Christmas is cancelled: A report from Ebola-struck Sierra Leone

If you’re heading off to visit family this Christmas, spare a moment for those people in Sierra Leone and Guinea, where Christmas has been cancelled due to the Ebola outbreak. The usual lively carnivals and public celebrations have been banned in order to prevent further spread of the disease. Earlier this month, Wellcome Trust Head of Population Health Dr Jimmy Whitworth, visited Sierra Leone to see first-hand the effect of the Ebola outbreak and identify areas where additional funding may be required for research. The Wellcome Trust will continue to work with the international community to help tackle this deadly outbreak, and Jimmy’s thoughts will feed into discussions about our approach. He shares his experience with us here…

The shadow of Ebola hangs over Freetown, the capital of Sierra Leone. The deathly trademarks of the virus are impossible to miss. In every office, shop and public building there water container and bleach to wash your hands by the door. A guard takes your temperature with an electronic thermometer.

Schools have been closed nationwide for several months now and you see many children in the streets all day. UNICEF has organised radio education for children and this reaches around half of them. On the way to WHO offices one morning, even I have the experience of listening to a chemistry lesson.

The effect the Ebola outbreak has had on general medical services is one of the biggest concerns. The numbers of deaths from malaria, diarrhoea, pneumonia and childbirth far outweigh those due to Ebola. One possible piece of good news is that this year there has not been the usual outbreak of cholera in Sierra Leone, perhaps because of all the hand washing. The government has just run a mass treatment campaign for malaria and will repeat this in January.

We know that immunisation has fallen by almost three quarters this year. Primary health units are open and staffed in most of the country but patients are not attending for fear of contracting Ebola.

It is really important to determine how these units can be run safely for staff and patients in the context of an Ebola outbreak and how to re-establish trust in the health services. However, despite the problems, the response to Ebola has ramped up in the past couple of months.

The Sierra Leone military has taken charge and the control efforts are run like a military campaign and led by the minister of defence. To me this makes sense, as the logistical coordination required is akin to waging a war.

The British presence has also increased in recent months. The British army has taken an important role alongside the Department for International Development (DFID) and has been responsible for building hospitals and health centres.

The facility in Kerrytown, south-east of Freetown, is slowly edging towards full capacity after a slow start. The military are running a specialist unit for the care of infected health workers with facilities close to those that could be provided in the UK by the NHS.

Save the Children are running the main unit catering for infected members of the community. The efforts required for providing proper care in these circumstances are enormous. Full personal protective equipment (PPE) is uncomfortable to wear at the best of times, but when the temperature is over 30 degrees with 50% humidity, workers can often only manage stretches of 20 minutes at a time. It is important for health workers to remain fully alert and concentrate as any slip up can lead to infection. This means that several teams of staff are required to nurse each patient through the day and night.

In addition Public Health England are running laboratory services that are able to provide a diagnostic service within 24 hours in most cases. Perhaps the most striking thing is that there are just so many groups, from multilateral agencies, humanitarian development groups, national health institutions and academic teams all working together to contribute to the effort.

Almost everybody you can think of who has been involved in infectious disease control over the past 20 years seems to be here. The cases of Ebola are now found mainly in Freetown and surrounding districts, and the southern and eastern provinces where the first cases were seen are now seeing much reduced numbers, but the situation can change very rapidly with clusters of cases suddenly being reported from areas previous clear of infection. The ministry is about to embark on a ‘surge’, a three-week effort of going from house to house looking for cases and bodies in Freetown and environs.

The aim is to try to markedly reduce transmission chains occurring in the community that are not coming into contact with health services. While there are still hundreds of new cases occurring each week, the number of available beds for Ebola cases is expanding and very soon will reach almost 2500.

It has been over 20 years since the last time I was in Freetown. So much has changed. Recent economic development has meant the city has grown, there are more cars, more roads, and lots of new buildings have sprung up. Now, Ebola is threatening all these positive steps.

It’s not just the health of the nation that is at stake: economic stability, access to education and local culture are all teetering at the edge of a precipice. We must continue to round up international support to turn this epidemic around so that all the positive steps forward are not lost in the wake of this terrible disease.

You can find out what the Wellcome Trust is doing to help tackle Ebola in this blog post and find out more about our special Ebola research funding on our website.