The Ebola Crisis: Report From the Front Lines

Project HOPE sent a team of medical and disaster relief experts to the front lines in Ebola-affected Sierra Leone to work with key health and emergency response officials and survey health facilities, logistics and lines of communication. The goal is to identify key gaps in the country’s ability to combat Ebola, effectively treat patients and operate its overall health system. The team leader and Director of Project HOPE’s Special Programs and Operations, Frederick Gerber, sent this report from Freetown: 

Everyone is stunned by the enormity of the situation here.  “We weren’t prepared” is a recurring theme among officials and health workers.  I’ve heard this many times before — it’s the common thread that runs through all disasters in the developing world – lack of preparation for the worst and a failure to prepare ahead of time.

The Ebola outbreak has taken an emotional toll on everyone.  Signs of stress are on every face. The government understands the need for technical and resourcing assistance, all beyond their capability, and there is a real need for international organizations to come into the country to implement solutions.  Some officials are frustrated at restrictions on travel by airline and shipping companies, which make it harder to scale up the relief effort.

In neighborhoods in the capital, at the airport and business district, shops and businesses are open, and people are still going about their business. But myths abound about the Ebola virus here. Hawking Sierra Leonean traditional medicine, local shamans are doing swift trade, peddling their belief in magic spells, witchcraft, and superstitions. There’s a local myth that chlorine wash solution – present at almost every store, house, hotel, restaurant entrance – causes cancer.

I heard a story going around about a man in Freetown who was told his Ebola test came back negative, but his HIV test was positive.  He exclaimed, “Thank God.”

There are abundant laws to stop human-to-human contact. “ABC” (“Avoid Body Contact”) is the chant going around; it is almost universal across Sierra Leone now.  Previous fines for not wearing a seat belt are now relaxed, as are laws for motorcyclists not wearing helmets, because of concern for people touching infected objects.

After arriving at the Freetown Airport at 0200 hours one morning last week, I had to wash my hands in chlorinated water before entering the terminal. I filled out a lengthy health form, had my temperature taken with a thermal imager, and then was released to pick up my bags. I was met by a Sierra Leone army lieutenant escort officer; I naturally shook his hand. A porter came over to me and whispered, “I saw you shook that man in uniform’s hand.  We don’t shake hands now in Sierra Leone because of Ebola.” He impressed upon me the “No Touch” rule that I saw the next day across the country. The fact a porter would approach me and counsel me on not shaking hands is a sign of how serious Sierra Leone is about stopping the spread of the disease, and how effective the government’s been, at least, in spreading the “No Touch” rule. The “Ebola handshake” is now rubbing elbows instead of hands.

Health workers in Sierra Leone and other Ebola-affected countries in West Africa have been seriously impacted and stigmatized.  Nurses and physicians have been turfed out of their houses and chiefdoms by neighbors and family because of the widespread fear that after treating Ebola victims, they’ll carry the disease home.

Most private hospitals are closed now because people are frightened about catching Ebola from other infected patients.  Routine treatment of other killer diseases such as malaria, typhoid and cholera has practically stopped now, as everyone is focused on Ebola. No one wants to go to clinics, hospitals or holding centers, because they are scared these facilities are “incubators” for the disease.

Some of these concerns are justified. Some hospitals seeing and treating Ebola patients were not – and still are not – using proper infection prevention and control (IPC) procedures. It’s the single biggest failure in Sierra Leone’s health system. Patients who didn’t have the disease when they first entered the facility later contract it from other non-segregated patients. Those old dictums – “hand washing and hand sanitization are the easiest and best way to prevent infections and illnesses from spreading” – continue to be true.

It’s likely that this crisis and the headline-making Ebola case in the U.S. will prompt the international community to be more invested in helping West Africa improve its health capacity. As the disease geometrically spreads, with one infected patient now infecting two others, who each infect four, who infect eight and so on, it will catch the international community’s attention. While Ebola is not easily spread, contrary to misinformed public and media hype, there are no vaccines or treatments against Ebola infection available for use in humans despite substantial research progress.

This may be the 21^st century, but we’re still finding that culture, customs and religion continue to have as strong a pull in the opposite direction as science and facts. But Ebola can be halted with education, safe practices and infection control. And that is a message we must continue to underline.

Disasters management follows four basic phases: Preparedness, Response, Recovery, Mitigation. A nation’s response to a disaster is always a reflection of how well it prepared for it, and this Ebola epidemic is no exception. The job of the developed world now is to help less well-off countries transition to better health care systems that can stave off future crises.