of any threatening, abusive, insulting or obscene language, gesture, or behaviour, or says or sings any insulting or offensive song or ballad or makes any noise with intent to provoke any other person to commit a breach of the peace; or
ii.        makes use of any threatening, abusive, insulting, obscene or profane language, or says or sings any insulting or offensive song or ballad, or makes a noise to the annoyance of any person in any place; or
iii.       
sends or delivers to any person any threatening, scurrilous, offensive, or obscene writing, print, engraving, picture or other representation; or
iv.      
calls any person by a name or description other than his own, with intent to insult or annoy such person;